Walter Roland B, Joerger Markus, Pestalozzi Bernhard C
Medical Clinic B and Division of Oncology, Department of Internal Medicine, University Hospital, Zürich, Switzerland.
Am J Kidney Dis. 2002 Oct;40(4):E16. doi: 10.1053/ajkd.2002.35758.
Gemcitabine has mild renal toxicity, but cases of gemcitabine-associated hemolytic-uremic syndrome (HUS) have been reported.
A case is presented of a 45-year-old woman on prolonged gemcitabine treatment for ovarian cancer who developed HUS and recovered after drug discontinuation. A mini-review of the literature based on a MEDLINE search follows.
Including our own patient, a total of 26 cases of gemcitabine-associated HUS were identified. Median patient age was 52 years. Treatment was for various tumors at advanced stages, and in some patients, other anticancer drugs previously had been administered. Mean time between initiation of gemcitabine therapy and onset of HUS was 7.4 +/- 3.5 months, or 21.9 +/- 10.9 doses of gemcitabine. The calculated median cumulative dose of gemcitabine was 20,000 mg/m(2) (range, 2,450 to 48,000 mg/m(2), or a total of 70,000 mg). The onset of disease was noted up to 2 months after the last gemcitabine infusion. Diagnosis of HUS was confirmed histologically in 13 patients and based on clinical findings in the other 15. Treatment included drug discontinuation, steroids, fresh frozen plasma, hemodialysis, absorption chromatography, plasmapheresis, and various combinations thereof. Of 23 patients with reported outcome, 11 died within a few weeks. In two cases, death was believed to be a direct consequence of HUS. Reexposure to the drug was reported in three patients but was uncomplicated in only one.
There are only a few confirmed cases of gemcitabine-associated HUS despite the widespread use of the drug. This potentially fatal complication is difficult to treat and should be widely known.
吉西他滨具有轻度肾毒性，但已有吉西他滨相关溶血尿毒综合征（HUS）的病例报道。
本文报告了1例45岁接受吉西他滨长期治疗卵巢癌的女性发生HUS，停药后康复的病例。随后基于医学文献数据库（MEDLINE）检索进行文献综述。
包括我们自己的患者在内，共确定了26例吉西他滨相关HUS病例。患者中位年龄为52岁。治疗针对晚期各种肿瘤，部分患者先前曾使用过其他抗癌药物。吉西他滨治疗开始至HUS发病的平均时间为7.4±3.5个月，或吉西他滨21.9±10.9剂。计算得出的吉西他滨中位累积剂量为20,000mg/m²（范围为2,450至48,000mg/m²，或总计70,000mg）。疾病发作在最后一次吉西他滨输注后长达2个月被发现。13例患者经组织学确诊为HUS，其他15例基于临床表现确诊。治疗包括停药、类固醇、新鲜冰冻血浆、血液透析、吸附层析、血浆置换及其各种组合。在报告结局的23例患者中，11例在数周内死亡。在2例中，死亡被认为是HUS的直接后果。3例患者再次接触该药物，但仅1例无并发症。
尽管该药物广泛使用，但吉西他滨相关HUS的确诊病例仅有少数。这种潜在致命并发症难以治疗，应广为人知。
