Risk factors and severe outcome in thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation

Cornelio Uderzo, Sonia Bonanomi, Alessandro Busca, Mila Renoldi, Pierantonio Ferrari, Massimo Iacobelli, Giuseppe Morreale, Edoardo Lanino, Claudio Annaloro, Aldo Della Volpe, Paolo Alessandrino, Daniela Longoni, Franco Locatelli, Haidi Sangalli, Attilio Rovelli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Background. Thrombotic microangiopathy (TMA) has been described assevere complication after hematopoietic stem cell transplantation (HSCT). The principal aim of this study was to focus the incidence and the outcome of TMA in the era of more complex HSCTs.Methods. We analyzed the role of some predicting factors for the incidence and the outcome of TMA after HSCT. We enrolled 539 consecutive patients (307 males, median age 31 years) undergoing HSCT from match or mismatch human leukocyte antigen family donor (314) or match/mismatch unrelated (195) and haploidentical donor (30) for malignant or nonmalignant diseases. TMA diagnosis was performed by homogeneous clinical and laboratory criteria.Results. Sixty-four of 539 patients presented TMA (11,87%) and the five-year cumulative incidence of TMA was 14% (HR=0.13). Fifty nine of 64 patients were affected by malignant and 5/64 by non-malignant diseases. On multivariate analysis, TMA occurrence was influenced by graft versus host disease > grade II (P=0.0001), donor type (P=0.029), gender (P=0.0233), total body irradiation based conditioning regimen (P=0.0041). Three factors for TMA outcome proved to be statistically significant by multivariate analysis: age (P=0.009), donor type (P=0.0187) and TMA index (P=0.029). The TMA mortality rate was 50%. The outcome was influenced by defibrotide (P=0.02 in univariate analysis).Conclusions. The study underlines the possibility of finding out which patients are more prone to developing post-HSCT TMA, and identifies which risk factors are more frequently associated with a dismal outcome after TMA.
Lingua originaleEnglish
pagine (da-a)638-644
Numero di pagine8
RivistaTransplantation
Volume82
DOI
Stato di pubblicazionePubblicato - 2006

Keywords

  • thrombotic microangiopathy
  • risk factors
  • stem cell transplantation

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