title: A case of transplantation-associated thrombotic microangiopathy with cardiac involvement successfully treated with plasma exchange.
abstract: Transplantation-associated thrombotic microangiopathy (TA-TMA) is occasionally described as a serious complication after allogeneic and, more rarely, autologous stem cell transplantation (SCT). It is characterized by poor outcome with high mortality rate. Plasma exchange (PE) has been reported as successful first-line therapy in other thrombotic microangiopathies. However, unlike to idiopathic forms, response to PE are usually suboptimal in TA-TMA and the use of PE remains controversial, because the exact mechanism of injury is not yet understood. The kidney is the most commonly affected organ and injury has rarely been reported elsewhere in the body, such as in lungs and gastrointestinal tract. Although several case reports have documented myocardial infarctions in patients presenting classic thrombotic thrombocytopenic purpura (TTP), there are no reports documenting cardiac involvement in TA-TMA. We describe a case of a 66-year-old man who experienced TA-TMA accompanied by cardiac ischemia after autologous SCT for multiple myeloma, successfully treated with PE. The immediate start of PE induced a complete remission of TA-TMA and disappearance of cardiac ischemic signs and symptoms except of a residual chronic renal failure.
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Paviglianiti
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Tomarchio
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Spurio
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cerchiara
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy ; Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Tirindelli
authors.affiliation: Department of Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Avvisati
keywords: Autologous stem cell transplantation; Cardiac ischemia; Plasma exchange; Transplantation-associated thrombotic microangiopathy