1. Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre.
- Author
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Grall M, Daviet F, Chiche NJ, Provot F, Presne C, Coindre JP, Pouteil-Noble C, Karras A, Guerrot D, François A, Benhamou Y, Veyradier A, Frémeaux-Bacchi V, Coppo P, and Grangé S
- Subjects
- Antimetabolites, Antineoplastic adverse effects, Antimetabolites, Antineoplastic therapeutic use, Blood Transfusion methods, Blood Transfusion statistics & numerical data, Complement Inactivating Agents administration & dosage, Deoxycytidine adverse effects, Deoxycytidine analogs & derivatives, Deoxycytidine therapeutic use, Female, France epidemiology, Humans, Kidney Function Tests methods, Male, Middle Aged, Recovery of Function, Remission Induction methods, Renal Replacement Therapy methods, Treatment Outcome, Gemcitabine, Acute Kidney Injury complications, Acute Kidney Injury diagnosis, Acute Kidney Injury therapy, Antibodies, Monoclonal, Humanized administration & dosage, Thrombotic Microangiopathies diagnosis, Thrombotic Microangiopathies etiology, Thrombotic Microangiopathies therapy
- Abstract
Background: Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA)., Methods: This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016., Results: Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4-44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2-22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0-10) before treatment vs 0 (range 0-1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m
2 respectively in the eculizumab group and in the control group., Conclusions: These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery., (© 2021. The Author(s).)- Published
- 2021
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