Literature case analysis of gemcitabine-induced heomlytic-uremic syndrome
10.3760/cma.j.cn114015-20200402-00345
- VernacularTitle:吉西他滨致溶血尿毒综合征文献病例分析
- Author:
Xuejia QIU
1
;
Gexi CAO
1
;
Baojing DUAN
1
;
Zhanjun DONG
1
Author Information
1. 河北省人民医院药学部，石家庄 050051
- Publication Type:Journal Article
- Keywords:
Antineoplastic agents;
Hemolytic-uremic syndrome;
Gemcitabine
- From:
Adverse Drug Reactions Journal
2020;22(7):393-397
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical and pathological characteristics of heomlytic-uremic syndrome (HUS) induced by gemcitabine.Methods:The relevant databases abroad were searched up to November 12, 2018. Case reports and clinical research papers about HUS induced by gemcitabine were collected. The patient′s general situation, use of gemcitabine, symptoms of HUS, relevant laboratory test results, renal biopsy results, time from medication to HUS onset, and the treatments and outcomes of HUS were recorded. The clinical and pathological characteristics of HUS induced by gemcitabine were analyzed by descriptive statistical method.Results:A total of 61 patients were enrolled in the study, including 22 males and 35 females with 4 unknown gender. The age of patients ranged from 25 to 81 years. The primary diseases included pancreatic cancer in 22 cases, lung cancer in 18 cases, cholangiocarcinoma in 7 cases, mammary cancer in 5 cases, ovarian cancer in 4 cases, non-Hodgkin′s lymphoma in 2 cases, soft tissue sarcoma in 1 case, bladder cancer in 1 case, and kidney cancer in 1 case. HUS occurred in 2-34 months after the first application of gemcitabine, and the median time was 6 months. The cumulative dose of gemcitabine was 4 000-99 540 mg/m 2 when HUS occurred, and the median cumulative dose was 19 100 mg/m 2. Of the 61 patients, 54 patients developed HUS symptoms, including hypertension (43 cases, 79.6%), peripheral edema (31 cases, 57.4%), and dyspnea (20 cases, 37.0%), and 7 patients were asymptomatic. There were different degrees of increase in serum creatinine and lactate dehydrogenase and decrease in platelet and hemoglobin in 61 patients. Fifteen patients performed renal biopsy and the thrombotic microangiopathy were found in all cases. Gemcitabine were stopped after the occurrence of HUS in all patients, and therapies such as symptomatic treatments, plasmapheresis, hemodialysis, symptomatic treatments+plasmapheresis, symptomatic treatments+glucocorticoid, or rituximab or ikuzumab treatment on the basis of above-mentioned therapy were given. Of the 61 patients, HUS was improved in 34 (55.7%) cases, but 27 patients (44.3%) died within 1-65 months after the occurrence of HUS, of which 13 cases (21.3%) died of HUS. Conclusions:The main clinical manifestations of HUS caused by gemcitabine are hypertension, peripheral edema, and dyspnea. A few patients may be asymptomatic, but all develop abnormal laboratory indicators related to toxuria and hemolysis. The main pathological changes in the kidney are thrombotic microangiopathy. The prognosis of HUS is poor. Severe cases can lead to death.
