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Review
. 2021 Jul;14(7):101081.
doi: 10.1016/j.tranon.2021.101081. Epub 2021 Apr 13.

Thrombotic microangiopathy in oncology - a review

Patrícia Valério  1 , João Pedro Barreto  2 , Hugo Ferreira  3 , Teresa Chuva  3 , Ana Paiva  3 , José Maximino Costa  3
Affiliations
Review

Thrombotic microangiopathy in oncology - a review

Patrícia Valério et al. Transl Oncol. 2021 Jul.

Abstract

Thrombotic microangiopathy is a syndrome triggered by a wide spectrum of situations, some of which are specific to the Oncology setting. It is characterized by a Coombs-negative microangiopathic haemolytic anemia, thrombocytopenia and organ injury, with characteristic pathological features, resulting from platelet microvascular occlusion. TMA is rare and its cancer-related subset even more so. TMA triggered by drugs is the most common within this group, including classic chemotherapy and the latest targeted therapies. The neoplastic disease itself and hematopoietic stem-cell transplantation could also be potential triggers. Evidence-based medical guidance in the management of cancer-related TMA is scarce and the previous knowledge about primary TMA is valuable to understand the disease mechanisms and the potential treatments. Given the wide spectrum of potential causes for TMA in cancer patients, the aim of this review is to gather the vast information available. For each entity, pathophysiology, clinical features, therapeutic approaches and prognosis will be covered.

Keywords: Cancer; Haematological malignancies; Hematopoietic stem cell transplantation; Onco-nephrology; Thrombotic microangiopathies.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
HSCT-TMA pathogenesis. Abbreviations: CNI, calcineurin inhibitors; GVHD, graft versus host disease; MAC, membrane attack complex; mTORI, mammalian target of rapamycin inhibitors; TBI, total body irradiation.
See this image and copyright information in PMC

References

    1. George J.N., Nester C.M. Syndromes of thrombotic microangiopathy. N. Engl. J. Med. 2014;371(7):654–666. - PubMed
    1. Moschcowitz E. Hyaline thrombosis of the terminal arterioles and capillaries: a hitherto undescribed disease. Proc. N Y Pathol. Soc. 1924;24:21–24.
    1. Singer K., Bornstein F.P., Wile S.A. Thrombotic thrombocytopenic purpura; hemorrhagic diathesis with generalized platelet thromboses. Blood. 1947;2(6):542–554. - PubMed
    1. Azevedo A., Faria B., Teixeira C., Carvalho F., Neto G., Santos J. Portuguese consensus document statement in diagnostic and management of atypical hemolytic uremic syndrome. Port J. Nephrol. Hypert. 2018;32(3):211–232.
    1. Weitz I.C. Thrombotic Microangiopathy in cancer. Semin. Thromb Hemost. 2019;45(4):348–353. - PubMed

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