Microangiopathic hemolytic anemia, a frequent complication of mitomycin therapy in cancer patients.

Microangiopathic hemolytic anemia (MAHA) has long been recognized as a rare complication in far-advanced malignant tumors. Recently several patients have been described in whom MAHA and renal insufficiency developed as a result of mitomycin therapy. We here describe another five such cases among 50 patients treated with mitomycin. All five cases were observed among the 14 patients who had received four or more doses of the drug. We conclude that MAHA is a frequent and potentially fatal complication of long-term mitomycin treatment. Careful monitoring for the early appearance of schistocytes is mandatory as the syndrome tends to be self-limited if this therapy is discontinued early.