[A Case of Post-Transplant Lymphoproliferative Disorder with Suspected Thrombosis Leading to Discontinuation of Daprodustat Following Pharmacist Intervention].

Abstract

A woman in her 50s was diagnosed with post-transplant lymphoproliferative disorder, diffuse large B-cell lymphoma, and germinal center B-cell-like type based on a lower gastrointestinal tract biopsy. The treatment course comprised R-CHOP chemotherapy. She had undergone a living-donor kidney transplantation 22 years ago. During the fifth cycle of R-CHOP, a pharmacist observed exertional dyspnea and edema of the left lower extremity. Transthoracic echocardiography revealed a decrease in global longitudinal strain; however, elevated D-dimer levels were noted. Additionally, the edema was unilateral, leading the pharmacist to suspect cancer-associated thrombosis as a possible cause of the lower extremity edema. The patient had been receiving daprodustat to treat renal anemia. However, because daprodustat is known to pose some risk to patients with thromboembolic disease, the pharmacist provided the attending physicians with information relevant to the discontinuation of daprodustat. Subsequently, the patient was diagnosed with left lower-extremity deep vein thrombosis, and daprodustat was discontinued.