[Gemcitabine-induced thrombotic microangiopathy].
BACKGROUND
Thrombotic microangiopathy (TMA) regroups the hemolytic and uremic syndrome (HUS) and thrombocytopenic thrombotic purpura (TTP). The TMA associated with cancer can be secondary to cancer, hence similar to TTP, or to chemotherapy, creating an HUS. Gemcitabine, used in the treatment of pulmonary, pancreatic and urothelial carcinomas, is generally well tolerated, but has recently been implied in the occurrence of TMA.


METHODS
In a patient treated for a metastatic urothelial carcinoma, HUS developed after 8 cues of gemcitabine used alone. After symptomatic treatment and withdrawal of gemcitabine, the hematological abnormalities disappeared and renal function returned to preceding values.


CONCLUSIONS
The incidence of TMA is of around 5 to 6% of metastatic carcinomas. Gemcitabine-induced TMA are of recent occurrence and some twelve cases have been reported. Their occurrence is delayed with regard to the initiation of gemcitabine. They lead to HUS with good prognosis since, on withdrawal of gemcitabine the renal abnormalities regress. Search for TMA should therefore be proposed after more than 10 cycles of treatment with gemcitabine.
Teixeira
L
L
Département de clinique médicale, service de médecine interne, Hôpital d'Instruction des Armées Desgenettes, 108, bd Pinel, 69003 Lyon.
Debourdeau
P
P
Zammit
C
C
Estival
J L
JL
Pavic
M
M
Colle
B
B
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D003841:Deoxycytidine / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D013927:Thrombosis / Q000139:chemically induced*; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014652:Vascular Diseases / Q000139:chemically induced*; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine