Cancer Awareness in Atypical Thrombotic Microangiopathies

Abstract

After completing this course, the reader will be able to:1. Outline the clinical and biological features that would prompt a clinician to investigate an underlying malignancy in a patient suffering from thrombotic microangiopathy.2. Conduct additional investigation to diagnose or rule out malignancy.3. Formulate in timely fashion an adapted treatment plan for a patient with a cancer-associated thrombotic microangiopathy.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME The Oncologist CME Program is located online at http://cme.theoncologist.com/. ABSTRACTTo take the CME activity related to this article, you must be a registered user. Cancer BiologyThe

Breast Cancer-Associated Thrombotic Microangiopathy

“…Although a severe deficiency has been described in some cases [6,10], in most published cases a normal or only minimally reduced activity of the protease has been found [5,6,9,11,12], which corresponds with our findings. Interestingly, there is evidence that cancer itself [13][14][15], as well as other severe medical conditions [16,17], is associated with a moderate ADAMTS13 deficiency.…”

“…Our results with fractionated chemotherapy are surprisingly favorable and are in contrast to previous reports [4][5][6]12]. The following reasons might explain these differences: -In contrast to others, we describe only breast cancer patients, for whom various highly efficient chemotherapy options are known.…”

“…In line with this, several long-term survivors have been described, all of them with a complete or partial remission of the carcinoma [4,6,[18][19][20][22][23][24][25]. Due to this growing body of evidence, we have changed the treatment algorithm in our clinic.…”

“…Diagnosis was based on the presence of thrombocytopenia and Coombs-negative hemolytic anemia, as previously reported [4][5][6].…”

Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus

“…32 In this regard, we have described for the first time the presence of circulating erythroblasts in all patients developing probable TMA. As previously reported by Oberic et al, 33 patients with cancerassociated TMAs had a typical presentation on diagnosis that was clearly distinct from that of idiopathic TMA. In particular, patients usually displayed moderate/massive erythroblastosis in peripheral blood a typical feature at presentation in comparison with patients with an idiopathic TMA.…”