Dataset Information

Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study.

ABSTRACT:

Background

Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA.

Methods

Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records.

Results

Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N =?39, 75%). ER+/HER2-, HER2+ and triple-negative phenotypes accounted for N =?33 (69%), N =?7 (15%) and N =?8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28?days (range 0-1035; Q1:10, Q3:186). Independent prognostic factors for early death (??28?days) were PS?>?2 (OR?=?7.0 [1.6; 31.8]), elevated bilirubin (OR?=?6.9 [1.1; 42.6]), haemoglobin ConclusionsBreast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.

SUBMITTER: Alhenc-Gelas M

PROVIDER: S-EPMC7814553 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study.

Alhenc-Gelas Marion M Cabel Luc L Berger Frederique F Delaloge Suzette S Frenel Jean-Sebastien JS Levy Christelle C Firmin Nelly N Ladoire Sylvain S Desmoulins Isabelle I Heudel Pierre-Etienne PE Dalenc Florence F Loirat Delphine D Dubot Coraline C Vuagnat Perrine P Deluche Elise E Mokdad-Adi Meriem M Patsouris Anne A Annic Josselin J Djerroudi Lounes L Lavigne Marion M Pierga Jean-Yves JY Coppo Paul P Bidard Francois-Clement FC

Breast cancer research : BCR 20210119 1

<h4>Background</h4>Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA.<h4>Methods</h4>Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitab ...[more]

PMID: 33468209

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Project description:BackgroundImmune-mediated haemolytic anaemia (IMHA) is reported to be the most common autoimmune disease of dogs, resulting in significant morbidity and mortality in affected animals. Haemolysis is caused by the action of autoantibodies, but the immunological changes that result in their production have not been elucidated.AimsTo investigate the frequency of regulatory T cells (Tregs) and other lymphocyte subsets and to measure serum concentrations of cytokines and peripheral blood mononuclear cell expression of cytokine genes in dogs with IMHA, healthy dogs and dogs with inflammatory diseases.Animals19 dogs with primary IMHA, 22 dogs with inflammatory diseases and 32 healthy control dogs.MethodsResidual EDTA-anti-coagulated blood samples were stained with fluorophore-conjugated monoclonal antibodies and analysed by flow cytometry to identify Tregs and other lymphocyte subsets. Total RNA was also extracted from peripheral blood mononuclear cells to investigate cytokine gene expression, and concentrations of serum cytokines (interleukins 2, 6 10, CXCL-8 and tumour necrosis factor α) were measured using enhanced chemiluminescent assays. Principal component analysis was used to investigate latent variables that might explain variability in the entire dataset.ResultsThere was no difference in the frequency or absolute numbers of Tregs among groups, nor in the proportions of other lymphocyte subsets. The concentrations of pro-inflammatory cytokines were greater in dogs with IMHA compared to healthy controls, but the concentration of IL-10 and the expression of cytokine genes did not differ between groups. Principal component analysis identified four components that explained the majority of the variability in the dataset, which seemed to correspond to different aspects of the immune response.ConclusionsThe immunophenotype of dogs with IMHA differed from that of dogs with inflammatory diseases and from healthy control dogs; some of these changes could suggest abnormalities in peripheral tolerance that permit development of autoimmune disease. The frequency of Tregs did not differ between groups, suggesting that deficiency in the number of these cells is not responsible for development of IMHA.

Project description:BACKGROUND:This study was designed to evaluate if erythropoietin (EPO) is effective in the treatment of cancer related anemia, and if its effect remains unchanged when data are analyzed according to various clinical and methodological characteristics of the studies. We also wanted to demonstrate that cumulative meta-analysis (CMA) can be used to resolve uncertainty regarding clinical questions. METHODS:Systematic Review (SR) of the published literature on the role of EPO in cancer-related anemia. A cumulative meta-analysis (CMA) using a conservative approach was performed to determine the point in time when uncertainty about the effect of EPO on transfusion-related outcomes could be considered resolved. PARTICIPANTS:Patients included in randomized studies that compared EPO versus no therapy or placebo. MAIN OUTCOME MEASURES:Number of patients requiring transfusions. RESULTS:Nineteen trials were included. The pooled results indicated a significant effect of EPO in reducing the number of patients requiring transfusions [odds ratio (OR) = 0.41; 95%CI: 0.33 to 0.5; p < 0.00001;relative risk (RR) = 0.61; 95% CI: 0.54 to 0.68]. The results remain unchanged after the sensitivity analyses were performed according to the various clinical and methodological characteristics of the studies. The heterogeneity was less pronounced when OR was used instead of RR as the measure of the summary point estimate. Analysis according to OR was not heterogeneous, but the pooled RR was highly heterogeneous. A stepwise metaregression analysis did point to the possibility that treatment effect could have been exaggerated by inadequacy in allocation concealment and that larger treatment effects are seen at hb level > 11.5 g/dl. We identified 1995 as the point in time when a statistically significant effect of EPO was demonstrated and after which we considered that uncertainty about EPO efficacy was resolved. CONCLUSION:EPO is effective in the treatment of anemia in cancer patients. This could have already been known in 1995 if a CMA had been performed at that time.

Dataset Information

Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study.

Background

Methods

Results

Publications

Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study.

Similar Datasets

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