The potential role of HLA-DRB111 in the development and outcome of haematopoietic stem cell transplantation-associated thrombotic microangiopathy

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 10; pp. 1321 - 1325
• Main Authors: Balassa, K, Andrikovics, H, Remenyi, P, Batai, A, Bors, A, Kiss, K P, Szilvasi, A, Rajczy, K, Inotai, D, Gopcsa, L, Lengyel, L, Barta, A, Reti, M, Tordai, A, Masszi, T
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2015; Nature Publishing Group
• Subjects: 631/250/1904; 692/420/2489/144; 692/699/1541; Antigens; Bone marrow; Care and treatment; Cell Biology; Cytomegalovirus; Drb1 protein; Female; Genetic aspects; Graft-versus-host reaction; Health aspects; Hematology; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Histocompatibility antigen HLA; HLA antigens; HLA-DRB1 Chains - immunology; HLA-DRB1 Chains - therapeutic use; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; original-article; Patients; Prognosis; Prophylaxis; Public Health; Retrospective Studies; Stem cell transplantation; Stem Cells; Survival Analysis; Tacrolimus; Thrombotic Microangiopathies - etiology; Thrombotic Microangiopathies - mortality; Thrombotic Microangiopathies - therapy; Thrombotic microangiopathy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Treatment Outcome; Vascular diseases; Hungary
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2015.161

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a serious complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) with high mortality rate. We retrospectively studied the frequency, clinical and genetic associations and prognostic effect of TA-TMA, in a total of 425 consecutive adult patients, who underwent allo-HSCT for a malignant haematological condition between 2007 and 2013 at our single centre. TA-TMA developed in 19% of the patients. Unrelated donor type ( P <0.001), acute GvHD grades II–IV ( P <0.001), myeloablative conditioning regimens ( P =0.003), tacrolimus-based GvHD prophylaxis ( P =0.003), CMV infection ( P =0.003) and carriership for HLA-DRB1*11 ( P =0.034) were associated with the development of TA-TMA. Survival was adversely affected by the presence of TA-TMA ( P <0.001). Among patients with TA-TMA, the outcome of HLA-DRB1*11 carriers was significantly better compared with non-carriers ( P =0.003). As a new finding, our observations suggest that the presence of HLA-DRB1*11 antigen contributes to the development of TA-TMA and affects the outcome.