Blood and Marrow Transplant Clinical Trials Network Toxicity Committee consensus summary: Thrombotic microangiopathy after hematopoietic stem cell transplantation

Vincent T. Ho, Corey Cutler, Shelly Carter, Paul Martin, Roberta Adams, Mary Horowitz, James Ferrara, Robert Soiffer, Sergio Giralt

Research output: Contribution to journalReview articlepeer-review

276 Scopus citations

Abstract

The syndrome of microangiopathic hemolysis associated with renal failure, neurologic impairment, or both is a recognized complication of hematopoietic stem cell transplantation. This entity is often called hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP), yet it is clear that the pathophysiology of transplant-associated HUS/TTP is different from that of classic HUS or TTP. Furthermore, the incidence of this syndrome varies from 0.5% to 76% in different transplant series, primarily because of the lack of a uniform definition. The toxicity committee of the Blood and Marrow Transplant Clinical Trials Network has reviewed the current literature on transplant-related HUS/TTP and recommends that it be henceforth renamed posttransplantation thrombotic microangiopathy (TMA). An operational definition for TMA based on the presence of microangiopathic hemolysis and renal and/or neurologic dysfunction is proposed. The primary intervention after diagnosis of TMA should be withdrawal of calcineurin inhibitors. Plasma exchange, although frequently used in this condition, has not been proven to be effective. In the absence of definitive trials, plasma exchange cannot be considered a standard of care for TMA. It is hoped that these positions will improve the identification and reporting of this devastating complication after hematopoietic stem cell transplantation and facilitate future clinical studies for its prevention and treatment.

Original languageEnglish (US)
Pages (from-to)571-575
Number of pages5
JournalBiology of Blood and Marrow Transplantation
Volume11
Issue number8
DOIs
StatePublished - Aug 2005

Keywords

  • Anemia
  • Hemolytic uremic syndrome
  • Microangiopathy
  • Stem cell transport
  • Thrombocytopenia
  • Thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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