Paclitaxel and carboplatin combination therapy-induced pure red cell aplasia in endometrial cancer patient and favorable response to low-dose corticosteroid treatment: a case report
Endometrial cancer, the sixth most common malignancy in women, is frequently treated with carboplatin-paclitaxel chemotherapy. While myelosuppression is a common adverse effect, drug-induced pure red cell aplasia (PRCA) is exceedingly rare. This report presents a case of refractory PRCA induced by this regimen, which was successfully reversed with low-dose corticosteroids, underscoring its clinical significance. A postmenopausal patient with endometrial cancer (stage IA, high p53 expression) received adjuvant paclitaxel and carboplatin chemotherapy. She subsequently developed severe anemia (reticulocytes 0.001×1012/L). Bone marrow examination revealed an absence of erythroid precursor cells. PRCA was diagnosed after excluding hemolysis, hematologic malignancies, infections, and autoimmune disorders. Given normal pre-chemotherapy hemoglobin (Hb) levels, drug-induced PRCA was suspected. Chemotherapy was discontinued, and stanozolol was initiated; however, Hb remained stable at 60 g/L without improvement. Low-dose corticosteroids (0.5 mg/kg) were added one week later, resulting in Hb increasing to 82 g/L within 2 weeks. Levels normalized within four weeks and remained stable after corticosteroid taper. This case highlights PRCA as a potential complication of carboplatin-paclitaxel therapy, emphasizing the importance of obtaining reticulocyte counts and bone marrow studies in cases of refractory chemotherapy-induced anemia. Early low-dose corticosteroid intervention proved effective and safe. Clinicians should include PRCA in the differential diagnosis during chemotherapy toxicity surveillance to optimize supportive care in cancer patients.