title: Risk factors and severe outcome in thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Thrombotic microangiopathy (TMA) has been described as severe complication after hematopoietic stem cell transplantation (HSCT). The principal aim of this study was to focus the incidence and the outcome of TMA in the era of more complex HSCTs.
  
  
  METHODS
  We analyzed the role of some predicting factors for the incidence and the outcome of TMA after HSCT. We enrolled 539 consecutive patients (307 males, median age 31 years) undergoing HSCT from match or mismatch human leukocyte antigen family donor (314) or match/mismatch unrelated (195) and haploidentical donor (30) for malignant or nonmalignant diseases. TMA diagnosis was performed by homogeneous clinical and laboratory criteria.
  
  
  RESULTS
  Sixty-four of 539 patients presented TMA (11,87%) and the five-year cumulative incidence of TMA was 14% (HR=0.13). Fifty nine of 64 patients were affected by malignant and 5/64 by non-malignant diseases. On multivariate analysis, TMA occurrence was influenced by graft versus host disease >grade II (P=0.0001), donor type (P=0.029), gender (P=0.0233), total body irradiation based conditioning regimen (P=0.0041). Three factors for TMA outcome proved to be statistically significant by multivariate analysis: age (P=0.009), donor type (P=0.0187) and TMA index (P=0.029). The TMA mortality rate was 50%. The outcome was influenced by defibrotide (P=0.02 in univariate analysis).
  
  
  CONCLUSIONS
  The study underlines the possibility of finding out which patients are more prone to developing post-HSCT TMA, and identifies which risk factors are more frequently associated with a dismal outcome after TMA.
authors.affiliation: Clinica Pediatrica dell'Università di Milano-Bicocca, Centro Trapianto di Midollo Osseo, Ospedale San Gerardo, Monza, Italy. cornelio.uderzo@pediatriamonza.it
authors.forename: Cornelio
authors.initials: C
authors.lastname: Uderzo
authors.forename: Sonia
authors.initials: S
authors.lastname: Bonanomi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Mila
authors.initials: M
authors.lastname: Renoldi
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Ferrari
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacobelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morreale
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
authors.forename: Claudio
authors.initials: C
authors.lastname: Annaloro
authors.forename: Aldo Della
authors.initials: AD
authors.lastname: Volpe
authors.forename: Paolo
authors.initials: P
authors.lastname: Alessandrino
authors.forename: Daniela
authors.initials: D
authors.lastname: Longoni
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Haidi
authors.initials: H
authors.lastname: Sangalli
authors.forename: Attilio
authors.initials: A
authors.lastname: Rovelli
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology*; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology