A syndrome of microangiopathic hemolytic anemia, renal impairment, and pulmonary edema in chemotherapy-treated patients with adenocarcinoma

Chemotherapy is frequently used to treat adenocarcinoma. Thirty-nine cases are reviewed in which the patients developed a hemolytic-uremic-like syndrome, apparently in response to chemotherapy. About 44% of the patients had gastric adenocarcinoma, and 82% had received mitomycin C. Most patients (75%) developed the syndrome 6 to 12 months after starting chemotherapy, and 60% were in remission. Severe microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment were each noted in about 90% of the cases. Neurologic symptoms were usually absent, but 49% of the patients developed adult respiratory distress syndrome (ARDS). The overall case fatality rate was 72%; those patients with ARDS had a 95% mortality rate, while 50% of those without ARDS survived. The half-life of survival of those who ultimately died was 2 months. Treatment is unsatisfactory, although steroids and plasmapheresis may prolong survival.