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Thrombotic microangiopathy with concomitant GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome
Author(s) -
Zhang Xiaohui,
Liu Xiao,
Wang Qianming,
He Yun,
Zhu Xiaolu,
Zhang Jiamin,
Han Wei,
Chen Huan,
Chen Yuhong,
Wang Fengrong,
Wang Jingzhi,
Zhang Yuanyuan,
Mo Xiaodong,
Chen Yao,
Wang Yu,
Fu Haixia,
Chang Yingjun,
Xu Lanping,
Liu KaiYan,
Huang XiaoJun
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12996
Subject(s) - thrombotic microangiopathy , concomitant , medicine , hematopoietic stem cell transplantation , gastroenterology , complication , univariate analysis , transplantation , immunology , multivariate analysis , disease
Objectives To explore the possible risk factors for the occurrence and mortality of thrombotic microangiopathy ( TMA ) with concomitant acute graft‐vs‐host disease ( aGVHD ) and to investigate outcomes and treatments of this disorder after allo‐ HSCT . Methods Fifty cases diagnosed with TMA with concomitant aGVHD and 150 controls were identified from a cohort composed of 3992 patients who underwent allo‐ HSCT from 2008 to 2016. Results Grade III ‐ IV aGVHD ( P = .000), acute kidney injury ( AKI ) ( P = .033), and hypertension ( P = .028) were significant independent risk factors associated with the occurrence of TMA with concomitant aGVHD . A haptoglobin level below normal ( P = .013), a maximum volume of diarrhea >2500 mL/d ( P = .015), and bloody diarrhea ( P = .049) were significant markers for death in both univariate and multivariate analyses. Patients diagnosed with TMA with concomitant aGVHD had a lower overall survival (OS), a higher non‐relapse mortality ( NRM ), but a lower risk of relapse. Conclusions Thrombotic microangiopathy with concomitant aGVHD is a significant complication after allo‐ HSCT , with a worse outcome, including significantly lower OS and higher NRM . There are specific risk factors associated with occurrence and mortality of this complication.