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Eur J Haematol. 2018 Feb;100(2):171-181. doi: 10.1111/ejh.12996. Epub 2017 Dec 17.

Thrombotic microangiopathy with concomitant GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome.

Zhang XH1,2,3, Liu X1,2,3, Wang QM1,2,3, He Y1,2,3, Zhu XL1,2,3, Zhang JM1,2,3, Han W1,2,3, Chen H1,2,3, Chen YH1,2,3, Wang FR1,2,3, Wang JZ1,2,3, Zhang YY1,2,3, Mo XD1,2,3, Chen Y1,2,3, Wang Y1,2,3, Fu HX1,2,3, Chang YJ1,2,3, Xu LP1,2,3, Liu KY1,2,3, Huang XJ1,2,3.

Author information

1
Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
2
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
3
Collaborative Innovation Center of Hematology, Peking University, Beijing, China.

Abstract

OBJECTIVES:

To explore the possible risk factors for the occurrence and mortality of thrombotic microangiopathy (TMA) with concomitant acute graft-vs-host disease (aGVHD) and to investigate outcomes and treatments of this disorder after allo-HSCT.

METHODS:

Fifty cases diagnosed with TMA with concomitant aGVHD and 150 controls were identified from a cohort composed of 3992 patients who underwent allo-HSCT from 2008 to 2016.

RESULTS:

Grade III-IV aGVHD (P = .000), acute kidney injury (AKI) (P = .033), and hypertension (P = .028) were significant independent risk factors associated with the occurrence of TMA with concomitant aGVHD. A haptoglobin level below normal (P = .013), a maximum volume of diarrhea >2500 mL/d (P = .015), and bloody diarrhea (P = .049) were significant markers for death in both univariate and multivariate analyses. Patients diagnosed with TMA with concomitant aGVHD had a lower overall survival (OS), a higher non-relapse mortality (NRM), but a lower risk of relapse.

CONCLUSIONS:

Thrombotic microangiopathy with concomitant aGVHD is a significant complication after allo-HSCT, with a worse outcome, including significantly lower OS and higher NRM. There are specific risk factors associated with occurrence and mortality of this complication.

KEYWORDS:

acute graft-vs-host disease; allogeneic hematopoietic stem cell transplantation; thrombotic microangiopathy

PMID:
29114931
DOI:
10.1111/ejh.12996
[Indexed for MEDLINE]

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