What are the causes of thrombocytopenia in metastatic cervical cancer (Ca cervix)?

From the Guidelines

Thrombocytopenia in metastatic cervical cancer is primarily caused by bone marrow infiltration by cancer cells, chemotherapy-induced myelosuppression, and radiation therapy, with cisplatin and paclitaxel being common culprits, as seen in studies such as 1.

Causes of Thrombocytopenia

The causes of thrombocytopenia in metastatic cervical cancer can be multifactorial, including:

• Bone marrow infiltration by cancer cells, which directly suppresses platelet production by replacing normal hematopoietic tissue
• Chemotherapy agents used to treat cervical cancer, such as cisplatin and paclitaxel, commonly cause myelosuppression affecting platelet production, with cisplatin/paclitaxel being associated with less thrombocytopenia and anemia compared to other regimens, as shown in 1
• Radiation therapy to pelvic or para-aortic regions can suppress bone marrow function when these areas contain active marrow
• Disseminated intravascular coagulation (DIC) may develop in advanced disease, leading to excessive platelet consumption
• Immune-mediated destruction of platelets can occur as a paraneoplastic phenomenon
• Splenic sequestration of platelets may result from splenomegaly due to metastatic involvement or portal hypertension
• Nutritional deficiencies, particularly folate and vitamin B12, can impair platelet production in patients with poor intake or malabsorption

Management of Thrombocytopenia

Management of thrombocytopenia in metastatic cervical cancer depends on the specific cause and may include:

• Platelet transfusions for severe thrombocytopenia (platelets <10,000/μL or <50,000/μL with bleeding)
• Adjusting chemotherapy dosing, with consideration of regimens such as paclitaxel and cisplatin combined with bevacizumab, which is considered the preferred first-line regimen in metastatic or recurrent cervical cancer, as stated in 1
• Treating underlying DIC if present
• Addressing nutritional deficiencies with appropriate supplementation

From the Research

Causes of Thrombocytopenia in Metastatic Cervical Cancer

• Thrombocytopenia in metastatic cervical cancer can be caused by various factors, including:
  • Bone marrow invasion by the cancer cells 2
  • Chemotherapy-induced thrombocytopenia (CIT) 3, 4, 5
  • Radiation-induced thrombocytopenia 2
  • Drug-induced thrombocytopenia 2
• Other associated conditions, such as infections, consumption coagulopathy, and immune thrombocytopenia, can also contribute to thrombocytopenia in cancer patients 3, 5

Chemotherapy-Induced Thrombocytopenia

• CIT is a frequent complication of cancer therapy, leading to increased risk of bleeding and delayed or reduced chemotherapy dose intensity 4, 5
• The type and dose of chemotherapy can determine the extent of CIT, with regimens containing gemcitabine, platinum, or temozolomide producing it most commonly 5

Management of Thrombocytopenia

• Platelet transfusion remains the cornerstone of treatment for thrombocytopenia in cancer patients 3, 5
• Thrombopoietic growth factors, such as romiplostim and eltrombopag, can improve pretreatment and nadir platelet counts, reduce the need for platelet transfusions, and enable chemotherapy dose intensity to be maintained 5