Mo Xiao-Dong, Xu Lan-Ping, Liu Dai-Hong, Zhang Xiao-Hui, Chen Huan, Chen Yu-Hong, Han Wei, Wang Yu, Wang Feng-Rong, Wang Jing-Zhi, Liu Kai-Yan, Huang Xiao-Jun
Institute of Hematology and People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Nei Ke Za Zhi. 2013 Feb;52(2):156-60.
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.
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.
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.
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.
探讨急性移植物抗宿主病（aGVHD）后移植相关血栓性微血管病（TA-TMA）的危险因素及预后，并评估可能影响TA-TMA预后的因素。
设计一项巢式病例对照研究。从2009年至2011年间接受异基因造血干细胞移植（allo-HSCT）后发生aGVHD的356例患者队列中，确定TA-TMA患者（n = 33）和在异基因造血干细胞移植时年龄及随访时间相匹配的对照组（n = 77）。
TA-TMA出现的中位时间为HSCT后3.5（1.2 - 23.0）个月。从aGVHD诊断至TA-TMA诊断以及一线治疗失败至TA-TMA诊断的中位时间分别为25（7 - 257）天和15（5 - 257）天。allo-HSCT后60天以上发生的aGVHD、初始III - IV级aGVHD、一线治疗失败以及接受他克莫司作为二线治疗与TA-TMA的发生独立相关，具有两个或更多危险因素的患者风险更高（OR = 210.0，P = 0.000）。22例（66.7%）TA-TMA患者死亡。进行性TA-TMA是影响TA-TMA患者生存的显著不利因素。没有任何治疗方法能改善TA-TMA患者的预后。
aGVHD的许多特征与TA-TMA相关，这有助于我们识别aGVHD后发生TA-TMA风险较高的个体，并选择更合理的GVHD治疗策略。
