Vincristine-induced anemia in hereditary spherocytosis

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  • Jennifer Michlitsch
    Department of Hematology/Oncology, UCSF Benioff Children’s Hospital, Oakland, CA 94609, USA
  • Sandra Larkin
    Children’s Hospital Oakland Research Institute, Oakland, CA 94609, USA
  • Elliott Vichinsky
    Department of Hematology/Oncology, UCSF Benioff Children’s Hospital, Oakland, CA 94609, USA
  • Frans A Kuypers
    Children’s Hospital Oakland Research Institute, Oakland, CA 94609, USA

Description

<jats:p> Vincristine, a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Vincristine-induced anemia has been observed, but its mechanism is not well understood. We describe a case involving serious vincristine-induced anemia in a patient with congenital spherocytosis and provide the explanation to the underlying mechanism. This report demonstrates that vincristine administration to patients with a red cell disorder may require additional clinical interventions to compensate for the vincristine-induced anemia. </jats:p><jats:sec><jats:title>Impact statement</jats:title><jats:p> Therapy with vincristine (VCR), a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Our paper indicates that treatment of patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia. Careful evaluation of other hematologic disorders is important in using a well-known oncology treatment. Whereas extreme concentrations of VCR were shown to alter red cell viability, data did not show negative effects in patients treated. Our data show that under conditions of increased hematopoiesis, hemoglobin in the circulation drops rapidly requiring transfusion. VCR administration to patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia. </jats:p></jats:sec>

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