Chemotherapy-related hemolytic-uremic syndrome following treatment of a carcinoma of the nasopharynx.
OBJECTIVE
A cisplatin-containing regimen followed by radiation therapy is the recommended treatment for patients with advanced nasopharyngeal carcinoma. We report a case of a 58-year-old woman with hemolytic-uremic syndrome (HUS) who received induction chemotherapy for undifferentiated squamous cell carcinoma of the nasopharynx.


METHODS
During the 2nd course of chemotherapy (consisting of bleomycin, cisplatin and epirubicin), the patient developed hemolytic anemia, thrombocytopenia, and acute renal failure. After HUS had been diagnosed, the patient was transferred to the intensive care unit.


RESULTS
Twice daily therapeutic plasma exchange (TPE) with fresh-frozen plasma, hemodialysis and high-dose cortisone was performed. Two weeks after the start of plasma exchange, thrombocytes and renal function began to normalize. Low-dose cortisone was continued until the patient recovered from hemolytic anemia. Six weeks after the administration of the second course of chemotherapy, the patient had fully recovered from HUS, and radiation therapy was carried out as planned. The patient responded well to treatment, but died 9 months after the diagnosis due to liver metastases.


CONCLUSIONS
We demonstrated that early TPE with fresh-frozen plasma and high-dose cortisone is a potentially successful treatment modality for the usually fatal, fulminant form of chemotherapy-induced HUS.
Thurnher
D
D
Department of Otorhinolaryngology, Head and Neck Surgery, University of Vienna Medical School, Vienna, Austria. dietmar.thurnher@univie.ac.at
Kletzmayr
J
J
Formanek
M
M
Quint
C
C
Czerny
C
C
Burian
M
M
Kornek
G
G
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003348:Cortisone / Q000627:therapeutic use; D015251:Epirubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D010949:Plasma; D010951:Plasma Exchange; D006435:Renal Dialysis
D001761:Bleomycin; D015251:Epirubicin; D002945:Cisplatin; D003348:Cortisone