Risk and prognostic factors of transplantation‐associated thrombotic microangiopathy in allogeneic haematopoietic stem cell transplantation: a nested case control study

Abstract

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a significant complication of haematopoietic stem cell transplantation. However, it remains controversial which clinical or laboratory markers are of evident risk and prognostic value. From 2006 to 2013, a nested case control study was carried out in our centre to study the risk and prognostic factors of TA-TMA. A total of 654 consecutive patients who underwent allogeneic haematopoietic stem cell transplantation were studied. Twenty-six (4.0%) patients matched the established diagnostic criteria. Subjects with TA-TMA had significantly higher 3-year none relapse mortality compared with those without (65.4% vs 15.4%, P < 0.0001). Grades 2 to 4 aGVHD and cytomegalovirus viremia were independent risk factors, and serum LDH level >500U/L as well as hypertension were early signs of TA-TMA occurrence. Liver dysfunction and significant gastric bleeding were independent risk factors for TA-TMA related mortality. Subjects with either liver dysfunction or significant gastric bleeding had significantly higher 3 year TA-TMA related mortality cumulative incidence than subjects without. These observations lead to the conclusion that allo-HSCT recipients with grades 2 to 4 aGVHD or cytomegalovirus viremia should be monitored for TA-TMA. Liver dysfunction and significant gastric bleeding are prognostic factors for TA-TMA. Copyright © 2016 John Wiley & Sons, Ltd.

Transplant‐associated thrombotic microangiopathy: an unresolved complication of unrelated allogeneic transplant for hematologic diseases

“…Regarding predisposing factors, previous clinical studies have identified age, donor type, conditioning regimen, calcineurin inhibitors, GVHD, and infections as important risk factors for TA-TMA. 1,3,5,[8][9][10][11] In our study, the presence of GVHD was the only independent predictor for the development of TA-TMA, possibly related to systemic endothelial damage. Therefore, successful prevention and treatment strategies for GVHD need to be timely employed to prevent complications, as emphasized by Ye and colleagues.…”

“…Therefore, successful prevention and treatment strategies for GVHD need to be timely employed to prevent complications, as emphasized by Ye and colleagues. 1 CMV viremia found in the latter study as an independent factor is also closely related to GVHD, possibly consisting a confounding factor. Furthermore, experience from treatment outcomes in these lifethreatening complications may be useful for future treatment strategies.…”

“…Estimates of its prevalence vary significantly among studies. [1][2][3][4][5][6][7] Although it has been a well-recognized syndrome for decades, our understanding in terms of epidemiology and, more importantly, treatment options remains unclear. Therefore, we aimed to retrospectively investigate the incidence of TA-TMA in patients who underwent HCT from unrelated donors and identify prognostic factors and treatment outcomes.We enrolled consecutive patients who underwent HCT from unrelated donors from 2003 to 2015.…”

“…We read with great interest the study by Ye and colleagues regarding risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA). 1 Indeed, TA-TMA represents a devastating and life-threatening complication occurring more frequently in allogeneic compared with autologous hematopoietic cell transplantation (HCT). Estimates of its prevalence vary significantly among studies.…”

Thrombotic microangiopathy with concomitant GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome

“…23,24 On the other hand, II-IV aGVHD could be a risk factor for TA-TMA occurrence. [25][26][27][28][29] Immunosuppressors are typically used for GVHD prophylaxis and treatment; these agents can be important factors regarding the onset and deterioration of TA-TMA. 5,30 Unfortunately, some patients may develop both TMA and aGVHD after allo-HSCT, leading to considerable difficulties in diagnosis and treatment in these patients.…”