title: Use of Eculizumab in Patients With Allogeneic Stem Cell Transplant-Associated Thrombotic Microangiopathy: A Study From the SFGM-TC.
abstract: BACKGROUND
  Thrombotic microangiopathy (TMA) occurring after allogeneic hematopoietic stem cell transplantation (HSCT) has a devastating prognosis. Response rates to current therapies (mainly plasma exchange) are unsatisfactory. Thrombotic microangiopathy after allogeneic HSCT shares similarities with atypical hemolytic uremic syndrome (aHUS) in the underlying pathomechanisms. Eculizumab has been associated with impressive results in aHUS.
  
  
  METHODS
  We retrospectively analyzed 12 patients who received Eculizumab in France between 2010 and 2013 for severe post-HSCT TMA.
  
  
  RESULTS
  All 12 patients had severe TMA with neurological and/or renal involvement. Fifty-eight percent were refractory to first-line plasma exchange. At the time of TMA diagnosis, infections were present in 50% of the patients and acute graft-versus-host disease in 33%. Patients were treated with Eculizumab according to the aHUS therapeutic scheme. With a median follow-up of 14 months, hematological response and overall survival were 50% and 33%, respectively. Active acute graft-versus-host disease at TMA diagnosis was the only factor associated with worse overall survival (P = 0.009).
  
  
  CONCLUSIONS
  Response rate and overall survival after Eculizumab in our cohort compare favorably with previously published data in TMA after allogeneic HSCT. Prospective trials are warranted to confirm these results. Early initiation of Eculizumab may have a favorable effect on long-term renal function and further contribute to the prolongation of survival.
authors: 1 Hématologie Greffe de Moelle, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris, France. 2 Service d'Hématologie Pédiatrique, Hôpital de la Timone, Marseille, France. 3 Service d'Onco-hematologie Pédiatrique, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Montpellier, Montpellier, France. 4 Service d'Hématologie, CHU de Purpan, Toulouse, France. 5 Département de Néphrologie et Transplantation d'organe, CHU de Rangueil, Toulouse, France. 6 Service d'Hématologie, Hôpital de la Pitié Salpetrière, APHP, Université Pierre et Marie Curie, Paris. 7 Service de Thérapie Cellulaire et d'Hématologie Clinique, Hôpital d'Estaing, CHU Clermont Ferrand, Université d'Auvergne, Clermont-Ferrand, France. 8 Service d'Immuno-hématologie et Rhumatologie pédiatrique, Hôpital Necker-Enfants Malades, Laboratoire INSERM U768, Institut Imagine, Université Sorbonne Paris-cité, Paris, France. 9 Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, APHM, Université d'Aix Marseille, Marseille, France. 10 Service d'Hématologie, Hôpital Hautepierre, Hôpitaux Universitaire de Strasbourg, Strasbourg, France. 11 Département de Biostatistiques, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris, France. 12 Service d'Immunologie Biologique, Hôpital Européen George Pompidou, APHP, CHU Paris Ouest, Paris, France. 13 Service d'Hématologie Biologique, Hôpital Antoine Beclère, APHP, Université Paris Sud, Clamart, France. 14 Service d'Hématologie, Centre de Référence des Microangiopathies Thrombotiques, Hôpitaux Universitaires de l'Est Parisien, APHP, Université Pierre et Marie Curie, Paris, France.
authors: Flore Sicre
authors: FS
authors: de Fontbrune
authors: Claire
authors: C
authors: Galambrun
authors: Anne
authors: A
authors: Sirvent
authors: Anne
authors: A
authors: Huynh
authors: Stanislas
authors: S
authors: Faguer
authors: Stephanie
authors: S
authors: Nguyen
authors: Jacques-Olivier
authors: JO
authors: Bay
authors: Bénédicte
authors: B
authors: Neven
authors: Julie
authors: J
authors: Moussi
authors: Laurence
authors: L
authors: Simon
authors: Alienor
authors: A
authors: Xhaard
authors: Matthieu
authors: M
authors: Resche-Riggon
authors: Alix
authors: A
authors: O'Meara
authors: Veronique
authors: V
authors: Fremeaux-Bacchi
authors: Agnes
authors: A
authors: Veyradier
authors: Gérard
authors: G
authors: Socié
authors: Paul
authors: P
authors: Coppo
authors: Régis Peffaut
authors: RP
authors: de Latour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D057049:Thrombotic Microangiopathies / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab