levoleucovorin and Anemia--Hemolytic--Autoimmune

Oxaliplatin is effective in advanced colorectal cancer and is known to have relatively few side effects, such as hemolysis and renal toxicity. We report a case of acute kidney injury (AKI) after treatment with a combination of oxaliplatin, folinic acid and 5-fluorouracil or capecitabine. The patient developed acute renal failure, hemolytic anemia and thrombocytopenia after the 34th course of chemotherapy including oxaliplatin. A positive direct antiglobulin test and detection of immunoglobulin G and complement C3b and C3d on erythrocytes suggested the diagnosis of immune-related severe intravascular hemolytic anemia. She was successfully treated and recovered using plasma exchange, corticosteroids and hemodialysis therapy. Only seven other cases of AKI associated with oxaliplatin use have been reported to date. As in this case, acute hemolysis due to autoimmune mechanisms and subsequent AKI occurred suddenly after frequent use of oxaliplatin in four of those cases. We should be aware that oxaliplatin may cause sudden life-threatening hemolysis by drug-induced antibodies and subsequent AKI, even though oxaliplatin is frequently administered without side effects. This represents the first case report of AKI-related hemolysis due to oxaliplatin in Japan.

Topics: Acute Kidney Injury; Anemia, Hemolytic, Autoimmune; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Colonic Neoplasms; Deoxycytidine; Fluorouracil; Humans; Leucovorin; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Prednisone; Thrombocytopenia

Topics: Aged; Anemia, Hemolytic, Autoimmune; Azathioprine; Drug Hypersensitivity; Female; Folic Acid; Humans; Leucovorin; Purpura, Thrombocytopenic, Idiopathic; Urticaria

We report a 59-year-old woman diagnosed with metastasic colorectal cancer who developed immune hemolytic anemia during FOLFOX chemotherapy (oxaliplatin/leucovorin/5-fluorouracil). Immunohematologic studies demonstrated that immune hemolysis was oxaliplatin-mediated. On the basis of this case and in a review of the literature in which 13 cases of previously reported oxaliplatin-induced immune cytopenia have been identified, we suggest some clinical clues regarding the use of oxaliplatin in cancer patients.

Topics: Adenocarcinoma; Anemia, Hemolytic, Autoimmune; Antidotes; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Autoantibodies; Colorectal Neoplasms; Erythrocytes; Female; Fluorouracil; Hemoglobins; Humans; Leucovorin; Liver Neoplasms; Lymphatic Diseases; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Platelet Count

Platinum-based chemotherapy agents have been associated with potentially fatal acute immune-mediated hemolytic anemia. The target antigen, cause of the positive direct antiglobulin test (DAT) and mechanism of hemolysis have been the subject of controversy.. We report a patient who developed a DAT-positive hemolytic episode after a red cell (RBC) transfusion was delivered during the infusion of her 17th cycle of oxaliplatin. Standard pretransfusion testing was uncomplicated; however, after infusion, the serum was no longer compatible with the transfused units and a strong (4+) panreactive IgG antibody was detected.. The patient's serum from 10 days after the episode, only when therapeutic concentrations of oxaliplatin were added, reacted with all RBCs tested using the indirect antiglobulin test (IAT) (3+). The effect was retained with a purified IgG fraction and almost eliminated with IgG-depleted serum. Immunoprecipitation analysis revealed a band with the molecular weight of the Band 3 anion channel only in the presence of the patient's serum and oxaliplatin.. Our investigations indicated that oxaliplatin interacted with both an IgG antibody and a RBC membrane epitope probably located on the Band 3 anion channel.

Topics: Adenocarcinoma; Anemia, Hemolytic, Autoimmune; Antibody Specificity; Antigens; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Blood Grouping and Crossmatching; Blood Transfusion; Camptothecin; Capecitabine; Colorectal Neoplasms; Deoxycytidine; Dexamethasone; Disease Progression; Fatal Outcome; Female; Fluorouracil; Humans; Immunoglobulin G; Irinotecan; Leucovorin; Middle Aged; Organoplatinum Compounds; Oxaliplatin