Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report
Abstract Background The incidence of gemcitabine-induced hemolytic uremic syndrome has already been described in adults. Several approaches have been employed in the treatment of gemcitabine-induced hemolytic uremic syndrome with different outcomes. One of the most promising agents is eculizumab, wh...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13256-017-1373-5 |
| _version_ | 1819157264295002112 |
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| author | Ludovica Facchini Maurizio Lucchesi Alessia Stival Rosa Maria Roperto Francesca Melosi Marco Materassi Silvia Farina Veronica Tintori Maurizio de Martino Iacopo Sardi |
| author_facet | Ludovica Facchini Maurizio Lucchesi Alessia Stival Rosa Maria Roperto Francesca Melosi Marco Materassi Silvia Farina Veronica Tintori Maurizio de Martino Iacopo Sardi |
| author_sort | Ludovica Facchini |
| collection | DOAJ |
| description | Abstract Background The incidence of gemcitabine-induced hemolytic uremic syndrome has already been described in adults. Several approaches have been employed in the treatment of gemcitabine-induced hemolytic uremic syndrome with different outcomes. One of the most promising agents is eculizumab, which is a monoclonal antibody directed against C5 complement protein. Case presentation We reported the case of a 3-year-old white boy with medulloblastoma who underwent high-dose chemotherapy and craniospinal irradiation. Afterwards he started maintenance chemotherapy with gemcitabine and oxaliplatin. After five courses he presented a progressive clinical worsening, which resulted in a systemic thrombotic microangiopathy. Initially he was treated with rituximab without clinical improvement. Therefore he started therapy with repeated cycles of eculizumab. After seven infusions he showed a gradual improvement and finally a complete remission of gemcitabine-induced hemolytic uremic syndrome. Conclusions Eculizumab prevents serious complement-mediated vascular damage for chemotherapy-induced thrombotic microangiopathy in pediatric cases. |
| first_indexed | 2024-12-22T16:06:00Z |
| format | Article |
| id | doaj.art-e31775af1ec44382abf83a5d0b0592aa |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-22T16:06:00Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-e31775af1ec44382abf83a5d0b0592aa2022-12-21T18:20:37ZengBMCJournal of Medical Case Reports1752-19472017-07-011111610.1186/s13256-017-1373-5Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case reportLudovica Facchini0Maurizio Lucchesi1Alessia Stival2Rosa Maria Roperto3Francesca Melosi4Marco Materassi5Silvia Farina6Veronica Tintori7Maurizio de Martino8Iacopo Sardi9Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s HospitalNeuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s HospitalNeuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s HospitalNephrology Unit, Meyer Children’s Hospital, University of FlorenceIntensive Care Unit, Meyer Children’s HospitalNephrology Unit, Meyer Children’s Hospital, University of FlorenceNeuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s HospitalTransplantation Unit, Department of Pediatric Oncology, Meyer Children’s HospitalDepartment of Health Sciences, University of Florence, Meyer Children’s HospitalNeuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s HospitalAbstract Background The incidence of gemcitabine-induced hemolytic uremic syndrome has already been described in adults. Several approaches have been employed in the treatment of gemcitabine-induced hemolytic uremic syndrome with different outcomes. One of the most promising agents is eculizumab, which is a monoclonal antibody directed against C5 complement protein. Case presentation We reported the case of a 3-year-old white boy with medulloblastoma who underwent high-dose chemotherapy and craniospinal irradiation. Afterwards he started maintenance chemotherapy with gemcitabine and oxaliplatin. After five courses he presented a progressive clinical worsening, which resulted in a systemic thrombotic microangiopathy. Initially he was treated with rituximab without clinical improvement. Therefore he started therapy with repeated cycles of eculizumab. After seven infusions he showed a gradual improvement and finally a complete remission of gemcitabine-induced hemolytic uremic syndrome. Conclusions Eculizumab prevents serious complement-mediated vascular damage for chemotherapy-induced thrombotic microangiopathy in pediatric cases.http://link.springer.com/article/10.1186/s13256-017-1373-5MicroangiopathyEculizumabGemcitabineMedulloblastomaRadiotherapyBrain tumors |
| spellingShingle | Ludovica Facchini Maurizio Lucchesi Alessia Stival Rosa Maria Roperto Francesca Melosi Marco Materassi Silvia Farina Veronica Tintori Maurizio de Martino Iacopo Sardi Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report Journal of Medical Case Reports Microangiopathy Eculizumab Gemcitabine Medulloblastoma Radiotherapy Brain tumors |
| title | Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report |
| title_full | Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report |
| title_fullStr | Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report |
| title_full_unstemmed | Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report |
| title_short | Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report |
| title_sort | role of eculizumab in a pediatric refractory gemcitabine induced thrombotic microangiopathy a case report |
| topic | Microangiopathy Eculizumab Gemcitabine Medulloblastoma Radiotherapy Brain tumors |
| url | http://link.springer.com/article/10.1186/s13256-017-1373-5 |
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