Gemcitabine-induced hemolytic-uremic syndrome treated with eculizumab or plasmapheresis: two case reports

• Published in: Clinical nephrology Vol. 87 (2017); no. 2; pp. 100 - 106
• Main Authors: López Rubio, María Esperanza, Rodado Martínez, Raquel, Illescas, María Luisa, Mateo Bosch, Encarnación, Martinez Díaz, Mercedes, de la Vara Inesta, Lourdes, Cabezuelo, Basilio, Morales Albuja, María Elisa, Lucas Guillén, Eladio, Jimeno García, Luisa
• Format: Journal Article
• Language: English
• Published: Germany Dustri - Verlag Dr. Karl Feistle GmbH & Co. KG 01.02.2017
• Subjects: Acute Kidney Injury - chemically induced; Adenocarcinoma - drug therapy; Adenocarcinoma - surgery; Aged; Antibodies, Monoclonal, Humanized - therapeutic use; Antimetabolites, Antineoplastic - adverse effects; Antimetabolites, Antineoplastic - therapeutic use; Apheresis; Bladder cancer; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - surgery; Case reports; Chemotherapy, Adjuvant - adverse effects; Combined Modality Therapy; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Hemodialysis; Hemolytic-Uremic Syndrome - chemically induced; Hemolytic-Uremic Syndrome - drug therapy; Hemolytic-Uremic Syndrome - therapy; Humans; Hypertension; Kidney Function Tests; Laboratories; Male; Monoclonal antibodies; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - surgery; Plasmapheresis; Purpura, Thrombotic Thrombocytopenic; Renal Dialysis - adverse effects; Treatment Outcome
• ISSN: 0301-0430
• DOI: 10.5414/CN108838

Drug-induced hemolytic-uremic syndrome (HUS) has shown good response to eculizumab (ECU). We present 2 cases of patients with gemcitabine-induced HUS (GEM-HUS), one of whom was treated with ECU and the other with conventional treatment. Patient 1: A 74-year-old male with resected adenocarcinoma of the pancreas started adjuvant treatment with GEM, but after 5 months GEM was discontinued due to acute kidney injury and severe hypertension. Laboratory analyses identified microangiopathic hemolytic anemia (MHA) and thrombocytopenia. Plasmapheresis (Pph) was initiated but was stopped due to a severe adverse reaction. Treatment with ECU was initiated at the time of clinical progression requiring hemodialysis. After 7 doses of ECU, hemolysis and kidney function improved and the patient was able to stop hemodialysis. 1 month after the last dose of ECU serum creatinine (sCr) was 1.8 mg/dL. Patient 2: A 68-year-old male with resected urothelial carcinoma stopped GEM after 2 months due to hematologic toxicity. 1 month later the patient visited the emergency room due to minimal effort dyspnea, hypertension, and peripheral edema. Laboratory analyses showed decreased kidney function, MHA, and thrombocytopenia. Symptomatic treatment was started. After an initial recovery, kidney dysfunction, hemolysis, and thrombocytopenia progressed. Corticoid boluses were ineffective and hemodialysis was initiated. Eleven Pph treatments were necessary to recover hematologic data. The patient remained on hemodialysis for 2 months and evolved to stage IV chronic kidney disease. 8 months after hospital release, sCr was 3.5 mg/dL. ECU successfully improved kidney function in a patient with GEM-HUS, while conventional treatment did not.
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