Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Bone Marrow Transplant. 2010 Apr;45(4):699-704. doi: 10.1038/bmt.2009.233. Epub 2009 Sep 21.
Factors predictive of response to plasma exchange (PE) in treatment of transplantation-associated thrombotic microangiopathy (TA-TMA) are generally poorly understood. To determine any clinical or laboratory factors predictive of response to PE in treatment of TA-TMA, we retrospectively reviewed all 11 cases of TA-TMA treated with PE at out institution between December 2001 and March 2008. Response to PE was correlated with associated clinical conditions, grade of TA-TMA, TA-TMA index and lactate dehydrogenase (LDH) level at diagnosis. Overall response to PE was 27%, with three complete responses (CRs) and eight non-responses (NRs) seen. Response to PE was significantly associated with the absence of acute GVHD at TA-TMA diagnosis, with three CR in four patients without active acute GVHD, and NR in seven patients with acute GVHD (P=0.024). There was no significant association seen between response to PE grade of TA-TMA (P=0.179), TA-TMA index (P=0.25) or LDH measurements (P=0.31). Our experience in use of therapeutic PE for management of TA-TMA suggests that PE may indeed be effective in the treatment of this disorder, depending on the clinical circumstance in which it develops. PE is potentially efficacious in the absence of active acute GVHD, and ineffective when acute GVHD is manifest.
预测血浆置换（PE）治疗移植相关血栓性微血管病（TA-TMA）反应的因素通常理解不佳。为了确定治疗 TA-TMA 时预测 PE 反应的任何临床或实验室因素，我们回顾性分析了 2001 年 12 月至 2008 年 3 月期间在我院接受 PE 治疗的 11 例 TA-TMA 患者。PE 反应与相关临床情况、TA-TMA 分级、TA-TMA 指数和乳酸脱氢酶（LDH）水平相关。PE 总体反应率为 27%，其中 3 例完全缓解（CR）和 8 例无反应（NR）。PE 反应与 TA-TMA 诊断时无急性 GVHD 显著相关，4 例无急性 GVHD 的患者中有 3 例 CR，7 例有急性 GVHD 的患者中有 8 例 NR（P=0.024）。PE 反应与 TA-TMA 分级（P=0.179）、TA-TMA 指数（P=0.25）或 LDH 测量值（P=0.31）之间无显著相关性。我们在使用治疗性 PE 治疗 TA-TMA 方面的经验表明，PE 可能确实对这种疾病有效，具体取决于其发生的临床情况。在无急性 GVHD 时，PE 可能有效，而在急性 GVHD 时无效。
