Sakai Kohei, Matsumura Takuro, Hamada Risako, Tominaga Takayuki, Takahashi Toru
Department of Hematology, Yamaguchi Prefectural Grand Medical Center.
Rinsho Ketsueki. 2020;61(11):1616-1619. doi: 10.11406/rinketsu.61.1616.
A 64-year-old woman was admitted to our hospital because of relapsed follicular lymphoma. Obinutuzumab (OBZ) and bendamustine (GB) therapy was administered for her lymphoma, and thrombocytopenia requiring platelet transfusion was observed after the first course. Although the dose of bendamustine had been reduced, her thrombocytopenia was observed again after the second course. Complete remission of her lymphoma was achieved after 4 courses of GB therapy, and the patient was switched to OBZ maintenance therapy. Nevertheless, thrombocytopenia was observed again during the maintenance therapy with OBZ alone. Observing the platelet count that changed over time after OBZ administration in detail, the platelet count started to decrease 1 hour after the end of OBZ administration, decreased to half after 6 hours, reached the lowest value 4 days after administration, and gradually recovered from 10 days after administration. Although OBZ administration-associated thrombocytopenia is a relatively common complication, acute thrombocytopenia up to 24 hours after administration is rare. However, as in this case, thrombocytopenia may progress in an extremely short time after administration, and it is necessary for clinicians to pay attention to OBZ treatment.
一名64岁女性因复发性滤泡性淋巴瘤入住我院。对其淋巴瘤采用奥妥珠单抗（OBZ）和苯达莫司汀（GB）治疗，在第一个疗程后观察到需要输注血小板的血小板减少症。尽管苯达莫司汀的剂量已降低，但在第二个疗程后再次观察到她出现血小板减少症。经过4个疗程的GB治疗后，她的淋巴瘤实现完全缓解，患者转为OBZ维持治疗。然而，在仅使用OBZ的维持治疗期间再次观察到血小板减少症。详细观察OBZ给药后随时间变化的血小板计数，血小板计数在OBZ给药结束后1小时开始下降，6小时后降至一半，给药后4天达到最低值，并在给药后10天逐渐恢复。尽管与OBZ给药相关的血小板减少症是一种相对常见的并发症，但给药后24小时内出现急性血小板减少症较为罕见。然而，如本病例所示，血小板减少症可能在给药后极短时间内进展，临床医生有必要关注OBZ治疗。
