Systemic Capillary Leak Syndrome Resulting from Gemcitabine Treatment in Renal Cell Carcinoma: A Case Report

Pulkkanen, Kalevi; Kataja, Vesa; Johansson, Rebecka

doi:10.1179/joc.2003.15.3.287

Cited by 29 publications

(14 citation statements)

References 19 publications

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“…However, the severity of such a complication, and the hypothesis that cases of peripheral oedema previously related to gemcitabine toxicity might be due to mild forms of capillary leak syndrome, make a case for careful checking of such toxicity in patients receiving gemcitabine 11 . The treatment of this latter complication relies on diuretics and high‐dose corticosteroids 19,21–23 . Gemcitabine cutaneous toxicity has been scarcely reported in the literature.…”

Section: Discussionmentioning

confidence: 79%

“…In other neoplastic diseases, haemolytic–uraemic syndrome was previously observed with gemcitabine usually arising after long‐term treatment, and showing reversibility after treatment cessation 14–17 . On the other hand, few studies reported capillary leak syndrome associated with gemcitabine, and up to now it has never been reported in patients with CTCL 18–22 . However, the severity of such a complication, and the hypothesis that cases of peripheral oedema previously related to gemcitabine toxicity might be due to mild forms of capillary leak syndrome, make a case for careful checking of such toxicity in patients receiving gemcitabine 11 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases

Jidar

Ingen‐Housz‐Oro

Beylot‐Barry

et al. 2009

British Journal of Dermatology

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases

Jidar

Ingen‐Housz‐Oro

Beylot‐Barry

et al. 2009

British Journal of Dermatology

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“…This acute toxicity was not observed in the control group, in the group G8 and in the remaining animals of the group G12 subsequently treated with 8 mg?kg -1 . Thus, an acute toxicity of aerosolised gemcitabine was suspected in these three animals and compared with that described in isolated cases in the literature after systemic infusion of gemcitabine [14,15]. However, the current study was not designed to compare the pulmonary safety profile of gemcitabine via aerosol and via systemic administration.…”

Section: Tumour Growthmentioning

confidence: 99%

Aerosol delivery of chemotherapy in an orthotopic model of lung cancer

Gagnadoux

Pape²,

Lemarié³

et al. 2005

European Respiratory Journal

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The aim of this study was to evaluate the effect on tumour growth of gemcitabine delivered by aerosol in an orthotopic model of lung carcinoma.Large cell carcinoma (NCI-H460) cells were implanted intrabronchially in 24 male BALB/c nude mice on day (d) 0. Aerosols were delivered once a week from d1 to d29 using an endotracheal sprayer. Altogether, 16 animals received gemcitabine at 8 (n58) and 12 mg?kg -1 (n58), and eight received a vehicle aerosol. Animals were sacrificed on d36 for histological examination. All animals in the vehicle group developed a large infiltrating carcinoma. Comparatively, four of 13 (31%) animals treated with gemcitabine had no visible tumour and nine of 13 (69%) had a smaller carcinoma with a mean¡SEM largest tumour diameter of 2.05¡0.7 versus 5¡0.3 mm in the vehicle group. Gemcitabine was well tolerated at 8 mg?kg -1 . At 12 mg?kg -1 , three cases of fatal pulmonary oedema were observed, prompting a dose reduction to 8 mg?kg -1 in the remaining animals. A dose effect was observed, with more marked tumour growth inhibition in the animals treated at 12 mg?kg -1 on d1 and d8.In conclusion, in this study, an animal model of aerosolised chemotherapy in lung cancer was developed and demonstrated inhibition of orthotopic tumour growth by aerosol delivery of gemcitabine.

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“…The pathophysiology of the damage is not known. A predictor, although a little sensitive, of capillary leak syndrome is the decrease of albumin [11]. This syndrome was described after snake bites [12] in patients with sepsis [13,14] and in patients treated with interleukin-2 [15] and taxotere [16].…”

Section: Discussionmentioning

confidence: 99%

Separate episodes of capillary leak syndrome and pulmonary hypertension after adjuvant gemcitabine and three years later after nab-paclitaxel for metastatic disease

et al. 2013

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BackgroundSystemic capillary leak syndrome is a rare disease with a high mortality rate. This syndrome is characterised by generalised edema, hypotension, hemoconcentration, and hypoproteinemia. The cause is the sudden onset of capillary hyperpermeability with extravasations of plasma from the intravascular to the extravascular compartment. We present the case of a patient who experienced two episodes of systemic capillary leak syndrome and pulmonary hypertension; the first after gemcitabine in an adjuvant setting and the second three years later after treatment with nab-paclitaxel for metastatic disease.Case presentationA 65-year-old patient underwent a pancreatectomy in January 2010 for ductal carcinoma (pT3 N0 M0, stage IIa), followed by adjuvant chemotherapy. Seven days after the last cycle, she developed dyspnea associated with orthopnea and cough. A transthoracic cardiac ecocolordoppler was performed, with evidence of pulmonary hypertension (58 mmHg). Blood tests showed an increase in creatinine, pro-BNP and D-Dimer. She began high-dose diuretic therapy combined with cortisone. After a month, the patient was eupneic and the anasarca had resolved. We decided gradually to reduce the steroid and diuretic therapy. After ten days of the reduction, the patient began to re-present the same symptoms after treatment with gemcitabine. Corticosteroid therapy was restored with rapid clinical benefit and decreased pro-BNP after a week of treatment. After two years, the disease returned. As a first line treatment, it was decided to use nab-paclitaxel 100 mg/m2 weekly. After two doses, followed by approximately 14 days of treatment, the patient developed acute respiratory distress syndrome. The clinical suspicion was a relapse of capillary leak syndrome and treatment with a high-dose diuretic (furosemide 250 mg daily) was started combined with cortisone (40 mg methylprednisolone). The patient showed a progressive clinical benefit.ConclusionsIn patients treated with gemcitabine and nab-paclitaxel who experience a sudden onset of diffuse edema with respiratory distress, capillary leak syndrome should be suspected. Immediate treatment with corticosteroids may be life-saving.

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Systemic Capillary Leak Syndrome Resulting from Gemcitabine Treatment in Renal Cell Carcinoma: A Case Report

Cited by 29 publications

References 19 publications

Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases

Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases

Aerosol delivery of chemotherapy in an orthotopic model of lung cancer

Separate episodes of capillary leak syndrome and pulmonary hypertension after adjuvant gemcitabine and three years later after nab-paclitaxel for metastatic disease

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