Characteristics of late transplant-associated thrombotic microangiopathy in patients who underwent allogeneic hematopoietic stem cell transplantation

Cihan Heybeli, Meera Sridharan, Hassan B. Alkhateeb, Jose C. Villasboas Bisneto, Francis K. Buadi, Dong Chen, David Dingli, Angela Dispenzieri, Morie A. Gertz, Ronald S. Go, Shahrukh K. Hashmi, Suzanne R. Hayman, William J. Hogan, David J. Inwards, Saad S. Kenderian, Shaji K. Kumar, Mark R. Litzow, Luis F. Porrata, Martha Q. Lacy, Ivana N. MicallefM. M. Patnaik, Mithun V. Shah, Nelson Leung

Research output: Contribution to journalArticlepeer-review

Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA) has a wide range of presentations after hematopoietic stem-cell transplantation (HSCT). We retrospectively studied the risk factors and outcomes of patients with early (≤day 100) and late ('day 100) TA-TMA. Among the 1451 HSCT recipients, early TA-TMA occurred in 45 (3.1%) patients at a median of 27 (3-91) days, and late TA-TMA in 39 (2.7%) patients at a median of 303 (122-2595) days. Patients with early TA-TMA were more likely to have high blood calcineurin-inhibitor levels (P '.001) and acute graph-vs-host disease (GVHD, P '.001), while late TMA patients were more likely to have chronic GVHD (P '.001). The estimated median overall survival after onset of TMA for the entire cohort was 6 months. The estimated median overall survival was not reached in patients with an improvement of TMA vs 2 months in patients with no improvement (P '.001). In the early TMA group, older age (for every 10 years, HR 1.40; 95% CI 1.00-1.94; P =.049) and bacterial infection (HR 2.42; 95% CI 0.98-6.00; P =.056) were positively associated with mortality. Switching to MMF treatment (HR 0.40; 95% CI 0.16-0.99; P =.047) and improvement of TMA (HR 0.08; 95% CI 0.03-0.25; P '.001) were negatively associated with mortality in the multivariate analysis. In the late TMA group, the improvement of TMA was the only independent predictor associated with a lower risk of death (HR 0.05; 95% CI 0.02-0.19; P '.001). Mortality rates in both early and late TMA remain unacceptably high. Future studies are needed for early diagnosis, trigger identifications, and use of targeted treatments.

Original languageEnglish (US)
Pages (from-to)1170-1179
Number of pages10
JournalAmerican journal of hematology
Volume95
Issue number10
DOIs
StatePublished - Oct 1 2020

ASJC Scopus subject areas

  • Hematology

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