Skip to main content

Hemolytic uremic syndrome following prolonged gemcitabine therapy: report of four cases from a single institution

Annals of Hematology volume 84, pages 110–114 (2005)Cite this article

Abstract

Hemolytic uremic syndrome (HUS) has been described following the administration of multiple antineoplastic agents, most notably mitomycin C. More recently, several cases of gemcitabine-induced HUS have been observed with the overall incidence of gemcitabine-induced HUS estimated at 0.015–0.25%. We here report on four patients who developed HUS following gemcitabine therapy at our institution within the last year (incidence 1.4%). All these patients had advanced-stage disease, were heavily pretreated, and received prolonged gemcitabine application, suggesting that in this subgroup of patients HUS may be more frequently encountered than documented so far.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Allford SL, Hunt BJ, Rose P, Machin SJ (2003) Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. Br J Haematol 120:556–573

    Article  PubMed  Google Scholar 

  2. Bell WR, Braine HG, Ness PM, Kickler TS (1991) Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med 325:398–403

    CAS  PubMed  Google Scholar 

  3. Borghardt EJ, Kirchertz EJ, Marten I, Fenchel K (1998) Protein A-immunoadsorption in chemotherapy associated hemolytic-uremic syndrome. Transfus Sci 19 [Suppl]:5–7

    Article  PubMed  Google Scholar 

  4. Brodowicz T, Breiteneder S, Wiltschke C, Zielinski CC (1997) Gemcitabine-induced hemolytic uremic syndrome: a case report. J Natl Cancer Inst 89:1895–1896

    Article  CAS  PubMed  Google Scholar 

  5. Fung MC, Storniolo AM, Nguyen B, Arning M, Brookfield W, Vigil J (1999) A review of hemolytic uremic syndrome in patients treated with gemcitabine therapy. Cancer 85:2023–2032

    CAS  PubMed  Google Scholar 

  6. Gasser C, Gautier E, Steck A, Siebenmann RE, Oechslin R (1955) Hemolytic-uremic syndrome: bilateral kidney cortex necrosis in acute acquired hemolytic anemia, Schweiz Med Wochenschr 85:905–909

    CAS  PubMed  Google Scholar 

  7. Gordon LI, Kwaan HC (1997) Cancer- and drug-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Semin Hematol 34:140–147

    CAS  PubMed  Google Scholar 

  8. Guchelaar HJ, Richel DJ, van Knapen A (1996) Clinical, toxicological and pharmacological aspects of gemcitabine. Cancer Treat Rev 22:15–31

    Article  CAS  PubMed  Google Scholar 

  9. Hui YF, Reitz J (1997) Gemcitabine: a cytidine analogue active against solid tumors. Am J Health Syst Pharm 54:162–170 (quiz 197-198)

    CAS  PubMed  Google Scholar 

  10. Lesesne JB, Rothschild N, Erickson B, Korec S, Sisk R, Keller J, Arbus M, Woolley PV, Chiazze L, Schein PS et al (1989) Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry. J Clin Oncol 7:781–789

    CAS  PubMed  Google Scholar 

  11. Melnyk AM, Solez K, Kjellstrand CM (1995) Adult hemolytic-uremic syndrome. A review of 37 cases. Arch Intern Med 155:2077–2084

    Article  CAS  PubMed  Google Scholar 

  12. Meyrier A, Becquemont L, Weill B, Callard P, Rainfray M (1991) Hemolytic-uremic syndrome with anticardiolipin antibodies revealing paraneoplastic systemic scleroderma. Nephron 59:493–496

    CAS  PubMed  Google Scholar 

  13. Palmisano J, Agraharkar M, Kaplan AA (1998) Successful treatment of cisplatin-induced hemolytic uremic syndrome with therapeutic plasma exchange. Am J Kidney Dis 32:314–317

    CAS  PubMed  Google Scholar 

  14. Remuzzi G, Ruggenenti P (1995) The hemolytic uremic syndrome. Kidney Int 48:2–19

    CAS  PubMed  Google Scholar 

  15. Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, Spasoff RA (1991) Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med 325:393–397

    CAS  PubMed  Google Scholar 

  16. Schiebe ME, Hoffmann W, Belka C, Bamberg M (1998) Mitomycin C-related hemolytic uremic syndrome in cancer patients. Anticancer Drugs 9:433–435

    CAS  PubMed  Google Scholar 

  17. Schieppati A, Ruggenenti P, Cornejo RP, Ferrario F, Gregorini G, Zucchelli P, Rossi E, Remuzzi G (1992) Renal function at hospital admission as a prognostic factor in adult hemolytic uremic syndrome. The Italian Registry of Haemolytic Uremic Syndrome. J Am Soc Nephrol 2:1640–1644

    CAS  PubMed  Google Scholar 

  18. Segonds A, Louradour N, Suc JM, Orfila C (1979) Postpartum hemolytic uremic syndrome: a study of three cases with a review of the literature. Clin Nephrol 12:229–242

    CAS  PubMed  Google Scholar 

  19. Serke S, Riess H, Oettle H, Huhn D (1999) Elevated reticulocyte count—a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report. Br J Cancer 79:1519–1521

    Article  CAS  PubMed  Google Scholar 

  20. Siegler RL (1995) The hemolytic uremic syndrome. Pediatr Clin North Am 42:1505–1529

    CAS  PubMed  Google Scholar 

  21. Snyder HW, Jr., Mittelman A, Oral A, Messerschmidt GL, Henry DH, Korec S, Bertram JH, Guthrie TH, Jr., Ciavarella D, Wuest D et al (1993) Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer 71:1882–1892

    PubMed  Google Scholar 

  22. Verwey J, Boven E, van der Meulen J, Pinedo HM (1984) Recovery from mitomycin C-induced hemolytic uremic syndrome. A case report. Cancer 54:2878–2881

    CAS  PubMed  Google Scholar 

  23. von Baeyer H (2002) Plasmapheresis in thrombotic microangiopathy-associated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher 6:320–328

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors want to thank C. Wartchow for the help in preparation of the manuscript.

Author information

Affiliations

  1. Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany

    S. Müller, P. Schütt, P. Bojko, M. R. Nowrousian, J. Hense, S. Seeber & T. Moritz

Authors
  1. S. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Schütt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Bojko
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. R. Nowrousian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Hense
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Seeber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Moritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Moritz.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Müller, S., Schütt, P., Bojko, P. et al. Hemolytic uremic syndrome following prolonged gemcitabine therapy: report of four cases from a single institution. Ann Hematol 84, 110–114 (2005). https://doi.org/10.1007/s00277-004-0938-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-004-0938-8

Keywords

  • Hemolytic uremic syndrome
  • Hemolysis
  • Gemcitabine
  • Thrombocytopenia
  • Renal failure
  • Microangiopathic thrombotic disease