Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

A retrospective analysis of gemcitabine induced haemolytic uraemic syndrome in a single centre in Western Australia (#241)

Shane Fitzgerald 1 , Dermot Farrell 1 , Paul Burke 1 , Leeona Gallagher 1 , Adarsh Das 1 , Andrew Dean 1
  1. St John of God Subiaco Hospital, Subiaco, WA, Australia

Background: Gemcitabine is an antimetabolite used in the treatment of various malignancies, including pancreatic and ovarian carcinoma. Although it has a favourable toxicity profile, one of the rarer complications is haemolytic uraemic syndrome (HUS). HUS is characterized by microangiopathic haemolytic anaemia, acute kidney injury (AKI) and thrombocytopenia1. Gemcitabine-induced HUS (GiHUS) incidence has been reported to be between 0.008% and 0.078%2. GiHUS can easily be mistaken for treatment-related events such as myelosuppression from chemotherapy or AKI secondary to gastrointestinal losses. If not managed adequately, the sequalae from HUS can include end stage renal disease and neurological issues including coma, with mortality rates being up to 50%3.

Methods: An electronic database search was conducted, looking for patients receiving gemcitabine that developed HUS from February 2021 to February 2024. The patients’ records, pathology, radiology, and medication records were examined.

Results: Four patients were identified. Malignancies included were pancreatic adenocarcinoma (n=2), endocervical adenocarcinoma (n=1) and cholangiocarcinoma (n=1). The median number of cycles to developing GiHUS was seven. Of note, one patient developed it after one cycle. They all presented with peripheral oedema, hypertension and investigations revealed AKI, thrombocytopenia, anaemia, and evidence of haemolysis on blood smear. All patients had normal ADAMTS13 levels and tested negative for Shiga Toxin-Producing Escherichia coli. They all received supportive care and either eculizumab (n=3) or ravulizumab (n=1) for their GiHUS. There were no significant complications with nil mortality reported, and they all went on to receive further lines of treatment without gemcitabine.

Conclusions: In our retrospective review, all patients recovered post treatment with no associated mortality. Early recognition and prompt treatment is essential to prevent the harmful sequelae of GiHUS. In patients treated with gemcitabine who present with peripheral oedema, hypertension, anaemia, thrombocytopenia, and AKI, gemcitabine should be withheld and prompt testing for HUS should be considered.

  1. 1. Michael M, Bagga A, Sartain SE, Smith RJH. Haemolytic uraemic syndrome. Lancet. 2022 Nov 12;400(10364):1722-1740. doi: 10.1016/S0140-6736(22)01202-8. Epub 2022 Oct 19. PMID: 36272423.
  2. 2. Cidon, E.U. and Alonso, P. (2018) ‘Gemcitabine induced hemolytic uremic syndrome: Underestimated?’, Annals of Oncology, 29, pp. v47–v48. doi:10.1093/annonc/mdy151.168.
  3. 3. Lee, H.W. et al. (2014) ‘Gemcitabine-induced hemolytic uremic syndrome in pancreatic cancer: A case report and review of the literature’, Gut and Liver, 8(1), pp. 109–112. doi:10.5009/gnl.2014.8.1.109.