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

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 LavigneJean Yves Pierga, Paul Coppo, Francois Clement Bidard

    Research output: Contribution to journalArticlepeer-review

    8 Citations (Scopus)

    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.

    Original languageEnglish
    Article number9
    JournalBreast Cancer Research
    Volume23
    Issue number1
    DOIs
    Publication statusPublished - 1 Dec 2021

    Keywords

    • Breast cancer
    • Microangiopathic haemolytic anaemia
    • Prognostic factors
    • Survival

    Cite this