Abstract: SA-PO259
Eculizumab in the Setting of Gemcitabine Induced Thrombotic Microangiopathy
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Klein, Adam, Methodist Health Systems of Dallas, Dallas, Texas, United States
- Chowdhury, Renuka, Methodist Health Systems of Dallas, Dallas, Texas, United States
Introduction
Thrombotic Microangiopathy (TMA) is a rarely encountered side effect in gemcitabine use. Previous studies have suggested that eculizumab might be an effective treatment in gemcitabine induced TMA. We present a case of gemcitabine induced TMA in a patient who did not improve with supportive care and withdrawal of the offending agent, who was successfully treated with eculizumab.
Case Description
A 68-year-old female with history of hypertension and metastatic breast cancer, previously treated with carboplatin and gemcitabine presented with anemia and fever. The patient was noted to have hemoglobin 4.6g/dL, reticulocyte percentage 4.79, elevated total bilirubin 2.5 mg/dL, evidence of hemolysis (haptoglobin < 20 mg/dL, elevated LDH 2810.0 U/L, and schistocytes on the peripheral smear), and thrombocytopenia (platelet count 83 x 103/uL). The patient had initiated treatment with gemcitabine two days before presenting to the Emergency Department. The patient’s creatinine on admission was 2.7 mg/dL, previously 0.80 mg/dL. Despite discontinuation of gemcitabine and institution of supportive care, the patient’s creatinine continued to rise throughout her hospitalization and she became anuric requiring dialysis. Needle core kidney biopsy demonstrated thrombotic microangiopathy. The patient underwent treatment with eculizumab and had recovery of her kidney function with improvement in her creatinine and urine output.
Discussion
Treatment with eculizumab in gemcitabine induced TMA has shown good results in previous case studies as well as an observational, retrospective, multicentric study previously performed in four French centers. In this report, the use of eculizumab supports the benefit of C5 inhibition for the treatment of gemcitabine induced TMA refractory to supportive care.