van der Lelie H, Baars J W, Rodenhuis S, van Dijk M A, de Glas-Vos C W, Thomas B L, van Oers R H, von dem Borne A E
Academic Medical Centre, University of Amsterdam, Department of Internal Medicine, Amsterdam, The Netherlands.
Cancer. 1995 Dec 1;76(11):2338-42. doi: 10.1002/1097-0142(19951201)76:11<2338::aid-cncr2820761123>3.0.co;2-p.
Chemotherapy intensification may lead to new forms of toxicity such as hemolytic uremic syndrome.
Three patients are described who developed this complication 4 to 6 months after high dose chemotherapy followed by autologous stem cell support. The literature on this subject is reviewed.
One patient was conditioned with BEAC (carmustine, etoposide, cytosine arabinoside, and cyclophosphamide) and received autologous bone marrow. The other two underwent triple peripheral stem cell transplantation after conditioning with CTC (carboplatin, cyclophosphamide, and thiotepa). Symptoms were hypertension, microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. One patient had a retinal vein thrombosis. One patient died of a cardiac arrest shortly after the diagnosis was made. The remaining two achieved a partial remission: one with fresh frozen plasma without plasmapheresis and fresh frozen plasma, but improved on high dose intravenous immunoglobulin and vincristine.
Hemolytic uremic syndrome is a serious complication of the more intensive chemotherapy made possible by stem cell support. Because of the rapidly growing indications for this approach, an increase in this type of vascular complication is expected.
强化化疗可能导致诸如溶血性尿毒症综合征等新的毒性形式。
描述了3例在大剂量化疗联合自体干细胞支持后4至6个月出现这种并发症的患者。并对该主题的文献进行了综述。
1例患者接受BEAC（卡莫司汀、依托泊苷、阿糖胞苷和环磷酰胺）预处理并接受自体骨髓移植。另外2例在接受CTC（卡铂、环磷酰胺和噻替派）预处理后进行了三联外周血干细胞移植。症状包括高血压、微血管病性溶血性贫血、血小板减少和肾功能不全。1例患者出现视网膜静脉血栓形成。1例患者在诊断后不久死于心脏骤停。其余2例患者病情部分缓解：1例患者仅接受新鲜冰冻血浆治疗，未进行血浆置换，另1例患者接受新鲜冰冻血浆联合大剂量静脉注射免疫球蛋白和长春新碱治疗后病情改善。
溶血性尿毒症综合征是干细胞支持下强化化疗的严重并发症。由于这种治疗方法的适应证迅速增加，预计此类血管并发症将会增多。
