[The risk factors and prognosis of transplant-associated thrombotic microangiopathy following acute graft-versus-host disease].

OBJECTIVE

To investigate the risk factors and prognosis of transplant-associated thrombotic microangiopathy (TA-TMA) following acute graft-versus-host disease (aGVHD), and to evaluate the factors that might influence the prognosis of TA-TMA.

METHODS

A nested case-control study was designed. Cases with TA-TMA (n = 33) and controls (n = 77) matched for age at allogeneic hematopoietic stem cell transplantation (allo-HSCT) and length of follow-up were identified from a cohort of 356 patients who suffered from aGVHD after allo-HSCT between 2009 and 2011.

RESULTS

The median time to presentation of TA-TMA was 3.5 (1.2-23.0) months post-HSCT. The median time from diagnosis and first-line treatment failure of aGVHD to TA-TMA diagnosis was 25 (7-257) days and 15 (5-257) days, respectively. aGVHD occurring beyond 60 days after allo-HSCT, initial grade III-IV aGVHD, first-line treatment failure and receiving tacrolimus as second-line treatment were independently associated with the occurrence of TA-TMA, and patients with two or more risk factors were at higher risk (OR = 210.0, P = 0.000). Twenty-two (66.7%) TA-TMA patients died. Progressive TA-TMA was the significantly adverse factor affecting the survival of TA-TMA cases. None of therapies could improve prognosis of patients with TA-TMA.

CONCLUSION

Many characteristics of aGVHD were associated with TA-TMA, which help us to identify the individuals who are at higher risk of developing TA-TMA following aGVHD and to select the more reasonable GVHD therapeutic strategies.