Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus.

Abstract

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a feared complication of allogeneic hematopoietic SCT (HSCT) owing to its high mortality rate. The use of calcineurin inhibitors or sirolimus (SIR) for GVHD prophylaxis has been suggested as a potential risk factor. However, the impact of tacrolimus (TAC) and SIR combinations on the increased risk of TA-TMA is currently not well defined. We retrospectively analyzed the incidence of TA-TMA in 102 allogeneic HSCT recipients who consecutively received TAC plus SIR (TAC/SIR) (n=68) or plus MTX (TAC/MTX)±ATG (n=34) for GVHD prophylaxis. No significant differences were observed in the incidence of TA-TMA between patients receiving TAC/SIR vs TAC/MTX±ATG (7.4% vs 8.8%, P=0.8). Only grade III-IV acute GVHD, previous HSCT and serum levels of TAC >25 ng/mL were associated with a greater risk of TA-TMA. Patients developing TA-TMA have significantly poorer survival (P<0.001); however, TA-TMA ceased to be an independent prognostic factor when it was included in a multivariate model. In conclusion, the combination of TAC/SIR does not appear to pose a higher risk of TA-TMA. By contrast, we identified three different risk groups for developing TA-TMA.

• Authors: J Labrador, L López-Corral, O López-Godino, L Vázquez, M Cabrero-Calvo, R Pérez-López, M Díez-Campelo, F Sánchez-Guijo, E Pérez-López, C Guerrero, I Alberca, M C Del Cañizo, J A Pérez-Simón, J R González-Porras, D Caballero
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 49 Issue 5 Pg. 684-90 (May 2014) ISSN: 1476-5365 [Electronic] England
• PMID: 24566710 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Sirolimus
• Tacrolimus
• Methotrexate

Topics

• Adult
• Aged
• Drug Therapy, Combination
• Female
• Graft vs Host Disease (drug therapy, epidemiology, prevention & control)
• Hematopoietic Stem Cell Transplantation (adverse effects, statistics & numerical data)
• Humans
• Immunosuppressive Agents (administration & dosage, blood)
• Incidence
• Male
• Methotrexate (administration & dosage, blood)
• Middle Aged
• Multivariate Analysis
• Prognosis
• Retrospective Studies
• Risk Factors
• Sirolimus (administration & dosage, blood)
• Tacrolimus (administration & dosage, blood)
• Thrombotic Microangiopathies (epidemiology, etiology)
• Transplantation, Homologous
• Young Adult