Erythropoietin Is Beneficial in Mitomycin-Induced Hemolytic-Uremic Syndrome

Abstract

Mitomycin C is a powerful antineoplastic agent. If used at high dosage, it may cause a secondary form of adult hemolytic-uremic syndrome (HUS). Blood transfusions worsen the evolution of this peculiar form of HUS. We describe a patient who developed HUS after treatment with mitomycin C (total dose 144 mg/m²) due to a carcinoma of the ascending colon. Repeated blood transfusions were associated with rapidly evolving renal failure coupled with anemia and thrombocytopenia. Haptoglobin was undetectable. Soon after starting subcutaneous erythropoietin, the velocity of progression of renal failure slowed whilst no more blood transfusions were required and haptoglobin levels returned to normal. Thereafter, the patient’s renal function slowly worsened and she started chronic hemodialysis 5 years later. Up to now, all investigations have failed to show a relapse of her adenocarcinoma. A possible explanation of these data is that erythropoietin permitted the termination of blood transfusions which both triggered and perpetuated the syndrome. However, we cannot exclude a primitive effect of erythropoietin on the endothelium or on the platelets.

Combination chemotherapy in advanced gastrointestinal cancers: ex vivo sensitivity to gemcitabine and mitomycin C

“…We believe that the effect of previous treatment may be a major factor in this unexpected difference between these two tumour types. Mitomycin C has been used in the treatment of gastrointestinal malignancies for over 30 years, and has been shown to be relatively safe and effective (Chester et al, 2000), although very rarely patients may develop the haemolytic -uraemic syndrome, usually at very high doses (Catalano et al, 2002;Gundappa et al, 2002). Pulmonary and renal toxicities are also a problem in some patients, again usually at high cumulative doses.…”