Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre

被引:27
作者
Grall, Maximilien [1 ,2 ]
Daviet, Florence [2 ,3 ]
Chiche, Noemie Jourde [2 ,3 ]
Provot, Francois [2 ,4 ]
Presne, Claire [2 ,5 ]
Coindre, Jean-Philippe [2 ,6 ]
Pouteil-Noble, Claire [2 ,7 ]
Karras, Alexandre [8 ]
Guerrot, Dominique [9 ]
Francois, Arnaud [10 ]
Benhamou, Ygal [2 ,11 ]
Veyradier, Agnes [2 ,12 ]
Fremeaux-Bacchi, Veronique [2 ,13 ]
Coppo, Paul [2 ,14 ]
Grange, Steven [1 ,2 ]
机构
[1] Rouen Univ Hosp, Med Intens Care Unit, 37 Blvd Gambetta, F-76031 Rouen, France
[2] Sorbonne Univ, Hop St Antoine, AP HP, French TMA Reference Ctr, Paris, France
[3] Concept Univ Hosp, AP HM, Dept Nephrol, Marseille, France
[4] Lille Univ Hosp, Dept Nephrol, Lille, France
[5] Amiens Univ Hosp, Dept Nephrol, Amiens, France
[6] Le Mans Gen Hosp, Dept Nephrol, Le Mans, France
[7] Lyon I Univ, Dept Nephrol, E Herriot Hosp, Lyon, France
[8] Georges Pompidou Hosp, AP HP, Dept Nephrol, Paris, France
[9] Rouen Univ Hosp, Dept Nephrol, Rouen, France
[10] Rouen Univ Hosp, Dept Pathol, Rouen, France
[11] Rouen Univ Hosp, Dept Internal Med, Rouen, France
[12] Lariboisiere Univ Hosp, AP HP, Dept Biol Hematol, Paris, France
[13] Georges Pompidou Hosp, AP HP, Dept Immunol, Paris, France
[14] Sorbonne Univ, Hop St Antoine, AP HP, Dept Hematol, Paris, France
关键词
Coagulation; thrombotic disorders and therapies; Cancer and thrombosis; Eculizumab; Gemcitabine-induced thrombotic microangiopathy; HEMOLYTIC-UREMIC SYNDROME; EFFICACY; THERAPY;
D O I
10.1186/s12882-021-02470-3
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA). Methods This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016. Results Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4-44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2-22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0-10) before treatment vs 0 (range 0-1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m(2) respectively in the eculizumab group and in the control group. Conclusions These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery.
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页数:8
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