title: Transplant-associated microangiopathy in patients receiving tacrolimus following allogeneic stem cell transplantation: risk factors and response to treatment.
abstract: 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.
authors: Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors: Betul
authors: B
authors: Oran
authors: Michele
authors: M
authors: Donato
authors: Ana
authors: A
authors: Aleman
authors: Chitra
authors: C
authors: Hosing
authors: Martin
authors: M
authors: Korbling
authors: Michelle A
authors: MA
authors: Detry
authors: Caimiao
authors: C
authors: Wei
authors: Paolo
authors: P
authors: Anderlini
authors: Uday
authors: U
authors: Popat
authors: Elizabeth
authors: E
authors: Shpall
authors: Sergio
authors: S
authors: Giralt
authors: Richard E
authors: RE
authors: Champlin
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000209:etiology* / Q000628:therapy; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus