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Thrombotic microangiopathy associated with lenvatinib therapy
Macarena Contreras Angulo1, Belén García Izquierdo1, Laura Armengod Grao1
1Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
Summary:
Systemic thrombotic microangiopathy (TMA) is a serious condition whose early treatment is essential to reduce morbidity and mortality. TMA with only renal involvement has been associated with tyrosine kinase inhibitors, including lenvatinib, a drug used for certain advanced neoplasms. To date, TMA with systemic involvement associated with this drug has not been described. We present the case of a patient with progressive metastatic thyroid cancer who developed this complication after starting treatment with lenvatinib. We describe the signs and symptoms that led to the diagnosis and the treatment required for her recovery.
Learning Points:
Thrombotic microangiopathy (TMA) is a group of disorders characterized by thrombosis in capillaries and arterioles due to an endothelial injury. Both, localized and systemic forms have been described.TMA with systemic involvement is characterized by hemolytic anemia, low platelets, and organ damage.Vascular endothelial growth factor signaling inhibitors have been associated with TMA, either restricted to the kidney or with systemic involvement.Lenvatinib has been rarely associated with TMA. Although only forms with isolated or predominantly renal involvement had been described so far, a predominantly systemic form can occur.Lenvatinib-induced systemic TMA must be distinguished from primary forms by measuring ADAMTS-13. Treatment includes discontinuation of the drug and supportive measures.When anemia and thrombocytopenia coexist in a patient receiving treatment with lenvatinib, a peripheral blood smear to exclude TMA is recommended.
Insights
Systemic thrombotic microangiopathy (TMA) is a serious condition. Lenvatinib, a cancer drug, has been linked to TMA, even with systemic involvement, which is described here for the first time.
Area of Science:
- Oncology
- Nephrology
- Hematology
Background:
- Systemic thrombotic microangiopathy (TMA) is a critical condition requiring prompt treatment.
- Tyrosine kinase inhibitors, such as lenvatinib used for advanced cancers, are associated with TMA, primarily renal forms.
- Systemic TMA involving multiple organs due to lenvatinib has not been previously documented.
Observation:
- A patient with metastatic thyroid cancer developed systemic TMA after initiating lenvatinib therapy.
- The case highlights the clinical presentation, diagnostic process, and successful treatment of this rare complication.
- This presentation underscores the potential for lenvatinib to induce TMA beyond renal involvement.
Findings:
- Lenvatinib can precipitate a predominantly systemic form of TMA, characterized by hemolytic anemia, thrombocytopenia, and organ damage.
- Distinguishing lenvatinib-induced TMA from primary forms is crucial and can be aided by ADAMTS-13 testing.
- Early recognition through peripheral blood smear analysis in patients with anemia and thrombocytopenia on lenvatinib is recommended.
Implications:
- This case expands the known spectrum of lenvatinib-associated TMA.
- It emphasizes the importance of vigilant monitoring for systemic TMA in patients treated with lenvatinib.
- Prompt drug discontinuation and supportive care are vital for managing this potentially life-threatening condition.
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