Cancer-Related Thrombotic Microangiopathy

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M. Cloos-v.Balen, L.Th. Vlasveld, T. Netelenbos, A.J. Gelderblom

Woensdag 20 april 2016

15:40 - 15:50u in Zaal 0.4

Categorieën: Parallelsessie

Parallel sessie: Parallelsessie 3: Case reports/research

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We present two cases (47 year old female with metastatic breast cancer and 68 year old male with metastatic prostate cancer) of cancer-related thrombotic microangiopathy (CR-TMA, a condition known for its bad prognosis).

Both presented with: anemia and thrombocytopenia, decline of kidney function, coombs negative hemolysis, schistocytes, low fibrinogen and high d-dimer. The ADAMTS13 and complement levels were normal (these results came after starting treatment). Under suspicion of TMA secondary to cancer progression or TTP they were both treated by plasmapheresis with fresh frozen plasma and chemotherapy. One was also temporarily treated with hemodialysis. In the patient with breast cancer the anti-tumor therapy had no effect and she was discharged with terminal care and died shortly afterwards. The patient with prostate cancer however, showed improvement of kidney function, anemia and thrombocytopenia normalized and he was discharged without needing hemodialysis. His PSA declined due to further chemotherapy and he is still alive with disease almost one year later.

We presented two cases of life-threatening CR-TMA. Despite the bad prognosis in CR-TMA, the patient with prostate cancer improved after plasmapheresis, dialysis and chemotherapy. This observation was described before by Lechner et al. (Medicine 2012,Jul;91(4):195-205) who presented 168 cases of TMA and showed that plasmapheresis was only effective in prostate cancer related TMA and the reaction to chemotherapy was a prognostic factor in their retrospective series. Our two cases confirm the literature that all treatment options should be considered in prostate cancer patients presenting with CR-TMA, especially when anti-tumor treatment is still possible.