Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1288-1295
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1288
Cancer-related microangiopathic hemolytic anemia in patients with advanced gastric cancer: A retrospective single-center analysis
Anne Katrin Berger, Michael Allgäuer, Leonidas Apostolidis, Anna Elisa Schulze-Schleithoff, Uta Merle, Dirk Jaeger, Georg Martin Haag
Anne Katrin Berger, Leonidas Apostolidis, Dirk Jaeger, Georg Martin Haag, Department of Medical Oncology, National Center for Tumor Diseases, University Hospital of Heidelberg, Heidelberg 69120, Germany
Michael Allgäuer, Department of Pathology, Institute of Pathology, University Hospital of Heidelberg, Heidelberg 69120, Germany
Anna Elisa Schulze-Schleithoff, Department of Gastroenterology, University Hospital of Heidelberg, Heidelberg 69120, Germany
Uta Merle, Department of Gastroenterology and Hepatology, University Hospital of Heidelberg, Heidelberg 69120, Germany
Author contributions: Berger AK completed conception and design, acquisition of data, analysis and interpretation of data, writing and revision of the manuscript; Allgäuer M and Apostolidis L finished analysis and interpretation of data, rewriting and review of the manuscript, technical support; Schulze-Schleithoff AE, Merle U and Jaeger D completed acquisition of data, writing and review of the manuscript; Haag GM finished conception and design, acquisition of data, analysis and interpretation of data, writing and review of the manuscript; All authors approved the final manuscript version.
Institutional review board statement: The study was approved by the local Ethics Committee University of Heidelberg, No. S-335/2014.
Informed consent statement: According to local ethics policy for retrospective analysis of own anonymized clinical data, informed consent was not obtained.
Conflict-of-interest statement: Haag MG has received fees for consulting or advisory role: Bristol-Myers Squibb, MSD Sharp & Dohme (Inst), EsoCap. Honoraria: Servier, MSD Sharp & Dohme. Research Funding: Nordic Pharma (Inst); Taiho Pharmaceutical (Inst), MSD (Inst). Travel, Accommodations: Bristol-Myers Squibb; Lilly, all outside the submitted work. Leonidas Apostolidis: reports grants, personal fees and non-financial support from Ipsen, personal and non-financial support from Novartis, all outside the submitted work. All other authors have no conflicts to declare.
Data sharing statement: The dataset is available from the corresponding author. 
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of item.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anne Katrin Berger, MD, Attending Doctor, Department of Medical Oncology, National Center for Tumor Diseases, University Hospital of Heidelberg, Im Neuenheimer Feld 460, Heidelberg 69120, Germany. anne.berger@med.uni-heidelberg.de
Received: July 7, 2020
Peer-review started: July 7, 2020
First decision: September 17, 2020
Revised: September 27, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: November 15, 2020
Processing time: 127 Days and 17.2 Hours
ARTICLE HIGHLIGHTS
Research background

Cancer-related microangiopathic hemolytic anemia (CR-MAHA) is an infrequent but alarming oncological emergency in patients with solid tumors. Advanced gastric cancer seems among the tumor types with the highest association with CR-MAHA. Data on appropriate treatment and patients' outcome are scarce.

Research motivation

To obtain knowledge about CR-MAHA and the course of disease to help guide treatment decisions in future patients with CR-MAHA and gastric cancer. 

Research objectives

Frequency, patient and tumor characteristics, symptom load, treatment efficacy and patient outcomes.

Research methods

We analyzed a prospectively maintained database for patients with CR-MAHA and gastric cancer at our high-volume university cancer center between 2012 and 2019. 

Research results

We identified 8 patients of whom 6 started polychemotherapy. Four of six showed initial response to treatment, but the survival was poor. Patients under chemotherapy had an overall survival (OS) of 10.3 wk. For the whole cohort, OS was 1.9 wk. One patient with microsatellite instability-high (MSI-H) tumor responded extremely well to immunotherapy with long-time survival exceeding 3 years.

Research conclusions

CR-MAHA in gastric cancer patients is a condition with an overall limited prognosis. Some patients respond to first-line treatment for several months. Second-line treatment does not seem beneficial. Testing for MSI status is recommended. 

Research perspectives

First-line chemotherapy should be discussed with patients with CR-MAHA and gastric cancer, but the limited prognosis should be addressed by the attending oncologists. We do not encourage for second-line approaches. MSI-H tumors seem to act differently, even in fatal conditions such as CR-MAHA. It remains unclear, if combined chemo-immunotherapy in those patients would be beneficial.