THROMBOTIC MICROANGIOPATHY AS A COMPLICATION OF HIGH-DOSE CHEMOTHERAPY FOR BREAST-CANCER

Five hundred and eighty-one patients with stage II-IV breast cancer we re treated at Duke University Medical Center with high-dose chemothera py, followed by hematopoietic support, All patients received a conditi oning regimen of cyclophosphamide, cisplatin and carmustine, Of these patients, 15 (2.6%) developed symptoms similar to the hemolytic-uremic syndrome with evidence of thrombotic microangiopathy (TMA), The time of onset ranged from 75 days to 281 days post-transplant, with a media n of 143 days, Hemolytic anemia and thrombocytopenia, without alternat ive cause, were required for diagnosis, All patients were treated with steroid therapy, In addition, 12 patients were treated primarily with plasmapheresis, and received a median of 46 treatments, Additional th erapy included staphylococcal protein A column apheresis (eight patien ts), vincristine (three patients) and danazol (one patient), The morta lity rate was 11 of 15 patients (73%), These patients had a median sur vival of 41 days from diagnosis of TMA (range 2-76 days), The four sur vivors are alive at 76, 186, 1837 and 2387 days from diagnosis of TMA, Three of these patients received twice daily plasmapheresis and prote in A column apheresis therapy, One patient recovered without specific therapy, TMA is an infrequent complication of high-dose chemotherapy, but is associated with a high mortality, It frequently follows signifi cant pulmonary drug toxicity, Survival may be improved with early diag nosis and aggressive plasmapheresis therapy.