Clinical characteristics, treatment, and outcomes of Oxaliplatin-induced immune thrombocytopenia.

BACKGROUND

Although myelosuppression is its common dose-limiting toxicity, oxaliplatin-induced immune thrombocytopenia (OITP), a rare and potentially fatal type II hypersensitivity reaction, is often misdiagnosed as ordinary myelosuppression due to insufficient clinical awareness.

METHODS

Relevant literature published up to December 31, 2025 were retrieved from databases including PubMed, Scopus, Embase, Web of Science, Cochrane Library, Wanfang Medical Database and China National Knowledge Infrastructure (CNKI). Cases confirmed as OITP were strictly screened for retrospective analysis.

RESULTS

Among the 40 included patients, the median age was 59 years (range, 36-83 years), with a significant female predominance (65.0%). The main primary disease was colorectal cancer (92.5%), and the most commonly used chemotherapy regimen was FOLFOX (77.5%). OITP onset was characterized by a distinct latent period, with a median time to onset of the 9th chemotherapy cycle (range, 2-28 cycles). The clinical manifestations were severe: 82.5% of patients had a platelet count drop to < 25×109/L, with a median nadir of only 6×109/L. Bleeding symptoms were evident in 65.0% of patients, and 52.5% of patients had accompanying systemic hypersensitivity symptoms such as fever and chills. Immunological tests showed that oxaliplatin-dependent platelet antibodies were detected in 48.4% of patients. In terms of treatment, oxaliplatin was discontinued in all patients (100%), combined with platelet transfusion (62.5%), glucocorticoids (55.0%), intravenous immunoglobulin (20.0%) and plasma exchange (12.5%). The overall recovery rate was 92.5%, with a median recovery time of 7 days, and the mortality rate reached 7.5%.

CONCLUSIONS

OITP is a severe immune complication occurring after cumulative exposure to oxaliplatin, often accompanied by systemic allergic symptoms. Clinicians should be alert to sudden severe thrombocytopenia after long-term oxaliplatin administration, and permanent discontinuation of oxaliplatin is strongly advised once OITP is diagnosed. In clinical practice, glucocorticoids and platelet transfusion are the main empirical treatment options for OITP, and plasma exchange may be a potential empirical salvage intervention for patients with refractory or life-threatening OITP, while the efficacy of these treatments has not been validated by comparative data.