Microangiopathie thrombotique et cancer

El-Fekih, Rania Kheder; Deltombe, Clément; Izzedine, Hassan

doi:10.1016/j.nephro.2017.01.023

Cited by 11 publications

(5 citation statements)

References 96 publications

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“…We described here a rare case of TMA under Gemcitabine (G-TMA) treatment in a long survival case of cholangiocarcinoma. In TMA following the curse of neoplasia it is helpful to differentiate 1/ paraneoplastic TMA and 2/ drugs induced TMA (15% of Acute Kidney Injury in cancer) (2). Iatrogenic TMA includes TMA under anti-vascular epithelial growth factor (VEGF) and TMA post-chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Thrombotic microangiopathy after long lasting treatment by Gemcitabine: description, evolution and treatment of a rare case report

Bertin

Gauthier

Boullenger

et al. 2023

Preprint

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Background : Thrombotic microangiopathy is an uncommon but severe complication that may occur in cancer patients under Gemcitabine chemotherapy. Gemcitabine induced thrombotic microangiopathy can clinically and biologically present as atypical hemolytic uremic syndrome, with activation of the complement pathway asking the question of the use of Eculizumab. Case presentation : We describe here the case of a patient suffering from metastatic cholangiocarcinoma treated by Gemcitabine for 4 years leading to remission of the underlying neoplasia. Despite an impressive response to therapy, she developed thrombopenia, regenerative anemia and acute kidney injury leading to the suspicion then diagnosis based on renal biopsy of a very late Gemcitabine associated thrombotic microangiopathy. Spontaneous evolution after treatment interruption was favorable without dialysis requirement. However, in this case where Gemcitabine is the only chemotherapy remaining for a mortal underlying condition, we discussed re-initiation of Gemcitabine under Eculizumab treatment. Conclusions : This atypical case of thrombotic microangiopathy illustrates the importance of recognizing, even belatedly, this rare but serious complication of chemotherapy. It asks the question of resumption of discontinued chemotherapy notably under Eculizumab cover, in this population with high risk of cancer progression.

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Section: Discussionmentioning

confidence: 99%

“…Gemcitabine is one of the usual agents implicated in secondary TMA with frequent severe renal involvement and poor prognosis (2). The management of Gemcitabine TMA is not codi ed.…”

Section: Introductionmentioning

confidence: 99%

Thrombotic microangiopathy after long lasting treatment by Gemcitabine: description, evolution and treatment of a rare case report

Bertin

Gauthier

Boullenger

et al. 2023

Preprint

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“…TMA is responsible for 15% of acute kidney failure cases in oncological settings, since the glomerular microvasculature is susceptible to injury from TMA. Anticancer-related TMA can be classified into two types: type I occurs secondary to chemotherapy (mitomycin C, gemcitabine) and is characterized by dose-dependent renal injury, while iatrogenic type II occurs secondary to anti-angiogenic agents and results in dose-independent renal involvement, with renal functional recovery typical after drug discontinuation [77, 78]. Recent research suggests that endothelial cell damage caused by the disrupted immunologic responses induced by immunosuppressive agents underlays.…”

Section: Main Textmentioning

confidence: 99%

“…Recent research suggests that endothelial cell damage caused by the disrupted immunologic responses induced by immunosuppressive agents underlays. If the TMA has a refractory or relapsing clinical course and does not respond to plasmapheresis and steroids, immunosuppressive agents are the treatment of choice [77]. Drug-induced TMA…”

Section: Main Textmentioning

confidence: 99%

Sepsis-associated disseminated intravascular coagulation and its differential diagnoses

et al. 2019

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Disseminated intravascular coagulation (DIC) is a common complication in sepsis. Since DIC not only promotes organ dysfunction but also is a strong prognostic factor, its diagnosis at the earliest possible timing is important. Thrombocytopenia is often present in patients with DIC but can also occur in a number of other critical conditions. Of note, many of the rare thrombocytopenic diseases require prompt diagnoses and specific treatments. To differentiate these diseases correctly, the phenotypic expressions must be considered and the different disease pathophysiologies must be understood. There are three major players in the background characteristics of thrombocytopenia: platelets, the coagulation system, and vascular endothelial cells. For example, the activation of coagulation is at the core of the pathogenesis of sepsis-associated DIC, while platelet aggregation is the essential mechanism in thrombotic thrombocytopenic purpura and endothelial damage is the hallmark of hemolytic uremic syndrome. Though each of the three players is important in all thrombocytopenic diseases, one of the three dominant players typically establishes the individual features of each disease. In this review, we introduce the pathogeneses, symptoms, diagnostic measures, and recent therapeutic advances for the major diseases that should be immediately differentiated from DIC in sepsis.

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“…Potentially fatal complication affecting mostly the kidneys and the brain microvascular changes occur with cisplatin, bleomycin and gemcitabine. Cisplatin induced endothelial vascular damage leads to coronary artery disease, but if this is dose dependent is not known [116, 117]. Vinca alkaloids and mitomycin C are associated with disseminated intravascular coagulation [118, 119].…”

Section: Hematological Malignancies and Atementioning

confidence: 99%

Hematological Malignancies and Arterial Thromboembolism

Visweshwar

Jaglal

Sokol

et al. 2019

Indian J Hematol Blood Transfus

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Established guidelines exist for prevention and treatment of venous thromboembolism in hematological malignancies, but none for arterial thromboembolism. However, arterial and venous thromboembolism share the same provoking features—including altered procoagulant factors and defective fibrinolytic system. The morbidity for arterial thromboembolism is increasing in hematological malignancies, with the advent of immunomodulatory and targeted therapy. However, survival rate for hematological malignancy is improving. Consequently, as patients with hematological malignancies live longer, comorbidities including diabetes, hypertension and dyslipidemia, may accentuate arterial thrombosis. Thus far, the scientific literature on prophylaxis and treatment for arterial thromboembolism in hematological malignancies is limited. This review highlights the pathogenesis, incidence and clinical features of arterial thromboembolism in hematological malignancies.

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Microangiopathie thrombotique et cancer

Cited by 11 publications

References 96 publications

Thrombotic microangiopathy after long lasting treatment by Gemcitabine: description, evolution and treatment of a rare case report

Thrombotic microangiopathy after long lasting treatment by Gemcitabine: description, evolution and treatment of a rare case report

Sepsis-associated disseminated intravascular coagulation and its differential diagnoses

Hematological Malignancies and Arterial Thromboembolism

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