Abstract
Thrombotic microangiopathy (TMA) is a syndrome involving fragmentation haemolysis, thrombocytopenia, and thrombosis. A range of disorders including cancer may have TMA as a clinical manifestation. TMA in cancer may be caused by several mechanisms, including systemic microvascular metastases, but may also be due to extensive bone marrow involvement with cancer or secondary necrosis. Chemotherapeutic agents may also cause associated TMA through a range of different mechanisms. Gemcitabine, platinum-based drugs, mitomycin C, and proteasome inhibitors are known to cause TMA in cancer patients. Transplant-associated TMA (TA-TMA) may affect either solid organ or HSCT patients. TA-TMA remains a difficult complication to address due to its high mortality rate, lack of standard diagnostic criteria, and limited therapeutic options. The challenge of cancer-associated TMA is furthered by the fact that plasma exchange is ineffective in its management.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK, George JN (2015) Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood 125:616–618
Ducos G, Mariotte E, Galicier L, Canet E, Boutboul D, Lemiale V, Schlemmer B, Veyradier A, Azoulay E, Zafrani L (2014) Metastatic cancer-related thrombotic microangiopathies: a cohort study. Future Oncol 10:1727–1734
Elliott MA, Letendre L, Gastineau DA, Winters JL, Pruthi RK, Heit JA (2010) Cancer-associated microangiopathic hemolytic anemia with thrombocytopenia: an important diagnostic consideration. Eur J Haematol 85:43–50
Hassan S, Westwood JP, Ellis D, Laing C, McGuckin S, Benjamin S, Scully M (2015) The utility of ADAMTS13 in differentiating TTP from other acute thrombotic microangiopathies: results from the UK TTP Registry. Br J Haematol 171:830–835
Jodele S, Davies SM, Lane A, Khoury J, Dandoy C, Goebel J, Myers K, Grimley M, Bleesing J, El-Bietar J, Wallace G, Chima RS, Paff Z, Laskin BL (2014) Diagnostic and risk criteria for HSCT-associated thrombotic microangiopathy: a study in children and young adults. Blood 124:645–653
Jodele S, Fukuda T, Vinks A, Mizuno K, Laskin BL, Goebel J, Dixon BP, Teusink A, Pluthero FG, Lu L, Licht C, Davies SM (2014) Eculizumab therapy in children with severe hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Biol Blood Marrow Transplant 20:518–525
Jodele S, Licht C, Goebel J, Dixon BP, Zhang K, Sivakumaran TA, Davies SM, Pluthero FG, Lu L, Laskin BL (2013) Abnormalities in the alternative pathway of complement in children with hematopoietic stem cell transplant-associated thrombotic microangiopathy. Blood 122:2003–2007
Kaidar-Person O, Nasrallah H, Haim N, Dann EJ, Bar-Sela G (2011) Disseminated carcinoma diagnosed by bone marrow biopsy in patients with microangiopathic hemolytic anemia and thrombocytopenia: a report of two cases with gastric cancer and a review of the literature. J Gastrointest Cancer 42:123–126
Khosla J, Yeh AC, Spitzer TR, Dey BR (2017) Hematopoietic stem cell transplant-associated thrombotic microangiopathy: current paradigm and novel therapies. Bone Marrow Transplant
Lechner K, Obermeier HL (2012) Cancer-related microangiopathic hemolytic anemia: clinical and laboratory features in 168 reported cases. Medicine (Baltimore) 91:195–205
Levi M, Toh CH, Thachil J, Watson HG (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol 145:24–33
Licht C, Greenbaum LA, Muus P, Babu S, Bedrosian CL, Cohen DJ, Delmas Y, Douglas K, Furman RR, Gaber OA, Goodship T, Herthelius M, Hourmant M, Legendre CM, Remuzzi G, Sheerin N, Trivelli A, Loirat C (2015) Efficacy and safety of eculizumab in atypical hemolytic uremic syndrome from 2-year extensions of phase 2 studies. Kidney Int 87:1061–1073
Lopez Rubio ME, Rodado Martinez R, Illescas ML, Mateo Bosch E, Martinez Diaz M, de la Vara Inesta L, Cabezuelo B, Morales Albuja ME, Lucas Guillen E, Jimeno Garcia L (2017) Gemcitabine-induced hemolytic-uremic syndrome treated with eculizumab or plasmapheresis: two case reports. Clin Nephrol 87(2017):100–106
Morton JM, George JN (2016) Microangiopathic hemolytic anemia and thrombocytopenia in patients with cancer. J Oncol Pract 12:523–530
Ono T, Mimuro J, Madoiwa S, Soejima K, Kashiwakura Y, Ishiwata A, Takano K, Ohmori T, Sakata Y (2006) Severe secondary deficiency of von Willebrand factor-cleaving protease (ADAMTS13) in patients with sepsis-induced disseminated intravascular coagulation: its correlation with development of renal failure. Blood 107:528–534
Phillips EH, Westwood JP, Brocklebank V, Wong EK, Tellez JO, Marchbank KJ, McGuckin S, Gale DP, Connolly J, Goodship TH, Kavanagh D, Scully MA (2016) The role of ADAMTS-13 activity and complement mutational analysis in differentiating acute thrombotic microangiopathies. J Thromb Haemost 14:175–185
Ritchie GE, Fernando M, Goldstein D (2017) Rituximab to treat gemcitabine-induced hemolytic-uremic syndrome (HUS) in pancreatic adenocarcinoma: a case series and literature review. Cancer Chemother Pharmacol 79:1–7
Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, Spasoff RA (1991) Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med 325:393–397
Scully M (2017) Thrombocytopenia in hospitalized patients: approach to the patient with thrombotic microangiopathy. Hematology Am Soc Hematol Educ Program 2017:651–659
Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ (2012) Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol
Tallman MS, Kwaan HC (1992) Reassessing the hemostatic disorder associated with acute promyelocytic leukemia. Blood 79:543–553
Taylor CM, Machin S, Wigmore SJ, Goodship TH (2010) Clinical practice guidelines for the management of atypical haemolytic uraemic syndrome in the United Kingdom. Br J Haematol 148:37–47
Turner JL, Reardon J, Bekaii-Saab T, Cataland SR, ARANGO MJ (2016) Gemcitabine-associated thrombotic microangiopathy: response to complement inhibition and reinitiation of gemcitabine. Clin Colorectal Cancer
Vendramin C, McGuckin S, Alwan F, Westwood JP, Thomas M, Scully M (2017) A single-center prospective study on the safety of plasma exchange procedures using a double-viral-inactivated and prion-reduced solvent/detergent fresh-frozen plasma as the replacement fluid in the treatment of thrombotic microangiopathy. Transfusion 57:131–136
Yousaf F, Spinowitz B, Charytan C, Galler M (2017) Pernicious anemia associated cobalamin deficiency and thrombotic microangiopathy: case report and review of the literature. Case Rep Med 2017:9410727
Yui JC, van Keer J, Weiss BM, Waxman AJ, Palmer MB, D’Agati VD, Kastritis E, Dimopoulos MA, Vij R, Bansal D, Dingli D, Nasr SH, Leung N (2016) Proteasome inhibitor associated thrombotic microangiopathy. Am J Hematol 91:E348–E352
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Thomas, M.R., Scully, M. (2019). Microangiopathy in Cancer: Causes, Consequences, and Management. In: Soff, G. (eds) Thrombosis and Hemostasis in Cancer. Cancer Treatment and Research, vol 179. Springer, Cham. https://doi.org/10.1007/978-3-030-20315-3_10
Download citation
DOI: https://doi.org/10.1007/978-3-030-20315-3_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-20314-6
Online ISBN: 978-3-030-20315-3
eBook Packages: MedicineMedicine (R0)