Treatment of Gemcitabine-Induced Thrombotic Microangiopathy Followed by Gemcitabine Rechallenge With Eculizumab

摘要

Clinical course of patient treated with eculizumab (Ecu). Shown is the trend of the lactate dehydrogenase (LDH) (a), serum creatinine (b), and platelet count (c) throughout exposure to gemcitabine (Gem) (pink capped line), followed by treatment with eculizumab (blue arrows), and finally during gemcitabine rechallenge with concomitant eculizumab. Day 0 represents initiation of gemcitabine after cancer diagnosis. A rapid decline in LDH is noted after initiating eculizumab (a). The serum creatinine decreased to a nadir 1.3 mg/dl after eculizumab. The serum creatinine increased to 1.9 mg/dl during gemcitabine rechallenge. It rapidly improved with volume expansion and was attributed to pre-renal azotemia (b). The platelet count improved after eculizumab. There was a transient decrease in platelet count after the first gemcitabine rechallenge dose accompanied by leukopenia and worsening anemia that was attributed to myelosuppression from gemcitabine. The cell count levels improved after the subsequent gemcitabine doses were reduced (c).