Gemcitabine-associated thrombotic microangiopathy in a patient with lung cancer: A case report

Abstract

Gemcitabine is frequently used for the treatment of a number of different cancer types. Gemcitabine-related thrombotic microangiopathy (TMA) has rarely been described, but it is a life-threatening complication. The incidence of the complication varies between 0.015 and 1.4%. The present study reports the case of a 63-year-old Caucasian male who was treated with 3 cycles of carboplatin plus gemcitabine, followed by 7 cycles of gemcitabine only, and developed clinical symptoms that, together with laboratory findings, were compatible with a diagnosis of hemolytic uremic syndrome TMA. The patient was admitted to Jean Godinot Cancer Center Institute with hemolysis, thrombocytopenia, macroscopic hematuria, renal dysfunction and worsening high blood pressure. Medical treatment for the high blood pressure, plasma infusion and hemodialysis were implemented without any improvement in creatine levels. The patient recovered from hematological disorders, left hospital and was followed-up. He required hemodialysis until he succumbed ~3 months subsequent to diagnosis of TMA. Even if thrombocytopenia, anemia and renal failure are common observations in patients treated by chemotherapy, clinicians should be aware of this potentially lethal complication. We recommend screening for TMA in such cases of anemia, thrombocytopenia and renal failure.

Cancer-Associated Thrombotic Microangiopathy in a Patient With Metastatic Esophageal Adenocarcinoma

“…The majority of cases are idiopathic, but several etiologies have been recognized, including drugs, and cytotoxic chemotherapies, such as gemcitabine, carboplatin, cisplatin, bleomycin, and a vinca alkaloid [3][4][5][6][7][8]. TMA induced by the use of an icos agonist in combination with a PD-1 inhibitor has not been described [9], and was not the cause of TMA in this case, as confirmed by autopsy findings.…”

Renal Toxicity From Pemetrexed and Pembrolizumab in the Era of Combination Therapy in Patients With Metastatic Nonsquamous Cell NSCLC

“…32 Drug-induced TMA has also been reported after treatment with a number of chemotherapeutic agents, including gemcitabine and the already mentioned cisplatin. 33 The exact incidence of drug-induced TMA is difficult to estimate because cases are underreported and the clinical presentation is sometimes confused with other causes. The mechanism by which the chemotherapeutic agent induces TMA can either be non-dose-dependent (immune-related) or more frequently dose-related (toxic).…”

Gemcitabine-Induced Thrombotic Microangiopathy in a Patient With Cholangiocarcinoma: An Atypical Case

“…A disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 (ADAMTS13) is demonstrated to be significant in the pathophysiology of TTP when either antibodies against ADAMTS13 are present (acquired TTP) or when antibodies against ADAMTS13 are lacking (inherited TTP). A severe deficiency of ADAMTS‐1 activity, with clinical symptoms of acute thrombocytopenia and evidence of microangiopathic hemolytic anemia, constitutes a diagnosis of TTP [ 9 ]. HUS is not associated with a deficiency in ADAMTS13 activity [ 9 ].…”