Myelotoxicity of gold

Area of Science:

• Rheumatology
• Hematology
• Clinical Pharmacology

Background:

• Gold compounds, such as sodium aurothiomalate, have been used to treat inflammatory conditions.
• Blood dyscrasias are a known adverse effect of gold therapy.
• Bone marrow hypoplasia represents a severe complication of these hematological side effects.

Purpose of the Study:

• To analyze the incidence and causes of blood dyscrasias in patients treated with gold.
• To identify risk factors and clinical patterns associated with gold-induced hematotoxicity.
• To provide recommendations for monitoring and managing gold therapy.

Main Methods:

• Retrospective analysis of 55 patients who developed blood dyscrasias during gold treatment.
• Categorization of dyscrasias based on total dose of sodium aurothiomalate received.
• Correlation of hematological findings with clinical outcomes, including mortality.

Main Results:

• Fifteen of 55 patients with gold-induced blood dyscrasias died, primarily from bone marrow hypoplasia.
• Immune hypersensitivity was suspected in cases with low cumulative doses.
• Cumulative toxicity was the likely cause in patients receiving higher total doses of gold.
• A significant fall in blood counts indicated toxicity, necessitating treatment cessation.

Conclusions:

• Frequent blood monitoring is essential for all patients undergoing gold treatment.
• Prompt cessation of gold therapy is recommended upon detection of significant hematological decline.
• Cautious re-initiation of therapy with lower doses may be considered in some patients.
• Understanding the dose-response relationship aids in managing gold-related toxicity.