Wednesday, October 7, 2015

Consult Rounds: Cancer Drug induced Thrombotic microangiopathies

Cancer Drug induced TMA come in 2 variants

1.       Type 1 TMA:- onset is delayed, usually 6-12 months after starting therapy
Cumulative dose related
Clinically, could be permanent and irreversible renal damage
Would avoid rechallenge
High incidence of acute mortality and may require dialysis even after stopping agent
Thrombi in both arteriole and glomerular capillary
Examples: Mitomycin C and gemcitabine induced

2.       Type 2 TMA:- onset is more acute and only at time of initiation of agent.
Not dose related
High likelihood of recovery
Some evidence of safe rechallenge
Thrombi in glomerular capillary mainly
Patient and kidney survival excellent
Examples:  anti VEGF and TKI agents induced

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