MAHA has been recognized as an uncommon, but fatal complication of cancer or its chemotherapy. From May, 1982 to Sep., 1988, we have experienced 29 cases of MAHA in cancer patients, of which 23 were thought to be cancer-associated and 6 to be chemotherapy-related. The clinical characteristica of MAHA in these patients are presented. Adenocarcinoma of the stomach was the most common primary cancer in cancer-associated MAHA. Mitomycin-C(MMC) was thought to be an offending agent of chemotherapy-related MAHA, and cumulative dose of MMC was 32-190 mg(mean 117 mg). Most patients presented abruptly with anemia or bleeding tendency. In some patients with chemotherapy-related MAklA, pulmonary edema or seizure was also observed. The most consistent laboratory findings were hemolytic anemia with characteristic schistocytes in the peripheral blood smear and thrombocytopenia. The most characteristic finding in cancer-associated MAHA was leukoerythroblastosis which was present in 74% of the patients, and that in chemotherapy-related MAHA was azotemia with microscopic hematuria or proteinuria which characterized the chemotherapy-related MAHA as chemotherapy-related hemolytic uremic syndrome (HUS). While MAHA was rapidly fatal in most patients managed with supportive treatment only, improve- ment of MAHA with partial response of cancer was achieved in 4 among 9 patients treated with FP (5-fluorouracil+cisplatin) chemotherapy. In case of chemotherapy-related MAHA, we treated 3 patients with plasmapheresis and MAHA was improved but azotemia was not. In conclusion, MAHA in cancer could be classified into cancer-associated MAHA and chemotherapy-related HUS. An early differential diagnosis and aggressive treatment could improve the prognosis of these previousiy fatal syndromes.
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