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.
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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)
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Chemical References |
- Immunosuppressive Agents
- Sirolimus
- Tacrolimus
- Methotrexate
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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
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