title: [The risk factors and prognosis of transplant-associated thrombotic microangiopathy following acute graft-versus-host disease].
abstract: OBJECTIVE
  To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD), and to evaluate the factors that might influence the prognosis of TA-TMA.
  
  
  METHODS
  A nested case-control study was designed. Cases with TA-TMA (n = 33) and controls (n = 77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.
  
  
  RESULTS
  The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT. The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days, respectively. aGVHD occurring beyond 60 days after allo-HSCT, initial grade III-IV aGVHD, first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA, and patients with two or more risk factors were at higher risk (OR = 210.0, P = 0.000). Twenty-two (66.7%) TA-TMA patients died. Progressive TA-TMA was the significantly adverse factor affecting the survival of TA-TMA cases. None of therapies could improve prognosis of patients with TA-TMA.
  
  
  CONCLUSIONS
  Many characteristics of aGVHD were associated with TA-TMA, which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.
authors: Institute of Hematology and People's Hospital, Peking University, Beijing 100044, China.
authors: Xiao-Dong
authors: XD
authors: Mo
authors: Lan-Ping
authors: LP
authors: Xu
authors: Dai-Hong
authors: DH
authors: Liu
authors: Xiao-Hui
authors: XH
authors: Zhang
authors: Huan
authors: H
authors: Chen
authors: Yu-Hong
authors: YH
authors: Chen
authors: Wei
authors: W
authors: Han
authors: Yu
authors: Y
authors: Wang
authors: Feng-Rong
authors: FR
authors: Wang
authors: Jing-Zhi
authors: JZ
authors: Wang
authors: Kai-Yan
authors: KY
authors: Liu
authors: Xiao-Jun
authors: XJ
authors: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology*; D055815:Young Adult