Chemotherapy-related hemolytic-uremic syndrome following treatment of a carcinoma of the nasopharynx

Objective: A cisplatin-containing regimen followed by radiation therapy is the recommended treatment for patients with advanced nasopharyngeal carcino ma. We report a case of a 58-year-old woman with hemolytic-uremic syndrome (HUS) who received induction chemotherapy for undifferentiated squamous cel l carcinoma of the nasopharynx. Patients and Methods: During the 2nd course of chemotherapy (consisting of bleomycin, cisplatin and epirubicin), the p atient developed hemolytic anemia, thrombocytopenia, and acute renal failur e. After HUS had been diagnosed, the patient was transferred to the intensi ve care unit. Results: Twice daily therapeutic plasma exchange (TPE) with f resh-frozen plasma, hemodialysis and high-dose cortisone was performed. Two weeks after the start of plasma exchange, thrombocytes and renal function began to normalize. Low-dose cortisone was continued until the patient reco vered from hemolytic anemia. Six weeks after the administration of the seco nd course of chemotherapy, the patient had fully recovered from HUS, and ra diation therapy was carried out as planned. The patient responded well to t reatment, but died 9 months after the diagnosis due to liver metastases. Co nclusion: We demonstrated that early TPE with fresh-frozen plasma and high- dose cortisone is a potentially successful treatment modality for the usual ly fatal, fulminant form of chemotherapy-induced HUS. Copyright (C) 2001 S. Karger AG, Basel.