The risk factors and prognosis of transplant-associated thrombotic microangiopathy following acute graft-versus-host disease
10.3760/cma.j.issn.0578-1426.2013.02.025
- VernacularTitle:急性移植物抗宿主病患者发生移植相关血栓性微血管病的危险因素及预后分析
- Author:
Xiaodong MO
;
Lanping XU
;
Daihong LIU
;
Xiaohui ZHANG
;
Huan CHEN
;
Yuhong CHEN
;
Wei HAN
;
Yu WANG
;
Fengrong WANG
;
Jingzhi WANG
;
Kaiyan LIU
;
Xiaojun HUANG
- Publication Type:Journal Article
- Keywords:
Graft vs host disease;
Thrombotic microangiopathy;
Hematopoietic stem cell transplantation,allogeneic
- From:
Chinese Journal of Internal Medicine
2013;(2):156-160
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD),and to evaluate the factors that might influence the prognosis of TA-TMA.Methods A nested case-control study was designed.Cases with TA-TMA (n =33) and controls (n =77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.Results The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT.The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days,respectively.aGVHD occurring beyond 60 days after allo-HSCT,initial grade Ⅲ-Ⅳ aGVHD,first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA,and patients with two or more risk factors were at higher risk (OR =210.0,P =0.000).Twenty-two (66.7％) TA-TMA patients died.Progressive TA-TMA was the significantly adverse factor affccting the survival of TA-TMA cases.None of therapies could improve prognosis of patients with TA-TMA.Conclusion Many characteristics of aGVHD were associated with TA-TMA,which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.
