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Autoimmune thrombocytopenia following tandem autologous peripheral blood stem cell transplantation for refractory germ cell tumor

Bone Marrow Transplantation volume 34, pages 279–280 (2004)Cite this article

Autoimmune thrombocytopenia (ITP) following autologous transplantation in solid tumors is a rare phenomenon and only few cases have been reported in literature.1, 2 Autoimmune thrombocytopenia after double dose-intensive chemotherapy with autologous peripheral blood stem cell transplantation (tandem transplantation)3 has never been reported. We report the first case of autoimmune thrombocytopenia after tandem transplantation in a patient with a refractory germ cell tumor.

A 45-year-old man with no significant past medical history was diagnosed with stage IIC extra testicular nonseminomatous germ cell tumor (normal tumor markers). After four cycles of bleomycin, etoposide and cisplatin (BEP), persistent retroperitoneal lymphadenopathy was found on CT scan. Bilateral retroperitoneal lymph node dissection revealed viable tumor. He then received two cycles of salvage chemotherapy consisting of vinblastine, ifosfamide and cisplatin (VeIP). Shortly thereafter, he developed recurrent retroperitoneal lymphadenopathy with elevation of tumor markers, α-fetoprotein 1050 μg/l and β-hcg 16 U/l (normal values: α-fetoprotein<9 μg/l and β-hcg<6 U/l). He was then considered to be an appropriate candidate for tandem autologous transplantation. High-dose cytoxan and etoposide with granulocyte colony-stimulating factor (G-CSF) was used for peripheral blood stem cell (PBSC) mobilization and 18 × 106 CD 34+ cells/kg of body weight were obtained. He underwent the first autologous PBSC transplant with carboplatin 250 mg/m2 × 3 days, etoposide 1200 mg/m2 × 2 days and cytoxan 1800 mg/m2 × 5 days along with mesna, and received 9 × 106 CD34+ cells/kg of body weight. Blood counts recovered by day 12 (neutrophils >1 × 109/l, hemoglobin >80 gm/l without transfusion and platelets >50 × 109/l without transfusion). Tumor markers normalized. He then underwent the second autologous PBSC transplant 8 weeks after first transplant with the same regimen and received the same dose of CD34+ cells. Counts recovered by day 12. He received G-CSF from day 1 after both transplants. A sudden drop in the platelet count to 7 × 109/l was noted on day +70 after the second transplant. White cell count, hemoglobin and blood coagulation parameters were normal. The peripheral smear did not reveal any abnormality except for thrombocytopenia. After the platelet transfusion, no significant post-transfusion increments were observed. His medications were reviewed and hepatitis A, B, C, CMV and HIV as potential causes for thrombocytopenia were excluded. A bone marrow examination performed on day +71 after the second transplant showed megakaryocytic hyperplasia, suggesting peripheral destruction of platelets rather than decreased production. He did not respond adequately to steroid and i.v. IgG and underwent splenectomy. After a transient improvement in the platelet count, the patient had relapse of ITP and was re-started on prednisone. Currently, his ITP is in remission on low doses of prednisone.

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  1. Saskatoon Cancer Centre, Saskatoon, Canada

    I Ahmad, K Haider & R Kanthan

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Ahmad, I., Haider, K. & Kanthan, R. Autoimmune thrombocytopenia following tandem autologous peripheral blood stem cell transplantation for refractory germ cell tumor. Bone Marrow Transplant 34, 279–280 (2004). https://doi.org/10.1038/sj.bmt.1704574

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