Early clinical indicators of transplant-associated thrombotic microangiopathy in pediatric neuroblastoma patients undergoing auto-SCT

Patients undergoing auto-SCT for neuroblastoma present a unique population to study transplant-associated thrombotic microangiopathy (TA-TMA), due to standardized chemotherapy and later exposure to radiation and cis-retinoic acid (cis-RA). We retrospectively analyzed 20 patients after auto-SCT to ev...

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Published inBone marrow transplantation (Basingstoke) Vol. 46; no. 5; pp. 682 - 689
Main Authors Laskin, B L, Goebel, J, Davies, S M, Khoury, J C, Bleesing, J J, Mehta, P A, Filipovich, A H, Paff, Z N, Lawrence, J M, Yin, H J, Pinkard, S L, Jodele, S
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.05.2011
Nature Publishing Group
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Summary:Patients undergoing auto-SCT for neuroblastoma present a unique population to study transplant-associated thrombotic microangiopathy (TA-TMA), due to standardized chemotherapy and later exposure to radiation and cis-retinoic acid (cis-RA). We retrospectively analyzed 20 patients after auto-SCT to evaluate early clinical indicators of TA-TMA. A total of 6 patients developing TA-TMA (30% prevalence) were compared with 14 controls. Four of six patients were diagnosed with TA-TMA by 25 days after auto-SCT. Compared with controls, TA-TMA patients had higher average systolic and diastolic blood pressure levels during high-dose chemotherapy and developed hypertension by day 13 after auto-SCT. Proteinuria was a significant marker for TA-TMA, whereas blood and platelet transfusion requirements were not. Serum creatinine did not differ between groups post transplant. However, patients with TA-TMA had a 60% decrease in renal function from baseline by nuclear glomerular filtration rate, compared with a 25% decrease in those without TA-TMA ( P =0.001). There was no TA-TMA-related mortality. Significant complications included end-stage renal disease ( n =1) and polyserositis ( n =3). Patients with TA-TMA were unable to complete cis-RA therapy after auto-SCT. We suggest that careful attention to blood pressure and urinalysis will assist in the early diagnosis of TA-TMA, whereas serum creatinine seems to be an insensitive marker for this condition.
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ISSN:0268-3369
1476-5365
DOI:10.1038/bmt.2010.182