Risk factors and severe outcome in thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation.
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.
Uderzo
Cornelio
C
Clinica Pediatrica dell'Università di Milano-Bicocca, Centro Trapianto di Midollo Osseo, Ospedale San Gerardo, Monza, Italy. cornelio.uderzo@pediatriamonza.it
Bonanomi
Sonia
S
Busca
Alessandro
A
Renoldi
Mila
M
Ferrari
Pierantonio
P
Iacobelli
Massimo
M
Morreale
Giuseppe
G
Lanino
Edoardo
E
Annaloro
Claudio
C
Volpe
Aldo Della
AD
Alessandrino
Paolo
P
Longoni
Daniela
D
Locatelli
Franco
F
Sangalli
Haidi
H
Rovelli
Attilio
A
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