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Chemotherapy-Associated Thrombotic Microangiopathy

Thrombotic microangiopathy (TMA) is a syndrome of microangiopathic hemolytic anemia and thrombocytopenia with end-organ dysfunction. Although the advent of plasma exchange, immunosuppression, and complement inhibition has improved morbidity and mortality for primary TMAs, the management of secondary...

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Autores principales: Aklilu, Abinet M., Shirali, Anushree C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Nephrology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103319/
https://www.ncbi.nlm.nih.gov/pubmed/36706238
http://dx.doi.org/10.34067/KID.0000000000000061
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author Aklilu, Abinet M.
Shirali, Anushree C.
author_facet Aklilu, Abinet M.
Shirali, Anushree C.
author_sort Aklilu, Abinet M.
collection PubMed
description Thrombotic microangiopathy (TMA) is a syndrome of microangiopathic hemolytic anemia and thrombocytopenia with end-organ dysfunction. Although the advent of plasma exchange, immunosuppression, and complement inhibition has improved morbidity and mortality for primary TMAs, the management of secondary TMAs, particularly drug-induced TMA, remains less clear. TMA related to cancer drugs disrupts the antineoplastic treatment course, increasing the risk of cancer progression. Chemotherapeutic agents such as mitomycin-C, gemcitabine, and platinum-based drugs as well as targeted therapies such as antiangiogenesis agents and proteasome inhibitors have been implicated in oncotherapy-associated TMA. Among TMA subtypes, drug-induced TMA is less well-understood. Treatment generally involves withdrawal of the offending agent and supportive care targeting blood pressure and proteinuria reduction. Immunosuppression and therapeutic plasma exchange have not shown clear benefit. The terminal complement inhibitor, eculizumab, has shown promising results in some cases of chemotherapy-associated TMA including in re-exposure. However, the data are limited, and unlike in primary atypical hemolytic uremic syndrome, the role of complement in the pathogenesis of drug-induced TMA is unclear. Larger multicenter studies and unified definitions are needed to elucidate the extent of the problem and potential treatment strategies.
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spelling pubmed-101033192023-08-03 Chemotherapy-Associated Thrombotic Microangiopathy Aklilu, Abinet M. Shirali, Anushree C. Kidney360 Review Article Thrombotic microangiopathy (TMA) is a syndrome of microangiopathic hemolytic anemia and thrombocytopenia with end-organ dysfunction. Although the advent of plasma exchange, immunosuppression, and complement inhibition has improved morbidity and mortality for primary TMAs, the management of secondary TMAs, particularly drug-induced TMA, remains less clear. TMA related to cancer drugs disrupts the antineoplastic treatment course, increasing the risk of cancer progression. Chemotherapeutic agents such as mitomycin-C, gemcitabine, and platinum-based drugs as well as targeted therapies such as antiangiogenesis agents and proteasome inhibitors have been implicated in oncotherapy-associated TMA. Among TMA subtypes, drug-induced TMA is less well-understood. Treatment generally involves withdrawal of the offending agent and supportive care targeting blood pressure and proteinuria reduction. Immunosuppression and therapeutic plasma exchange have not shown clear benefit. The terminal complement inhibitor, eculizumab, has shown promising results in some cases of chemotherapy-associated TMA including in re-exposure. However, the data are limited, and unlike in primary atypical hemolytic uremic syndrome, the role of complement in the pathogenesis of drug-induced TMA is unclear. Larger multicenter studies and unified definitions are needed to elucidate the extent of the problem and potential treatment strategies. American Society of Nephrology 2023-01-27 /pmc/articles/PMC10103319/ /pubmed/36706238 http://dx.doi.org/10.34067/KID.0000000000000061 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Review Article
Aklilu, Abinet M.
Shirali, Anushree C.
Chemotherapy-Associated Thrombotic Microangiopathy
title Chemotherapy-Associated Thrombotic Microangiopathy
title_full Chemotherapy-Associated Thrombotic Microangiopathy
title_fullStr Chemotherapy-Associated Thrombotic Microangiopathy
title_full_unstemmed Chemotherapy-Associated Thrombotic Microangiopathy
title_short Chemotherapy-Associated Thrombotic Microangiopathy
title_sort chemotherapy-associated thrombotic microangiopathy
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103319/
https://www.ncbi.nlm.nih.gov/pubmed/36706238
http://dx.doi.org/10.34067/KID.0000000000000061
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