Antineoplastics
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Reactions 583 - 13 Jan 1996 S Antineoplastics Haemolytic uraemic syndrome: 3 case reports Three patients developed haemolytic uraemic syndrome 4–6 months after they received high-dose antineoplastic therapy prior to autologous stem cell support. The first patient, a 48-year-old woman with carcinoma of the fallopian tube, was treated with 3 cycles of CTC comprising cyclophosphamide 1500 mg/m 2 , thiotepa 60 mg/m 2 twice daily and carboplatin 400 mg/m 2 , all given on 4 consecutive days. Following each cycle, she received peripheral stem cell reinfusion at 5-week intervals. After the third cycle she had elevated liver enzymes and bacteraemia. Four months later, she developed hypertension, microangiopathic haemolytic anaemia and renal insufficiency. From the results of laboratory tests, she was diagnosed with haemolytic uraemic syndrome. The woman was given 2 units of fresh frozen plasma daily for 6 days and her haemoglobin level stabilised after 3 units of erythrocytes. The syndrome resolved over the next 3 months. The second patient, a 36-year-old man with testicular carcinoma, was given 3 cycles of CTC followed by peripheral stem cell infusion and achieved complete remission. Six months after the last stem cell transplantation, he developed hypertension, thrombocytopenia, renal insufficiency and microangiopathic haemolytic anaemia. He was also diagnosed with haemolytic uraemic syndrome and given 2 units/day of fresh frozen plasma. However, haemolysis progressed and he had a cardiac arrest and died. Autopsy findings suggested that the cause of death was severe anaemia, fluid overload and hypertension. The third patient was a 33-year-old man with insulin- dependent diabetes mellitus and advanced Hodgkin’s disease. Prior to autologous bone marrow transplantation on day 0, he was given high-dose antineoplastic therapy comprising carmustine 300 mg/m 2 and etoposide 100 mg/m 2 , cytarabine 100 mg/m 2 twice daily and cyclophosphamide 35 mg/kg. Five months after transplantation, he reported fatigue and 1 month later he had disturbed vision and incomplete bilateral thromboses of his central retinal veins. He then developed raised BP, renal insufficiency, thrombocytopenia and microangiopathic haemolytic anaemia. After intensive treatment with plasmapheresis, fresh frozen plasma, high- dose methylprednisolone, IV gammaglobulin and vincristine, his symptoms gradually improved. Author comment: ‘We conclude that hemolytic uremic syndrome after intensive chemotherapy is a severe complication.’ van der Lelie H, et al. Hemolytic uremic syndrome after high dose chemotherapy with autologous stem cell support. Cancer 76: 2338-2342, 1 Dec 1995 - Netherlands 800409996 1 Reactions 13 Jan 1996 No. 583 0114-9954/10/0583-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 583 - 13 Jan 1996
SAntineoplastics
Haemolytic uraemic syndrome: 3 case reportsThree patients developed haemolytic uraemic syndrome
4–6 months after they received high-dose antineoplastictherapy prior to autologous stem cell support.
The first patient, a 48-year-old woman with carcinoma of thefallopian tube, was treated with 3 cycles of CTC comprisingcyclophosphamide 1500 mg/m2, thiotepa 60 mg/m2 twicedaily and carboplatin 400 mg/m2, all given on 4 consecutivedays. Following each cycle, she received peripheral stem cellreinfusion at 5-week intervals. After the third cycle she hadelevated liver enzymes and bacteraemia. Four months later,she developed hypertension, microangiopathic haemolyticanaemia and renal insufficiency. From the results of laboratorytests, she was diagnosed with haemolytic uraemic syndrome.The woman was given 2 units of fresh frozen plasma daily for 6days and her haemoglobin level stabilised after 3 units oferythrocytes. The syndrome resolved over the next 3 months.
The second patient, a 36-year-old man with testicularcarcinoma, was given 3 cycles of CTC followed by peripheralstem cell infusion and achieved complete remission. Sixmonths after the last stem cell transplantation, he developedhypertension, thrombocytopenia, renal insufficiency andmicroangiopathic haemolytic anaemia. He was also diagnosedwith haemolytic uraemic syndrome and given 2 units/day offresh frozen plasma. However, haemolysis progressed and hehad a cardiac arrest and died. Autopsy findings suggested thatthe cause of death was severe anaemia, fluid overload andhypertension.
The third patient was a 33-year-old man with insulin-dependent diabetes mellitus and advanced Hodgkin’s disease.Prior to autologous bone marrow transplantation on day 0, hewas given high-dose antineoplastic therapy comprisingcarmustine 300 mg/m2 and etoposide 100 mg/m2, cytarabine100 mg/m2 twice daily and cyclophosphamide 35 mg/kg. Fivemonths after transplantation, he reported fatigue and 1 monthlater he had disturbed vision and incomplete bilateralthromboses of his central retinal veins. He then developedraised BP, renal insufficiency, thrombocytopenia andmicroangiopathic haemolytic anaemia. After intensivetreatment with plasmapheresis, fresh frozen plasma, high-dose methylprednisolone, IV gammaglobulin and vincristine,his symptoms gradually improved.
Author comment: ‘We conclude that hemolytic uremicsyndrome after intensive chemotherapy is a severecomplication.’van der Lelie H, et al. Hemolytic uremic syndrome after high dose chemotherapywith autologous stem cell support. Cancer 76: 2338-2342, 1 Dec 1995 -Netherlands 800409996
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Reactions 13 Jan 1996 No. 5830114-9954/10/0583-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
