Gemcitabine
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Haemolytic uraemic syndrome: case report A 63-year-old man developed haemolytic uraemic syndrome during treatment with gemcitabine for pancreatic cancer. The man underwent a distal pancreatectomy and splenectomy in November 2006. Nineteen days after surgery he started chemotherapy with gemcitabine. Each course consisted of gemcitabine 1000 mg/m2 [route not stated] administered once a week for 3 consecutive weeks, then drug rest on the fourth week. Following completion of the 6 scheduled courses, there were no findings of recurrence but the patient wished to continue gemcitabine. From the beginning of 2008, at the time of the fifteenth course of gemcitabine, anaemia and an increased BP were noted. Iron was administered and following investigations gemcitabine was continued. After the sixteenth course, he presented with shortness of breath on exertion and oedema in the legs. Laboratory tests revealed a RBC count of 186 × 104/mm3, haemoglobin 5.2 g/dL and platelets 4.1 × 104/mm3 . Renal dysfunction was also noted. A bone marrow puncture was performed. Gemcitabine-induced haemolytic uraemic syndrome was diagnosed. Improvements in the man’s anaemia and thrombocytopenia were noted following plasma exchange. However, renal function gradually worsened and on day 24 of admission a renal biopsy was performed. Thrombotic microangiopathy was diagnosed and prednisolone was started. Anuria developed and he required haemodialysis. Renal function improved and dialysis was discontinued and prednisolone was tapered. However, in June 2008, renal function worsened and he again required haemodialysis. A second renal biopsy was performed and the histological findings indicated protraction of the haemolytic uraemic syndrome. The dosage of prednisolone was increased but renal function did not improve and he required chronic haemodialysis. His renal function stabilised. There was no recurrence of the pancreatic cancer 37 months after surgery. Wato M, et al. A case of hemolytic uremic syndrome after adjuvant chemotherapy with gemcitabine in a patient with pancreatic cancer. Nippon Shokakibyo Gakkai Zasshi 107: 1676-1685, Oct 2010 [Japanese; summarised from a translation] 803048221 Japan
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Reactions 22 Jan 2011 No. 1335
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