TY - JOUR
T1 - Transplant-Associated Microangiopathy in Patients Receiving Tacrolimus Following Allogeneic Stem Cell Transplantation
T2 - Risk Factors and Response to Treatment
AU - Oran, Betul
AU - Donato, Michele
AU - Aleman, Ana
AU - Hosing, Chitra
AU - Korbling, Martin
AU - Detry, Michelle A.
AU - Wei, Caimiao
AU - Anderlini, Paolo
AU - Popat, Uday
AU - Shpall, Elizabeth
AU - Giralt, Sergio
AU - Champlin, Richard E.
PY - 2007/4
Y1 - 2007/4
N2 - Transplant-associated microangiopathy (TAM) is a life-threatening complication after allogeneic HSCT, particularly with the use of calcineurin inhibitors as post-transplantation immunosuppressive therapy. We report our experience with TAM after HSCT with tacrolimus-based GVHD prophylaxis in a single-center study. Sixty-six of 1219 transplant recipients developed TAM with a cumulative incidence of 5.9%. Risk factors for TAM were female gender, lymphoid malignancy, receipt of a matched unrelated donor, and grade II-IV aGVHD. Most patients had infection and/or active GVHD at the diagnosis of TAM (82%). In the absence of renal dysfunction or encephalopathy, tacrolimus was generally continued, maintaining blood levels within the lower therapeutic range. Sixty-three patients were treated with plasma exchange. The cumulative incidence of response of TAM was 60%. Only 1 patient had a response of TAM without resolution of concomitant infections or GVHD. Six-month survivals were 0% and 50% for TAM nonresponders and responders, respectively. In conclusion, TAM is a common, life-threatening complication of allogeneic hematopoietic transplantation using tacrolimus prophylaxis. Control of TAM generally requires response of associated infections and GVHD. TMA response may occur despite continuation of tacrolimus treatment.
AB - Transplant-associated microangiopathy (TAM) is a life-threatening complication after allogeneic HSCT, particularly with the use of calcineurin inhibitors as post-transplantation immunosuppressive therapy. We report our experience with TAM after HSCT with tacrolimus-based GVHD prophylaxis in a single-center study. Sixty-six of 1219 transplant recipients developed TAM with a cumulative incidence of 5.9%. Risk factors for TAM were female gender, lymphoid malignancy, receipt of a matched unrelated donor, and grade II-IV aGVHD. Most patients had infection and/or active GVHD at the diagnosis of TAM (82%). In the absence of renal dysfunction or encephalopathy, tacrolimus was generally continued, maintaining blood levels within the lower therapeutic range. Sixty-three patients were treated with plasma exchange. The cumulative incidence of response of TAM was 60%. Only 1 patient had a response of TAM without resolution of concomitant infections or GVHD. Six-month survivals were 0% and 50% for TAM nonresponders and responders, respectively. In conclusion, TAM is a common, life-threatening complication of allogeneic hematopoietic transplantation using tacrolimus prophylaxis. Control of TAM generally requires response of associated infections and GVHD. TMA response may occur despite continuation of tacrolimus treatment.
KW - Graft-versus-host disease
KW - Tacrolimus
KW - Transplant-associated microangiopathy
UR - http://www.scopus.com/inward/record.url?scp=33947240963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33947240963&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2006.11.020
DO - 10.1016/j.bbmt.2006.11.020
M3 - Article
C2 - 17382253
AN - SCOPUS:33947240963
SN - 1083-8791
VL - 13
SP - 469
EP - 477
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -