TITLE

Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus

AUTHOR(S)
Labrador, J; López-Corral, L; López-Godino, O; Vázquez, L; Cabrero-Calvo, M; Pérez-López, R; Díez-Campelo, M; Sánchez-Guijo, F; Pérez-López, E; Guerrero, C; Alberca, I; del Cañizo, M C; Pérez-Simón, J A; González-Porras, J R; Caballero, D
PUB. DATE
May 2014
SOURCE
Bone Marrow Transplantation;May2014, Vol. 49 Issue 5, p684
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Transplantation-associated thrombotic microangiopathy (TA-TMA) is a feared complication of allogeneic hematopoietic SCT (HSCT) owing to its high mortality rate. The use of calcineurin inhibitors or sirolimus (SIR) for GVHD prophylaxis has been suggested as a potential risk factor. However, the impact of tacrolimus (TAC) and SIR combinations on the increased risk of TA-TMA is currently not well defined. We retrospectively analyzed the incidence of TA-TMA in 102 allogeneic HSCT recipients who consecutively received TAC plus SIR (TAC/SIR) (n=68) or plus MTX (TAC/MTX)±ATG (n=34) for GVHD prophylaxis. No significant differences were observed in the incidence of TA-TMA between patients receiving TAC/SIR vs TAC/MTX±ATG (7.4% vs 8.8%, P=0.8). Only grade III-IV acute GVHD, previous HSCT and serum levels of TAC >25 ng/mL were associated with a greater risk of TA-TMA. Patients developing TA-TMA have significantly poorer survival (P<0.001); however, TA-TMA ceased to be an independent prognostic factor when it was included in a multivariate model. In conclusion, the combination of TAC/SIR does not appear to pose a higher risk of TA-TMA. By contrast, we identified three different risk groups for developing TA-TMA.
ACCESSION #
95891095

 

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