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Temozolomide for Anaplastic Astrocytoma: A Case Report of Aplastic Anemia, Sustained Treatment Response, and Spontaneous Marrow Recovery

Nadine Lam, Frances Cusano, Jill Bullock, Jacob C Easaw


Introduction:Temozolomide is an alkylating agent used in the treatment of high-grade glioma. Rarely, it can induce an aplastic anemia that is usually rapidly fatal if the patient is unable to undergo a bone marrow transplant. This is the first case report of a temozolomide-induced aplastic anemia in an anaplastic astrocyoma patient, and of spontaneous complete marrow recovery with supportive care.

Presentation of Case: 21 year old Caucasian female presented with pancytopenia after 39 days of temozolomide at 75mg/m2/day concurrent with radiation. Hematologic nadir occurred and aplastic anemia was diagnosed 3 months after the first dose of temzolomide. She required multiple platelet and red cell transfusions in addition to granulocyte colony stimulating factor therapy. During this time, the patient also became pregnant and delivered a healthy baby. With supportive care, the patient's white cell count recovered after 6 months, red cell count after 1.5 years, and platelets after 3 years. Her tumour remains stable more than 4 years after temozolomide and radiation with no further treatment.

Conclusions:Aplastic anemia may occur with low-dose temozolomide. Spontaneous marrow recovery using only supportive care is possible following temozolomide-induced aplastic anemia.


Temozolomide; Aplastic anemia; Anaplastic astrocytoma; Glioma

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