New insights into risk factors for transplant-associated thrombotic microangiopathy in pediatric HSCT [documento electrónico] / Luz Natalia Builes Restrepo,  . - 2020.
Obra : Blood Advances

Idioma : Inglés (eng)

Palabras clave :	tissue microarray  transplantation  trimethylamine  hematopoietic stem cell transplantation
Resumen :	This study aimed to identify a risk profile for development of transplant-associated thrombotic microangiopathy (TA-TMA) in children undergoing hematopoietic stem cell transplantation (HSCT). Between 2013 and 2016, 439 children underwent 474 HSCTs at 2 supraregional United Kingdom centers. At a median of 153 days post-HSCT, TA-TMA occurred among 25 of 441 evaluable cases (5.6%) with no evidence of center variation. Sex, underlying disease, intensity of the conditioning, total body irradiation–based conditioning, the use of calcineurin inhibitors, venoocclusive disease, and viral reactivation did not influence the development of TA-TMA. Donor type: matched sibling donor/matched family donor vs matched unrelated donor vs mismatched unrelated donor/haplo-HSCT, showed a trend toward the development of TA-TMA in 1.8% vs 6.1% vs 8.3%, respectively. Presence of active comorbidity was associated with an increased risk for TA-TMA; 13% vs 3.7% in the absence of comorbidity. The risk of TA-TMA was threefold higher among patients who received >1 transplant. TA-TMA rates were significantly higher among patients with acute graft-versus-host disease (aGVHD) grades III to IV vs aGVHD grade 0 to II. On multivariate analysis, the presence of active comorbidity, >1 transplant, aGVHD grade III to IV were risk factors for TA-TMA (odds ratio [OR]: 5.1, 5.2, and 26.9; respectively), whereas the use of cyclosporine A/tacrolimus-based GVHD prophylaxis was not a risk factor for TA-TMA (OR: 0.3). Active comorbidity, subsequent transplant, and aGVHD grades III to IV were significant risk factors for TA-TMA. TA-TMA might represent a form of a vascular GVHD, and therefore, continuing control of aGVHD is important to prevent worsening of TA-TMA associated with GVHD.
Mención de responsabilidad :	Reem Elfeky, Giovanna Lucchini, Su-Han Lum, Giorgio Ottaviano, Natalia Builes, Zohreh Nademi, Alexandra Battersby, Terence Flood, Stephen Owens, Andrew J Cant, Helen Young, Sinéad Greener, Patrick Walsh, David Kavanagh, Srinivas Annavarapu, Kanchan Rao, Persis Amrolia, Robert Chiesa, Austen Worth, Claire Booth, Roderick Skinner, Bilyana Doncheva, Joseph Standing, Andrew R Gennery, Waseem Qasim, Mary Slatter, Paul Veys
Referencia :	Blood Adv. 2020 Jun 9;4(11):2418-2429.
DOI (Digital Object Identifier) :	10.1182/bloodadvances.2019001315
PMID :	32492158
En línea :	https://ashpublications.org/bloodadvances/article/4/11/2418/460608/New-insights- [...]
Enlace permanente :	https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5105