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Temozolomide-induced aplastic anaemia and incidental low-grade B-cell non-Hodgkin lymphoma in a geriatric patient with glioblastoma multiforme
  1. Felipe Batalini1,2,
  2. Matthew R Kaufmann1,
  3. Gabriel Francisco Aleixo3 and
  4. Reed Drews2
  1. 1 Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
  2. 2 Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Universidade do Oeste Paulista Faculdade de Medicina, Presidente Prudente, São Paulo, Brazil
  1. Correspondence to Dr Felipe Batalini, fbatalin{at}


Glioblastoma multiforme is an astrocyte-derived tumour representing the most aggressive primary brain malignancy. The median overall survival is 10–12 months, but it drops to 3–8.5 months for the cohort with more than 65 years old, which account to half of all patients. Initial management in this patient population aims to balance overall patient survival and quality of life with the inherent risks of treatment intervention, which include maximal safe tumour resection, radiation and temozolomide (TMZ) chemotherapy. This is accomplished through risk stratification as a function of patient age, functional status, comorbidities, tumour location and methylguanine methyltransferase promoter methylation status. We describe the care of a patient with prolonged febrile neutropaenia, with a rare but fatal complication from TMZ-induced idiosyncratic reaction, leading to aplastic anaemia and a provoking diagnosis of low-grade B-cell non-Hodgkin’s lymphoma.

  • geriatric medicine
  • haematology (incl blood transfusion)
  • oncology
  • CNS cancer
  • infectious diseases

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  • Contributors FB and MRK have contributed equally and both took personal care of this patient, conceptualised and planned the report. FB and MRK conducted the report and acquired the data. Design, analysis and interpretation were performed by all authors and lead by FB. MRK, FB and GFA drafted the article. MRK acquired and analysed all pathology-related content with the help of FB and GFA. FB and RD were involved in revising critically for important intellectual content. All authors approved the version published. All agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not used a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.