Medical School of Chinese PLA, Beijing, China (mainland).
Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China (mainland).
Ann Transplant. 2023 Jun 20;28:e939890. doi: 10.12659/AOT.939890.
BACKGROUND Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplantation (HSCT). The efficacy and survival of plasma exchange (PE) for TA-TM have not been fully clarified. In addition, there is a lack of consensus on diagnostic criteria for TA-TMA. MATERIAL AND METHODS We retrospectively analyzed 32 patients diagnosed with TA-TMA by different diagnostic criteria from January 2018 to February 2022 at the First Medical Center of the PLA General Hospital. RESULTS (1) The patients with TA-TMA treated with PE in this study had a remission rate of 42.8%, a 100-day OS of 47.6%, and a 6-month OS of 38.1%. The only factor affecting the response to PE treatment was the number of PE sessions (P = 0.047). (2) III-IV aGVHD prior to TA-TMA diagnosis (P = 0.002), renal or neurological dysfunction (P = 0.021), and the time to onset of TA-TMA (P = 0.002) were independent risk factors for overall survival with TA- TMA. (3) Probable TA-TMA had the highest survival rate, but the Jodele criteria are expected to diagnose earlier and provide the greatest benefit to patients. CONCLUSIONS PE is an effective treatment for TA-TMA especially in cases where complement blockers are not available. In addition, probable TA-TMA improved prognostic survival through early detection of patients with TA-TMA. There is a need for further large prospective trials to identify the population more suitable for PE treatment of TA-TMA and more valid diagnostic criteria.
移植相关血栓性微血管病（TA-TMA）是造血干细胞移植（HSCT）的严重并发症。血浆置换（PE）治疗 TA-TMA 的疗效和生存情况尚未完全明确。此外，TA-TMA 的诊断标准也缺乏共识。
我们回顾性分析了 2018 年 1 月至 2022 年 2 月在解放军总医院第一医学中心根据不同诊断标准诊断为 TA-TMA 的 32 例患者。
（1）本研究中接受 PE 治疗的 TA-TMA 患者缓解率为 42.8%，100 天 OS 为 47.6%，6 个月 OS 为 38.1%。唯一影响 PE 治疗反应的因素是 PE 次数（P = 0.047）。（2）TA-TMA 诊断前 III-IV 度急性移植物抗宿主病（aGVHD，P = 0.002）、肾功能或神经系统功能障碍（P = 0.021）以及 TA-TMA 发病时间（P = 0.002）是 TA-TMA 总生存的独立危险因素。（3）可能的 TA-TMA 具有最高的生存率，但 Jodele 标准有望更早诊断，并为患者带来最大益处。
PE 是治疗 TA-TMA 的有效方法，特别是在补体阻滞剂不可用时。此外，通过早期发现 TA-TMA 患者，可能的 TA-TMA 提高了预后生存率。需要进一步的大型前瞻性试验来确定更适合 TA-TMA 的 PE 治疗人群和更有效的诊断标准。
