Gemcitabine-related thrombotic microangiopathy: a single-centre retrospective series

Abstract

Introduction:

Thrombotic microangiopathy (TMA) has been reported as a complication of chemotherapy. Many antineoplastic agents have been linked to TMA, gemcitabine being one of the most frequently cited as related to this syndrome.

Methods:

A retrospective search for chemotherapy-induced TMA cases among gemcitabine users in a single oncology centre from January 2009 to September 2012 was performed.

Results:

Three cases of gemcitabine-induced TMA were reported, from a total of 264 patients (incidence: 1·13%) who received the drug. From the three cases reported, two (66%) patients died as a consequence of the syndrome.

Discussion:

These findings are compatible with previous analyses, which report an incidence of gemcitabine-associated TMA ranging from 0·008 to 2·2% and mortality rates from 15 to 90%. Unlike previously reported, however, cumulative dose was not predictive of risk.

Conclusion:

Gemcitabine-induced TMA is an underdiagnosed condition characterized by high mortality rates. Attention should be called for a higher level of awareness to provide early diagnosis and proper treatment.

Keywords:

• Chemotherapy
• Drug toxicity
• Gemcitabine
• Thrombotic thrombocytopenic purpura
• Thrombotic microangiopathies

Acknowledgements

We would like to thank the pharmacist, Lara Paro Dias, for her kind support in providing electronic files of the chemotherapy registration lists.

We would also like to thank Debora Salerno for her kind support in grammar and style.