title: Early clinical indicators of transplant-associated thrombotic microangiopathy in pediatric neuroblastoma patients undergoing auto-SCT.
abstract: Patients undergoing auto-SCT for neuroblastoma present a unique population to study transplant-associated thrombotic microangiopathy (TA-TMA), due to standardized chemotherapy and later exposure to radiation and cis-retinoic acid (cis-RA). We retrospectively analyzed 20 patients after auto-SCT to evaluate early clinical indicators of TA-TMA. A total of 6 patients developing TA-TMA (30% prevalence) were compared with 14 controls. Four of six patients were diagnosed with TA-TMA by 25 days after auto-SCT. Compared with controls, TA-TMA patients had higher average systolic and diastolic blood pressure levels during high-dose chemotherapy and developed hypertension by day 13 after auto-SCT. Proteinuria was a significant marker for TA-TMA, whereas blood and platelet transfusion requirements were not. Serum creatinine did not differ between groups post transplant. However, patients with TA-TMA had a 60% decrease in renal function from baseline by nuclear glomerular filtration rate, compared with a 25% decrease in those without TA-TMA (P=0.001). There was no TA-TMA-related mortality. Significant complications included end-stage renal disease (n=1) and polyserositis (n=3). Patients with TA-TMA were unable to complete cis-RA therapy after auto-SCT. We suggest that careful attention to blood pressure and urinalysis will assist in the early diagnosis of TA-TMA, whereas serum creatinine seems to be an insensitive marker for this condition.
authors.affiliation: Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA. benjamin.laskin@cchmc.org
authors.forename: B L
authors.initials: BL
authors.lastname: Laskin
authors.forename: J
authors.initials: J
authors.lastname: Goebel
authors.forename: S M
authors.initials: SM
authors.lastname: Davies
authors.forename: J C
authors.initials: JC
authors.lastname: Khoury
authors.forename: J J
authors.initials: JJ
authors.lastname: Bleesing
authors.forename: P A
authors.initials: PA
authors.lastname: Mehta
authors.forename: A H
authors.initials: AH
authors.lastname: Filipovich
authors.forename: Z N
authors.initials: ZN
authors.lastname: Paff
authors.forename: J M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: H J
authors.initials: HJ
authors.lastname: Yin
authors.forename: S L
authors.initials: SL
authors.lastname: Pinkard
authors.forename: S
authors.initials: S
authors.lastname: Jodele
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D009447:Neuroblastoma / Q000601:surgery*; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D000959:Antihypertensive Agents