Peering into the darkness of drug-induced thrombotic microangiopathy: complement, are you in there?

[摘要] Conventional management of drug-induced thrombotic microangiopathies (DI-TMAs) is centered around drug cessation and supportive care (1). This can be quite troublesome since many of these offending medications are important antineoplastic or immunosuppressive drugs that may not have equivalent alternatives (2). Furthermore, chronic kidney disease and other long-term morbidities are common after DI-TMAs, even with prompt discontinuation of the offending drug (3,4). End stage renal disease occurred in 24% of patients with gemcitabine-induced TMA in a prior study despite immediate drug stoppage (4). Outside of drug removal, there is no accepted therapy for DI-TMA and plasmapheresis does not appear to improve outcomes (5). Drug-specific antibodies have been identified for a handful of drugs, however the majority of DI-TMAs occur through unknown mechanisms (2). These challenges exemplify the significance of this treatment complication and the need for an effective therapeutic intervention. They also confirm that different types of DI-TMAs exist which means they should not all be managed in the same way.

[学科分类] 肿瘤学

[关键词] Thrombotic microangiopathy;gemcitabine;complement;C5 inhibitor