Thrombotic microangiopathy after allogeneic blood and marrow transplantation is associated with dose-intensive myeloablative conditioning regimens, unrelated donor, and methylprednisolone T-cell depletion.
BACKGROUND
Allogeneic blood and marrow transplantation (BMT)-associated thrombotic microangiopathy (TM) contributes to transplant-related morbidity and mortality. This report examines the incidence of and risk factors for allogeneic BMT-associated TM in two patient cohorts treated before and after changes in myeloablative conditioning regimen intensity (high vs. standard intensity).


METHODS
Cohort 1 includes 153 consecutive allogeneic BMT patients who underwent transplantation between April 1994 and October 1997 with an allogeneic BMT-associated TM crude incidence of 12%. Cohort 2 includes 75 consecutive allogeneic BMT patients who underwent transplantation from November 1997 to November 2000 with an allogeneic BMT-associated TM crude incidence of 1%.


RESULTS
In cohort 1, matched unrelated donor transplant and methylprednisolone (MP) T-cell depletion (TCD) of donor bone marrow were significantly associated with allogeneic BMT-associated TM by univariate analysis; therefore, a logistic model incorporating these effects was constructed to calculate the expected number of allogeneic BMT-associated TM cases in cohort 2. Seven cases would have been expected, but only one was observed (P = 0.003; bayesian predictive test). The multivariate analysis of both cohorts yielded MP-TCD (P<0.001), high-intensity myeloablative conditioning regimens used in cohort 1 (P = 0.02), and matched unrelated donor (P = 0.03) as significant predictors of time to allogeneic BMT-associated TM.


CONCLUSIONS
Avoidance of high-intensity conditioning regimens may decrease the incidence of allogeneic BMT-associated TM.
Hahn
Theresa
T
Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. theresa.hahn@roswellpark.org
Alam
Arif Raza
AR
Lawrence
David
D
Ford
Laurieann
L
Baer
Maria R
MR
Bambach
Barbara
B
Bernstein
Zale P
ZP
Czuczman
Myron S
MS
Silva
Joaquin
J
Slack
James L
JL
Wetzler
Meir
M
Becker
Joanne
J
McCarthy
Philip L
PL
D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D008212:Lymphocyte Depletion / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology*; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology*; D065227:Transfusion Reaction; D014184:Transplantation, Homologous
D008775:Methylprednisolone