Hegde Upendra P, Wilson Wyndham H, White Therese, Cheson Bruce D
Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Blood. 2002 Sep 15;100(6):2260-2.
Fludarabine can exacerbate idiopathic thrombocytopenia (ITP) in chronic lymphocytic leukemia (CLL). We report 3 CLL patients with refractory fludarabine-associated ITP who responded to rituximab. The patients had Rai stages III, III, and IV disease. Before fludarabine treatment, the platelet counts were 141 000/microL, 118 000/microL, and 70 000/microL. ITP developed within week 1 of cycle 3 in 2 patients and within week 2 of cycle 1 in 1 patient. Platelet count nadirs were 4000/microL, 1000/microL, and 2000/microL, respectively, and did not respond to treatment with steroids or intravenous immunoglobulin. Rituximab therapy (375 mg/m(2) per week for 4 weeks) was begun on days 18, 23, and 20 of ITP. Patient 1 achieved a platelet count of more than 50 000/microL at day 21 and more than 133 000/microL at day 28, patient 2 achieved a platelet count of more than 50 000/microL at day 4 and more than 150 000/microL at day 10, and patient 3 achieved a platelet count of more than 50 000/microL at day 5 and 72 000/microL at day 28 of rituximab therapy, with platelet response durations of 17+, 6+, and 6 months. These results suggest rituximab can rapidly reverse refractory fludarabine-associated ITP.
氟达拉滨可加重慢性淋巴细胞白血病（CLL）患者的特发性血小板减少症（ITP）。我们报告了3例难治性氟达拉滨相关性ITP的CLL患者，他们对利妥昔单抗有反应。这些患者的Rai分期分别为III期、III期和IV期。在接受氟达拉滨治疗前，血小板计数分别为141000/μL、118000/μL和70000/μL。2例患者在第3周期第1周内、1例患者在第1周期第2周内发生ITP。血小板计数最低点分别为4000/μL、1000/μL和2000/μL，对类固醇或静脉注射免疫球蛋白治疗无反应。在ITP发生后的第18天、23天和20天开始利妥昔单抗治疗（375mg/m²，每周1次，共4周）。患者1在第21天血小板计数超过50000/μL，第28天超过133000/μL；患者2在第4天血小板计数超过50000/μL，第10天超过150000/μL；患者3在利妥昔单抗治疗第5天血小板计数超过50000/μL，第28天为72000/μL，血小板反应持续时间分别为17个月以上、6个月以上和6个月。这些结果表明利妥昔单抗可迅速逆转难治性氟达拉滨相关性ITP。
