Perrier Quentin, Noble Johan, Grangé Steven, Bedouch Pierrick, Tetaz Rachel, Rostaing Lionel
Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France.
Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France.
Case Rep Oncol. 2021 Apr 12;14(1):676-680. doi: 10.1159/000514982. eCollection 2021 Jan-Apr.
Thrombotic microangiopathy (TMA) is most of the time caused by thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. A 60-year-old female was diagnosed in 2014 with mammary breast adenocarcinoma treated by several-line therapy: mastectomy, docetaxel, cyclophosphamide, radiotherapy, doxorubicine, and capecitabine. By mid-November, the patient was admitted to the hospital with regenerative, mechanical, and hemolytic anemia, schistocytes at 3%, and thrombopenia (99 G/L), associated with high blood transfusion requirement. After 9 sessions of plasmapheresis, there was no significant improvement in the biological parameters, nor after 2 cycles of paclitaxel. The patient was then treated with eculizumab during 4 weeks, with a slight reduction in blood requirement, and simultaneously with palbociclib. Since being treated with palpociclib, she had a great reduction in blood requirement and a good clinical condition. To conclude, we reported an initial moderate improvement of paraneoplasm-related TMA syndrome under eculizumab therapy with a slight reduction in red blood cell requirement; however, palbociclib therapy achieved a very good response with a dramatic reduction in red blood cell requirement.
血栓性微血管病（TMA）多数情况下由血栓性血小板减少性紫癜或溶血性尿毒症综合征引起。一名60岁女性于2014年被诊断为乳腺腺癌，接受了多线治疗：乳房切除术、多西他赛、环磷酰胺、放疗、阿霉素和卡培他滨。到11月中旬，患者因再生性、机械性和溶血性贫血、裂体细胞占3%以及血小板减少（99 G/L）入院，伴有大量输血需求。经过9次血浆置换，生物学参数无显著改善，紫杉醇治疗2个周期后也无改善。随后患者接受了4周的依库珠单抗治疗，输血需求略有减少，同时接受了哌柏西利治疗。自接受哌柏西利治疗以来，她的输血需求大幅减少，临床状况良好。总之，我们报告了依库珠单抗治疗下副肿瘤相关TMA综合征最初有中度改善，红细胞需求略有减少；然而，哌柏西利治疗取得了非常好的效果，红细胞需求大幅减少。
