Okazaki Satoshi, Hori Jun-ichi, Watanabe Masaki, Hashizume Kazumi, Kobayashi Shin, Azumi Makoto, Kita Masafumi, Iwata Tatsuya, Matsumoto Seiji, Kakizaki Hidehiro
The Department of Renal and Urologic Surgery, Asahikawa Medical University.
Hinyokika Kiyo. 2016 Feb;62(2):73-6.
An 81-year-old man was referred to our hospital because of a right renal tumor with vena cava thrombus and multiple lung metastases that were detected by computed tomography (CT) scan during evaluation of respiratory discomfort. We started medical treatment with sunitinib at a dose of 50 mg daily in a 2-week-on, 1-week-off schedule after confirming clear cell renal cell carcinoma by tumor biopsy. After 2-week sunitinib treatment, thrombocytopenia continued and platelet count decreased to 1.8×10(9)/l at day 11 after stopping sunitinib. We needed to administer a total of 60 units platelet transfusion because of persistent thrombocytopenia. Bone marrow aspiration did not reveal myelosuppression or carcinoma invasion to bone marrow. Under the clinical diagnosis of drug-induced thrombocytopenia secondary to sunitinib, we started immunoglobulin therapy at day 23 after stopping sunitinib. Platelet count returned to normal 10 days after starting immunoglobulin. The patient developed exacerbating lung metastasis and carcinomatous lymphangiosis during subsequent course and died of renal cell carcinoma 79 days after starting sunitinib. Thrombocytopenia after sunitinib therapy is often encountered but prolonged thrombocytopenia is rare after stopping sunitinib. This case suggests that immunoglobulin therapy is effective for drug-induced prolonged thrombocytopenia through immunological mechanism.
一名81岁男性因呼吸不适接受评估时，经计算机断层扫描（CT）发现右肾肿瘤伴腔静脉血栓形成及多发肺转移，遂转诊至我院。经肿瘤活检确诊为透明细胞肾细胞癌后，我们开始使用舒尼替尼进行药物治疗，剂量为每日50 mg，采用2周用药、1周停药的方案。舒尼替尼治疗2周后，血小板减少症持续存在，在停用舒尼替尼后的第11天血小板计数降至1.8×10⁹/L。由于血小板减少持续存在，我们共输注了60单位血小板。骨髓穿刺未发现骨髓抑制或癌组织侵犯骨髓。在临床诊断为舒尼替尼继发的药物性血小板减少症后，我们在停用舒尼替尼后的第23天开始免疫球蛋白治疗。开始免疫球蛋白治疗10天后血小板计数恢复正常。患者在随后的病程中出现肺转移和癌性淋巴管炎加重，并在开始使用舒尼替尼79天后死于肾细胞癌。舒尼替尼治疗后血小板减少症较为常见，但停用舒尼替尼后出现长时间血小板减少症的情况较为罕见。该病例提示免疫球蛋白治疗通过免疫机制对药物性长时间血小板减少症有效。
