مقاله انگلیسی رایگان در مورد سرطان سینه همزیست و ازدیاد پلاکت های خون – هینداوی ۲۰۱۸

Background

Essential thrombocythemia (ET) is a myeloproliferative neoplasm (MPN) [1]. Patients with this condition have an increased risk to develop a second cancer including both haematological [2] and nonhaematological [2, 3] risks. However, breast cancer in the MPN population is not increased in comparison with the general population [4]. Physicians are faced with several therapeutic challenges when ET coexists with another tumour, in particular solid tumours. )ese should be managed on an individual basis. Physicians should take into consideration the risk of thrombosis, characteristics of the cancer, and the therapeutic approach for the tumour whether surgical, chemotherapy, or both.

Case

A 65-year-old female presented with a breast lump, diagnosed to be oestrogen and progesterone receptor positive, HER2 negative, and T1cN1bM0 moderately differentiated infiltrating ductal carcinoma. She had a platelet count of 600 thou/cu mm. )ere was no history of thrombotic or bleeding episodes. Further testing showed that JAK2 mutation was positive and t(9;22) mutation was negative. Her bone marrow biopsy showed increased megakaryocytes. Her other lab workup was unremarkable including iron panel and liver function tests. She had no splenomegaly on ultrasound. She was diagnosed with ET in the setting of breast cancer. Aspirin was commenced but held seven days prior to her breast conservation surgery, restarted postoperatively and continued thereafter. Postoperative thromboprophylaxis with low-molecular weight heparin (LMWH) was continued until the patient was fully ambulatory. Aspirin was restarted on day 7 after the surgery. Anticipating thrombocytopenia during chemotherapy, and given the absence of data combining hydroxyurea with standard chemotherapy used for breast cancer (in this case docetaxel and cyclophosphamide), we felt it prudent to delay cytoreductive therapy for her ET until after completion of breast cancer treatment. Her indication for cytoreductive therapy was >60 years. She was treated with adjuvant docetaxel and cyclophosphamide and continued on aspirin 81 mg for the entire duration of her chemotherapy. She tolerated the 6 cycles of chemotherapy well. Following the completion of her chemotherapy, she was started on letrozole and radiotherapy with the aim to continue the letrozole for 5 years. Hydroxyurea (500 mg) was also started and titrated to a goal to 400– ۴۵۰ thou/cu mm platelets. Zoledronic acid was started for osteoporosis prevention. Her average platelet count during chemotherapy was 480 thou/cu mm with the lowest being 377 thou/cu mm (Table 1). Her platelet count remained at goal between 300 and 350 thou/cu mm after four months of hydroxyurea (Table 2). )roughout her treatment, there were no bleeding or thrombotic complications. After one year on letrozole, hydroxyurea, and aspirin, the patient was doing well without complications with platelet counts at goal.