Successful Treatment of Oxaliplatin-Induced Immune Thrombocytopenia in a Schizophrenic Patient With Contraindication to Steroids Using Cyclosporine Plus Eltrombopag: A Case Report.

[BACKGROUND] Oxaliplatin is widely used in the treatment of gastrointestinal tumors but is associated with rare adverse effects, including immune thrombocytopenia. The incidence of oxaliplatin-associated immune thrombocytopenia (OIIT) may be frequently overlooked due to its rarity, and in some cases, it can be difficult to treat. We present our successful experience with the use of combination therapy consisting of cyclosporine and eltrombopag in one patient, who was not suitable for steroid medication due to schizophrenia and had failed to respond when treated with eltrombopag alone.

[CASE PRESENTATION] A 57-year-old Chinese woman with colon cancer suffered from schizophrenia, whereas thrombocytopenia had never been demonstrated. She experienced persistent thrombocytopenia and recurrent bleeding at mucocutaneous sites after oxaliplatin-containing chemotherapy. Then, oxaliplatin-induced immune thrombocytopenia was diagnosed after almost all necessary examinations. The medical history limits the use of long-term hormone therapy. Her condition remained uncontrolled following a range of treatments regimen that involved eltrombopag alone. However, after initiating a combination of agents such as cyclosporine and eltrombopag, her platelet count normalized within 6 months, and she experienced no relapses during a 2-year follow-up period.

[CONCLUSION] Our results suggest that combination therapy with cyclosporine and eltrombopag exhibits better response rates in settings of the existence of contraindications to other therapies and less efficacy of eltrombopag alone. This knowledge will be helpful for other clinicians to choose an appropriate treatment in such difficult circumstances.