Serum neutrophil extracellular trap levels predict thrombotic microangiopathy after allogeneic stem cell transplantation.
Transplantation-associated thrombotic microangiopathy (TA-TMA) is a devastating complication of hematopoietic stem cell transplantation. TA-TMA likely represents the final stage of vascular endothelial injury; however, its pathophysiology is largely unknown, making clinical management difficult. Recently, the association of neutrophil extracellular traps (NETs) with the development of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome has been reported. Thus, we explored whether NETs are also relevant to the occurrence of TA-TMA. We retrospectively analyzed post-transplant trends of serum NET levels in 90 patients, 11 of whom developed TA-TMA. Relative to baseline (before the conditioning regimen), elevated serum NET levels either at 4 weeks after transplantation or as early as the day of transplantation were associated with significantly increased risk of TA-TMA. In contrast, thrombomodulin, a potential marker for TA-TMA, was not helpful to predict the occurrence of TA-TMA in our study. In addition, we directly detected glomerular deposition of NETs in 2 TA-TMA patients. Increased NET levels are a significant risk factor for TA-TMA, suggesting that NET level is a useful biomarker for TA-TMA.
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yasuyuki
Y
Arai
Kouhei
K
Yamashita
Kiyomi
K
Mizugishi
Tomohiro
T
Watanabe
Soichiro
S
Sakamoto
Toshiyuki
T
Kitano
Tadakazu
T
Kondo
Hiroshi
H
Kawabata
Norimitsu
N
Kadowaki
Akifumi
A
Takaori-Kondo
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology / Q000378:metabolism*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D057049:Thrombotic Microangiopathies / Q000097:blood* / Q000209:etiology; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
Allogeneic stem cell transplantation; Neutrophil extracellular traps; Predictive biomarker; Thrombotic microangiopathy