CARCINOMA-ASSOCIATED HEMOLYTIC-UREMIC SYNDROME - A COMPLICATION OF MITOMYCIN-C CHEMOTHERAPY
CARCINOMA-ASSOCIATED HEMOLYTIC-UREMIC SYNDROME - A COMPLICATION OF MITOMYCIN-C CHEMOTHERAPY
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DOI：
10.1200/jco.1985.3.5.723
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发表时间：
1985-01-01
影响因子：
45.3
通讯作者：
SCHEIN, PS
中科院分区：
文献类型：
--
作者：
CANTRELL, JE;PHILLIPS, TM;SCHEIN, PS
在12例腺癌患者中，经含丝裂霉素c的药物治疗后，肿瘤完全或接近完全缓解，诊断出类似溶血性尿毒症综合征的血栓性微血管病变。微血管病溶血性贫血、血小板减少症和肾功能衰竭最初都出现在所有病例中。所有患者最终均出现肺水肿和全身性动脉高血压，3例出现神经系统并发症。输血加重了9例患者的综合征。高滴度的血小板聚集血浆免疫复合物在所有6例中被测量。每个复合物的组成抗体不能与丝裂霉素C抗原制剂反应，而体外对内胚层源性肿瘤的反应性被证实。血浆置换术仅与1例患者的综合征改善相关。在接受丝裂霉素C化疗的患者中，贫血和血小板减少或氮质血症的发展可能代表这种新定义的血栓性微血管病变的初始表现。目前还没有确定一种一贯有效的治疗这种综合征的方法。
A thrombotic microangiopathy resembling the hemolytic uremic syndrome was diagnosed in 12 patients with adenocarcinoma, in whom the tumor was in complete or near-complete remission after treatment with mitomycin C-containing drug regimens. Microangiopathic hemolytic anemia, thrombocytopenia, and renal failure were initially present in all cases. All patients eventually developed pulmonary edema and systemic arterial hypertension and 3 experienced neurologic complications. Blood transfusions exacerbated the syndrome in 9 patients. High titers of platelet-aggregating plasma immume complexes were present in all 6 cases in which they were measured. The constituent antibody of each complex failed to react with mitomycin C antigen preparations, whereas in vitro reactivity to endodermally derived neoplasms was demonstrated. Plasmapheresis was associated with amelioration of the syndrome in only 1 patient. In patients receiving mitomycin C chemotherapy, the development of anemia and thrombocytopenia or azotemia may represent the initial manifestations of this newly defined thrombotic microangiopathy. A consistently effective form of management of this syndrome has not as yet been defined.