Clinical analysis of 9 patients with transplant-related thrombotic microangiopathy
10.3760/cma.j.issn.0578-1426.2019.06.005
- VernacularTitle:移植相关性血栓性微血管病九例临床分析
- Author:
Binglei ZHANG
1
;
Jian ZHOU
;
Ruirui GUI
;
Yingling ZU
;
Yanli ZHANG
;
Yongping SONG
Author Information
1. 郑州大学附属肿瘤医院血液科 450003
- Keywords:
Hematopoietic stem cell transplantation;
Thrombotic microangiopathies;
Treatment outcome;
Prognosis
- From:
Chinese Journal of Internal Medicine
2019;58(6):423-427
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical features,efficacy and outcomes in patients with transplantation associated thrombotic microangiopathy (TA-TMA).Methods The clinical data of 9 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation (allo-HSCT) were retrospectively analyzed from January 2011 to August 2018 in Affiliated Tumor Hospital of Zhengzhou University.Results There were 6 male and 3 female patiens with a median age of 31 (12-38) years.The median time from transplantation to TA-TMA was 76 (24-155) days.The baseline blood and biochemical parameters at diagnosis of TA-TMA included median hemoglobin (Hb) 66 (58-77) g/L,platelet (PLT) count 22 (4-38) × 109/L,serum lactic dehydrogenase (LDH) 655 (305-4 238) U/L,blood urine nitrogen (BUN)level 15.9 (4.8-26.2) mmol/L,blood creatinine (Cr) level 118 (24-380) μmol/L.The proportion of median peripheral blood schistocytes was 2.6％(1.2％-9％).All patients had positive urinary occult blood tests,and urinary protein was seen in 4 patients.Three patients had mental symptoms.Coombs tests were all negative.The main treatments of TA-TMA composed of reduction and withdrawal of calcineurin inhibitor,steroids and plasma exchange.Response was seen in 4 patients.Patients who did not response to the treatment had a higher proportion of schistocytes,more severe acute graft-versus-host disease (aGVHD),more elevated serum LDH and other transplant-related complications.Conclusions TA-TMA after allo-HSCT is a serious complication with high mortality rate.The proportion of schistocytes in peripheral blood,serum LDH level and comorbidities are prognostic factors of clinical outcome.
