Carcinoma-associated hemolytic-uremic syndrome: a complication of mitomycin C chemotherapy

• Published in: Journal of clinical oncology Vol. 3; no. 5; p. 723
• Main Authors: Cantrell, Jr, J E, Phillips, T M, Schein, P S
• Format: Journal Article
• Language: English
• Published: United States 01.05.1985
• Subjects: Acute Kidney Injury - chemically induced; Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adult; Anemia, Hemolytic - chemically induced; Antibiotics, Antineoplastic - adverse effects; Antigen-Antibody Complex - analysis; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cardiovascular Diseases - chemically induced; Erythrocyte Transfusion; Female; Hemolytic-Uremic Syndrome - chemically induced; Hemolytic-Uremic Syndrome - mortality; Hemolytic-Uremic Syndrome - therapy; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Mitomycin; Mitomycins - adverse effects; Plasmapheresis; Pulmonary Edema - chemically induced; Thrombocytopenia - chemically induced; Transfusion Reaction
• ISSN: 0732-183X
• DOI: 10.1200/jco.1985.3.5.723

A thrombotic microangiopathy resembling the hemolytic uremic syndrome was diagnosed in 12 patients with adenocarcinoma, in whom the tumor was in complete or near-complete remission after treatment with mitomycin C-containing drug regimens. Microangiopathic hemolytic anemia, thrombocytopenia, and renal failure were initially present in all cases. All patients eventually developed pulmonary edema and systemic arterial hypertension, and three experienced neurologic complications. Blood transfusions exacerbated the syndrome in nine patients. High titers of platelet-aggregating plasma immune complexes were present in all six cases in which they were measured. The constituent antibody of each complex failed to react with mitomycin C antigen preparations, whereas in vitro reactivity to endodermally derived neoplasms was demonstrated. Plasmapheresis was associated with amelioration of the syndrome in only one patient. In patients receiving mitomycin C chemotherapy, the development of anemia and thrombocytopenia or azotemia may represent the initial manifestations of this newly defined thrombotic microangiopathy. A consistently effective form of management of this syndrome has not as yet been defined.