TY - JOUR
T1 - Thrombotic thrombocytopenic purpura-like syndromes following bone marrow transplantation
T2 - An analysis of associated conditions and clinical outcomes
AU - Roy, V.
AU - Rizvi, M. A.
AU - Vesely, S. K.
AU - George, J. N.
N1 - Funding Information:
This work was supported by the Hemostasis Research Fund of the University of Oklahoma Health Sciences Center. We thank Dr Georgia Vogelsang for continuing critical advice.
PY - 2001
Y1 - 2001
N2 - The diagnosis and treatment of thrombotic thrombocytopenic purpura (TTP) in patients following BMT are often uncertain and unsuccessful. To better understand the evaluation and management of these patients, we describe 17 patients treated with plasma exchange for a presumptive diagnosis of TTP following BMT during a 10 year period, 1989-1998. Because of the uncertainty of the diagnosis, these patients are described as having a 'TTP-like syndrome'. All 17 patients had received an allogeneic BMT. Comparison with the other 245 patients who had an allogeneic BMT during the same period demonstrated that patients with a TTP-like syndrome more frequently had unrelated and/or HLA-mismatched donors, and had also experienced more serious complications: grade III-IV acute GVHD and systemic bacterial, fungal, and viral infections. Three months after the diagnosis of the TTP-like syndrome, only four of 17 patients (24%) were alive; currently only one patient survives. These data emphasize: (1) the diagnosis of TTP following BMT is uncertain because of the presence of multiple BMT-associated complications. (2) The outcome of patients with TTP-like syndromes following BMT is poor. (3) Urgent intervention with plasma exchange when TTP is suspected following BMT may not always be appropriate. Alternative explanations for the signs and symptoms should be considered and treated aggressively.
AB - The diagnosis and treatment of thrombotic thrombocytopenic purpura (TTP) in patients following BMT are often uncertain and unsuccessful. To better understand the evaluation and management of these patients, we describe 17 patients treated with plasma exchange for a presumptive diagnosis of TTP following BMT during a 10 year period, 1989-1998. Because of the uncertainty of the diagnosis, these patients are described as having a 'TTP-like syndrome'. All 17 patients had received an allogeneic BMT. Comparison with the other 245 patients who had an allogeneic BMT during the same period demonstrated that patients with a TTP-like syndrome more frequently had unrelated and/or HLA-mismatched donors, and had also experienced more serious complications: grade III-IV acute GVHD and systemic bacterial, fungal, and viral infections. Three months after the diagnosis of the TTP-like syndrome, only four of 17 patients (24%) were alive; currently only one patient survives. These data emphasize: (1) the diagnosis of TTP following BMT is uncertain because of the presence of multiple BMT-associated complications. (2) The outcome of patients with TTP-like syndromes following BMT is poor. (3) Urgent intervention with plasma exchange when TTP is suspected following BMT may not always be appropriate. Alternative explanations for the signs and symptoms should be considered and treated aggressively.
KW - Hemolytic uremic syndrome
KW - Plasmapheresis
KW - Thrombotic thrombocytopenic purpura
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U2 - 10.1038/sj.bmt.1702849
DO - 10.1038/sj.bmt.1702849
M3 - Article
C2 - 11319595
AN - SCOPUS:0035038021
SN - 0268-3369
VL - 27
SP - 641
EP - 646
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 6
ER -