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Retrospective analysis on the clinical outcomes of recombinant human soluble thrombomodulin for disseminated intravascular coagulation syndrome associated with solid tumors

BACKGROUND: Recombinant human soluble thrombomodulin (rTM) has been established and introduced in the clinic as a standard treatment for disseminated intravascular coagulation (DIC). However, the efficacy and safety of rTM for DIC associated with solid tumors (DIC-STs) have not been fully establishe...

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Detalles Bibliográficos
Autores principales: Ouchi, Kota, Takahashi, Shin, Chikamatsu, Sonoko, Ito, Shukuei, Takahashi, Yoshikazu, Kawai, Sadayuki, Okita, Akira, Kasahara, Yuki, Okada, Yoshinari, Imai, Hiroo, Komine, Keigo, Saijo, Ken, Takahashi, Masahiro, Shirota, Hidekazu, Takahashi, Masanobu, Gamoh, Makio, Ishioka, Chikashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Japan 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097084/
https://www.ncbi.nlm.nih.gov/pubmed/29511940
http://dx.doi.org/10.1007/s10147-018-1261-z
Descripción
Sumario:BACKGROUND: Recombinant human soluble thrombomodulin (rTM) has been established and introduced in the clinic as a standard treatment for disseminated intravascular coagulation (DIC). However, the efficacy and safety of rTM for DIC associated with solid tumors (DIC-STs) have not been fully established. Here, we performed a retrospective analysis of the clinical outcomes of rTM for DIC-STs and considered a treatment strategy with rTM for DIC-STs. METHODS: Patients with DIC-STs between November 2009 and March 2016 in 2 cancer core hospitals were retrospectively analyzed. Data, including patient background, treatment course, and clinical outcomes of rTM for DIC-STs, were extracted. The clinical outcomes were evaluated by comparing the DIC score, resolution rate, and overall survival (OS) duration. RESULTS: The study included 123 patients with DIC-STs. The median OS in all patients was 41 days. The DIC resolution rate was 35.2%. DIC scores and DIC-related blood test data (fibrin degradation product and prothrombin time-international normalized ratio) significantly improved at the end of rTM administration (P < 0.001). The OS duration was longer in patients who were treated with chemotherapy after DIC onset than in those who were not treated with chemotherapy (median, 178 days vs. 17 days, P < 0.001). In both univariate and multivariate analyses, chemotherapy after DIC onset showed the strongest association with OS. CONCLUSIONS: rTM can at least temporarily improve or maintain the state of DIC-STs. It is suggested that prolongation of survival can be expected when control of DIC and treatment of the underlying disease are compatible. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10147-018-1261-z) contains supplementary material, which is available to authorized users.