Di Costanzo Gaetano, Loquercio Giovanna, Marcacci Gianpaolo, Iervolino Vincenzo, Mori Stefano, Petruzziello Arnolfo, Barra Pasquale, Cacciapuoti Carmela
Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy.
Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy.
Onco Targets Ther. 2015 Feb 9;8:401-4. doi: 10.2147/OTT.S68469. eCollection 2015.
The allogeneic platelet (PLT) gel offers to be a valid supportive measure in the management of chemotherapy extravasation injuries. We report a case of a 58-year-old patient with multiple myeloma enrolled for high-dose chemotherapy and autologous stem cell transplantation. As pretransplant therapy, the patient received induction therapy with bortezomib, adriblastina, and desametazone. A port was inserted in the vein on the back of the hand. After three cycles, the patient reported rapid development of redness, pain, and necrotic tissue in the left hand, and a diagnosis of extravasation was addressed. The patient presented a raw area on the back of the hand caused by cytotoxic/chemotherapeutic drug leakage because of the malposition of venous access devices. Skin ulcer was debrided, and the wound was reconstructed with a combination of local random rotational flap and abdomen skin graft. Two weeks later, a 20% skin flap necrosis was observed. In the context of wound healing, topical plasma-rich PLT gel is able to accelerate the regeneration and repair of tissue, so it was set out to assess PLT gel efficacy in this case. The PLT gel was applied topically once every 5 days, for a duration of 60 days on average. There were no adverse reactions observed during the topical therapy. Complete wound healing was observed after 12 PLT-rich plasma applications. No ulcer recurrence was noted in the patient during the follow-up period of 2-19 months.
异体血小板凝胶有望成为化疗外渗损伤管理中的一种有效支持措施。我们报告了一例58岁的多发性骨髓瘤患者，该患者接受高剂量化疗和自体干细胞移植。作为移植前治疗，患者接受了硼替佐米、阿霉素和地塞米松的诱导治疗。在手背静脉插入了一个端口。三个周期后，患者报告左手迅速出现发红、疼痛和坏死组织，诊断为外渗。由于静脉通路装置位置不当，患者手背出现了因细胞毒性/化疗药物渗漏导致的创面。对皮肤溃疡进行清创，并采用局部随意旋转皮瓣和腹部皮肤移植相结合的方法重建伤口。两周后，观察到20%的皮瓣坏死。在伤口愈合过程中，局部应用富含血小板的凝胶能够加速组织的再生和修复，因此着手评估该病例中血小板凝胶的疗效。血小板凝胶每5天局部应用一次，平均持续60天。局部治疗期间未观察到不良反应。在应用12次富含血小板的血浆后观察到伤口完全愈合。在2至19个月的随访期内，患者未出现溃疡复发。
