Secondary immune thrombocytopenic purpura in a child with acute lymphoblastic leukemia on maintenance chemotherapy with 6-mercaptopurine: a rare case report
DOI:
https://doi.org/10.18203/2349-3291.ijcp20252236Keywords:
Secondary immune thrombocytopenic purpura, Acute lymphoblastic leukemia, 6-mercaptopurineAbstract
In patients with acute lymphoblastic leukemia (ALL), thrombocytopenia is most commonly attributed to chemotherapy-induced myelosuppression or disease relapse. We report the case of a 6 years young girl who developed isolated thrombocytopenia during the 12th week of maintenance therapy with 6-mercaptopurine and methotrexate. Despite discontinuation of chemotherapy for two weeks, her platelet counts did not improve. Multiple platelet transfusions were administered without response. Bone marrow examination revealed a hypercellular marrow with adequate megakaryocytes, suggesting peripheral platelet destruction, possibly secondary to chemotherapy. She was subsequently treated with a short course of steroids, as per her COG maintenance protocol, to which she responded well. This case underscores the importance of considering secondary immune thrombocytopenia (ITP) as a differential diagnosis in ALL patients on maintenance chemotherapy who present with persistent isolated thrombocytopenia.
Metrics
References
Horino S, Rikiishi T, Niizuma H, Abe H, Watanabe Y, Onuma M, et al. Refractory chronic immune thrombocytopenic purpura in a child with acute lymphoblastic leukemia. Int J Hematol. 2009;90(4):483-5. DOI: https://doi.org/10.1007/s12185-009-0424-0
Price V, Barnes C, Canning P, Blanchette V, Greenberg M. Immune thrombocytopenia following successful treatment of cancer in children. Pediatr Blood Cancer. 2006;46(3):372-6. DOI: https://doi.org/10.1002/pbc.20341
Gao A, Zhang L, Zhong D. Chemotherapy-induced thrombocytopenia: literature review. Discov Onc. 2023;14:10. DOI: https://doi.org/10.1007/s12672-023-00616-3
Jubelirer SJ, Harpold R. The role of the bone marrow examination in the diagnosis of immune thrombocytopenic purpura: case series and literature review. Clin Appl Thromb Hemost. 2002;8(1):73-6. DOI: https://doi.org/10.1177/107602960200800110
Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol 2013;98:24-33. DOI: https://doi.org/10.1007/s12185-013-1370-4
Yenicesu I, Sanli C, Gürgey A. Idiopathic thrombocytopenic purpura in acute lymphocytic leukemia. Pediatr Hematol Oncol. 2000;17:719-720. DOI: https://doi.org/10.1080/08880010050211457
Nishimoto T, Kuwana M. CD4+CD25+Foxp3+ regulatory T cells in the pathophysiology of immune thrombocytopenia. Semin Hematol. 2013;50(1):S43-9. DOI: https://doi.org/10.1053/j.seminhematol.2013.03.018
Arandi N, Mirshafiey A, Jeddi-Tehrani M, Shaghaghi M, Sadeghi B, Abolhassani H, et al. Alteration in frequency and function of CD4⁺CD25⁺FOXP3⁺ regulatory T cells in patients with immune thrombocytopenic purpura. Iran J Allergy Asthma Immunol. 2014;13(2):85-92.
Liu B, Zhao H, Poon MC, Han Z, Gu D, Xu M, et al. Abnormality of CD4(+)CD25(+) regulatory T cells in idiopathic thrombocytopenic purpura. Eur J Haematol. 2007;78(2):139-43. DOI: https://doi.org/10.1111/j.1600-0609.2006.00780.x
Baraka A, Maher B, Mohamed HA, Mohamed AAA. Study of T-regulatory cells in patients with acute, idiopathic thrombocytopenic purpura. Egypt J Haematol. 2014;39(2):37-41. DOI: https://doi.org/10.4103/1110-1067.139751
Fernández Ramos AA, Catherine ML, Virginie P, Samantha A, Pierre LB, et al. 6-mercaptopurine promotes energetic failure in proliferating T cells. Oncotarget. 2017;8(26):43048-60. DOI: https://doi.org/10.18632/oncotarget.17889
Bayhan T, Ünal Ş, Gümrük F, Çetin M. Immune Thrombocytopenic Purpura During Maintenance Phase of Acute Lymphoblastic Leukemia: A Rare Coexistence Requiring a High Degree of Suspicion, a Case Report and Review of the Literature. Turk J Haematol. 2015;32(4):363-6. DOI: https://doi.org/10.4274/tjh.2014.0138
Downloads
Published
How to Cite
Issue
Section
