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Breast Cancer Research
Published in: Breast Cancer Research 1/2021

01-12-2021 | Breast Cancer | Research article

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

Authors: Marion Alhenc-Gelas, Luc Cabel, Frederique Berger, Suzette Delaloge, Jean-Sebastien Frenel, Christelle Levy, Nelly Firmin, Sylvain Ladoire, Isabelle Desmoulins, Pierre-Etienne Heudel, Florence Dalenc, Delphine Loirat, Coraline Dubot, Perrine Vuagnat, Elise Deluche, Meriem Mokdad-Adi, Anne Patsouris, Josselin Annic, Lounes Djerroudi, Marion Lavigne, Jean-Yves Pierga, Paul Coppo, Francois-Clement Bidard

Published in: Breast Cancer Research | Issue 1/2021

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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 < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]).

Conclusions

Breast 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.
Appendix
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Metadata
Title
Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study
Authors
Marion Alhenc-Gelas
Luc Cabel
Frederique Berger
Suzette Delaloge
Jean-Sebastien Frenel
Christelle Levy
Nelly Firmin
Sylvain Ladoire
Isabelle Desmoulins
Pierre-Etienne Heudel
Florence Dalenc
Delphine Loirat
Coraline Dubot
Perrine Vuagnat
Elise Deluche
Meriem Mokdad-Adi
Anne Patsouris
Josselin Annic
Lounes Djerroudi
Marion Lavigne
Jean-Yves Pierga
Paul Coppo
Francois-Clement Bidard
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Breast Cancer Research / Issue 1/2021
Electronic ISSN: 1465-542X
DOI
https://doi.org/10.1186/s13058-021-01386-y

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