title: Third-party mesenchymal stromal cell infusion is associated with a decrease in thrombotic microangiopathy symptoms observed post-hematopoietic stem cell transplantation.
abstract: TA-TMA is a pathology that occurs after allogenic HSC transplantation with an incidence of 4-13%, and represents one of the most severe vascular damage related with this therapy. We report here the case of a nine-yr-old girl suffering from a severe refractory aplastic anemia who received an unrelated, 9/10 HLA-matched HSC. Soon after transplantation, the patient developed a graft-versus-host disease (GvHD), a TA-TMA, and renal insufficiency. These pathologies remained refractory to the various treatments undertaken and required several hospitalizations in the intensive care unit. On day 106 post-HSC transfusion, after several episodes of intensive care, the patient was infused with mismatched, third-party MSCs. Schizocyte levels rapidly decreased after MSC infusion, and two wk later, most biological parameters returned to normal. Erythrocyte and thrombocyte transfusions were discontinued, and the patient remained stable for 10 wk. Thereafter, TA-TMA symptoms, viral reactivation, pleural and cardiac effusions reappeared and lead to the death of the patient. Our observations suggest that allogenic MSC infusion may decrease the symptoms of TA-TMA, but further investigation is required to determine how and when MSC should be infused to develop a long-lasting protective effect.
authors.affiliation: Department of Pediatrics, Hematology Unit, University Hospital Geneva, Geneva, Switzerland. marc.ansari@hcuge.ch
authors.forename: Marc
authors.initials: M
authors.lastname: Ansari
authors.forename: Dirk
authors.initials: D
authors.lastname: Strunk
authors.forename: Katharina
authors.initials: K
authors.lastname: Schallmoser
authors.forename: Cristina
authors.initials: C
authors.lastname: Delcò
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Rougemont
authors.forename: Solange
authors.initials: S
authors.lastname: Moll
authors.forename: Jean
authors.initials: J
authors.lastname: Villard
authors.forename: Fabienne
authors.initials: F
authors.lastname: Gumy-Pause
authors.forename: Yves
authors.initials: Y
authors.lastname: Chalandon
authors.forename: Paloma
authors.initials: P
authors.lastname: Parvex
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Hulya
authors.initials: H
authors.lastname: Ozsahin
authors.forename: Vincent
authors.initials: V
authors.lastname: Kindler
mesh_terms: D000741:Anemia, Aplastic / Q000601:surgery*; D002648:Child; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D011183:Postoperative Complications / Q000601:surgery*; D051437:Renal Insufficiency / Q000209:etiology / Q000601:surgery; D057049:Thrombotic Microangiopathies / Q000209:etiology / Q000601:surgery*