Bjelic-Radisic V, Stöger H, Winter R, Beham-Schmid C, Petru E
Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
Anticancer Res. 2006 Mar-Apr;26(2B):1627-30.
Primary metastatic breast cancer with bone marrow involvement and pronounced thrombocytopenia is rare. The myelosuppressive effect of most cytotoxic drugs limits chemotherapy in patients with cytopenia due to marrow involvement.
A 62-year-old patient, who presented with locally and systemically advanced breast cancer, is reported. The initial work-up revealed bone marrow carcinosis with thrombocytopenia of less than 20,000/mm3 lung and osseous metastases without signs of suppressed erythropoiesis and leucopoiesis. The patient was stabilized with 6 different standard-dose chemotherapy regimens, antihormonal therapy, and trastuzumab before dying 57 months after first diagnosis. The patient received only platelet transfusions on 2 instances with platelets of 2,000/mm3.
This case illustrates that aggressive standard chemotherapy may be feasible in selected patients with bone marrow carcinosis-associated thrombocytopenia without major bleeding episodes.
原发性转移性乳腺癌伴骨髓受累及明显血小板减少症较为罕见。大多数细胞毒性药物的骨髓抑制作用限制了对因骨髓受累而出现血细胞减少症患者的化疗。
报告了一名62岁的患者，其患有局部和全身晚期乳腺癌。初始检查发现骨髓转移癌，血小板减少至低于20,000/mm³，伴有肺和骨转移，无红细胞生成和白细胞生成受抑制的迹象。该患者在首次诊断57个月后死亡前，接受了6种不同的标准剂量化疗方案、抗激素治疗和曲妥珠单抗治疗，病情得以稳定。该患者仅在两次血小板计数为2,000/mm³时接受了血小板输注。
该病例表明，对于某些伴有骨髓转移癌相关血小板减少症且无严重出血事件的患者，积极的标准化疗可能是可行的。
