The toxic effects of ¹³¹I-therapy on bone marrow in patients with differentiated thyroid carcinoma.

Prinsen, H. (Hester) (2014) The toxic effects of ¹³¹I-therapy on bone marrow in patients with differentiated thyroid carcinoma. thesis, Medicine.

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Abstract

Introduction. DTC is the most common endocrine malignancy with a rising prevalence. Due to the favorable prognosis of DTC there is an increasing interest in quality of life of these patients. Treatment with ¹³¹I follows after (total) thyroidectomy, and is associated with better DTC survival. However, this therapy is also associated with possible adverse effects on the bone marrow, though data about this subject are scarce in the literature. Purpose. The primary aim of this retrospective study was to determine if changes in blood count parameters occur after treatment with ¹³¹I. The secondary aim was to define the characteristics of patients with blood count drops, including TNM-classification, histology, age, cumulative ¹³¹I dose. Methods. All DTC patients, treated with ¹³¹I in the UMCG between January 1989 and July 2013 were analyzed. Patients without baseline or follow-up data and/or co-morbidity that could have caused the blood count drops were excluded. Mean values of Hb, leukocytes and platelets were analyzed to estimate significant changes in blood counts, 3 and 6 months after each treatment. After this, we determined which patient characteristics were associated with the occurrence of anaemia, leukopenia and thrombocytopenia after the cumulative dose. RESULTS. 586 patients fulfilled the inclusion criteria. Male: female ratio was 26.5:73.5. The mean±SD age of the patients was 49.35±17.6 years and the median received cumulative dose was 300 mCi (IQR=150-350). A significant increase of Hb and decrease of leukocyte-count occurred after the initial dose. After the second ¹³¹I treatment, also platelet counts decreased significantly. Decreases of leukocyte and platelet counts remained during the rest of the treatments. All mean decreases fell within the normal range. Patient characteristics associated with blood count drops (below value of reference), were an older age (>45 years), a large primary tumour (T4), distant metastases and a high cumulative ¹³¹I dose (<450 mCi). Conclusion. This study shows a significant decline of mean leukocyte and platelet counts after treatment with ¹³¹I in DTC patients. Although these mean declines still fall within the normal range, clinicians should be aware of this phenomenon in patients with low bone marrow reserve or patients with risk factors associated with blood count drops.

Item Type:	Thesis (Thesis)
Supervisor name:	Links, Prof. Dr. T.P. and Klein Hesselink, E.N
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:05
Last Modified:	25 Jun 2020 11:05
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2527

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