Comparison of thrombotic microangiopathy after allogeneic hematopoietic cell transplantation with high-dose or nonmyeloablative conditioning

• Published in: Bone marrow transplantation (Basingstoke) Vol. 45; no. 4; pp. 689 - 693
• Main Authors: Willems, E, Baron, F, Seidel, L, Frère, P, Fillet, G, Beguin, Y
• Format: Journal Article Web Resource
• Language: English
• Published: London Nature Publishing Group UK 01.04.2010; Nature Publishing Group
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cell Biology; Child; Child, Preschool; Conditioning; Development and progression; Female; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - complications; GVHD; Hematology; hematopoietic cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Human health sciences; Humans; Hématologie; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; nonmyeloablative; original-article; Proportional Hazards Models; Public Health; Retrospective Studies; Risk Factors; Sciences de la santé humaine; Stem cell transplantation; Stem Cells; Survival Analysis; Thrombotic Microangiopathies - etiology; Thrombotic microangiopathy; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplantation, Homologous; Venous thrombosis; Young Adult; Belgium; GVHD; thrombotic microangiopathy; nonmyeloablative; hematopoietic cell transplantation; Immunopathology; Graft versus host disease; Hematology; Stem cell; Hematopoietic cell; Homograft; Cardiovascular disease; Non myeloablative treatment; Thrombohemolytic microangiopathy; Vascular disease; Allogeneic hematopoietic stem cell transplantation; Graft; High dose; Comparative study
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2009.230

The role of conditioning intensity on occurrence of thrombotic microangiopathy (TMA) after allogeneic hematopoietic cell transplantation (HCT) has remained unclear thus far. Here, we retrospectively compared the incidence of TMA in patients given allogeneic hematopoietic stem cells after either nonmyeloablative ( n =176) or high-dose ( n =111) conditioning. The 1-year cumulative incidence of TMA was 13% in nonmyeloablative recipients versus 15% in high-dose conditioning recipients ( P =0.5). In multivariate Cox analysis, occurrence of grade 3–4 acute graft-versus-host disease (GVHD) (hazard ratio (HR)=2.3, P <0.001), older age (HR=1.01, P =0.045), and unrelated donors (HR=1.6, P =0.01) were each associated with a higher risk of TMA, whereas nonmyeloablative conditioning was associated with a lower risk of TMA (HR=0.6, P =0.01). We conclude that acute GVHD, age, donor type, and conditioning intensity might have a role in the physiopathology of TMA after allogeneic HCT.