Eculizumab therapy in gemcitabine-induced thrombotic microangiopathy in a renal transplant recipient

Martin, Kylie; Roberts, Veena; Chong, Geoffrey; Goodman, David; Hill, Prue; Ierino, Francesco L.

doi:10.1093/omcr/omz048

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…Reports of patients with G-TMA treated by eculizumab are rare [18][19][20][21][22][23][24][25][26][27]. To our knowledge, only 13 cases have been reported in literature, and a similar good outcome was observed.…”

Section: Discussionmentioning

confidence: 64%

Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre

et al. 2021

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Background Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA). Methods This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016. Results Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4–44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2–22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0–10) before treatment vs 0 (range 0–1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m2 respectively in the eculizumab group and in the control group. Conclusions These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery.

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Section: Discussionmentioning

confidence: 64%

Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre

et al. 2021

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“…Eculizumab, a C5 inhibitor, is commonly used for aHUS and paroxysmal nocturnal hemoglobinuria [10]. Some success has been achieved when secondary HUS was associated with cancer and was described as malignancy iatrogenic type 1 [8, 11]. The use of eculizumab in paraneoplastic syndrome is not recommended, because of its cost; in addition, cancer patients may have a poor clinical status, rapid evolution (weeks to days), and fatal issue[3].…”

Section: Discussionmentioning

confidence: 99%

Atypical Evolution of Secondary Hemolytic Uremic Syndrome Defined as Paraneoplastic Syndrome under Eculizumab and Palbociclib Therapies

Perrier¹,

Noble²,

Grangé³

et al. 2021

Case Rep Oncol

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Thrombotic microangiopathy (TMA) is most of the time caused by thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. A 60-year-old female was diagnosed in 2014 with mammary breast adenocarcinoma treated by several-line therapy: mastectomy, docetaxel, cyclophosphamide, radiotherapy, doxorubicine, and capecitabine. By mid-November, the patient was admitted to the hospital with regenerative, mechanical, and hemolytic anemia, schistocytes at 3%, and thrombopenia (99 G/L), associated with high blood transfusion requirement. After 9 sessions of plasmapheresis, there was no significant improvement in the biological parameters, nor after 2 cycles of paclitaxel. The patient was then treated with eculizumab during 4 weeks, with a slight reduction in blood requirement, and simultaneously with palbociclib. Since being treated with palpociclib, she had a great reduction in blood requirement and a good clinical condition. To conclude, we reported an initial moderate improvement of paraneoplasm-related TMA syndrome under eculizumab therapy with a slight reduction in red blood cell requirement; however, palbociclib therapy achieved a very good response with a dramatic reduction in red blood cell requirement.

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“…Eculizumab has also been used in the management of GiTMA with significant improvement in both renal function and hematological parameters [5,[14][15][16][17]. It is often used for patients who are at high risk for complications such as thrombocytopenia, progressive renal failure, or extrarenal complications such as abnormal vascular permeability.…”

Section: Discussionmentioning

confidence: 99%

A Case of Gemcitabine-Induced Thrombotic Microangiopathy Treated With Ravulizumab in a Patient With Stage IV Pancreatic Cancer

MacDougall

Schwartz

Harewood

et al. 2021

Cureus

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Eculizumab therapy in gemcitabine-induced thrombotic microangiopathy in a renal transplant recipient

Cited by 9 publications

References 10 publications

Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre

Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre

Atypical Evolution of Secondary Hemolytic Uremic Syndrome Defined as Paraneoplastic Syndrome under Eculizumab and Palbociclib Therapies

A Case of Gemcitabine-Induced Thrombotic Microangiopathy Treated With Ravulizumab in a Patient With Stage IV Pancreatic Cancer

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