Risk Factors for Transplant-Associated Thrombotic Microangiopathy after Autologous Hematopoietic Cell Transplant in High-Risk Neuroblastoma.

Autor: Tolbert VP; Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children's Hospital, San Francisco, California., Dvorak CC; Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children's Hospital, San Francisco, California., Golden C; Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, Oakland, California., Vissa M; Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, Oakland, California., El-Haj N; Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, Oakland, California., Perwad F; Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children's Hospital, San Francisco, California., Matthay KK; Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children's Hospital, San Francisco, California., Vo KT; Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children's Hospital, San Francisco, California. Electronic address: Kieuhoa.Vo@ucsf.edu.
Jazyk: angličtina
Zdroj: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2019 Oct; Vol. 25 (10), pp. 2031-2039. Date of Electronic Publication: 2019 Jun 12.
DOI: 10.1016/j.bbmt.2019.06.006
Abstrakt: High-risk neuroblastoma has a poor prognosis, and research studies have shown that increasing the intensity of therapy improves outcomes. Autologous hematopoietic cell transplant (aHCT) as consolidation therapy confers a significant survival advantage but is accompanied by significant morbidity. Transplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication caused by endothelial injury that often leads to hemolytic anemia, microthrombotic platelet consumption, and renal injury. Here we investigated the incidence, potential risk factors, and sequelae of TA-TMA in patients with high-risk neuroblastoma. We conducted a retrospective chart review of all patients (n = 141) with neuroblastoma in our institutions who underwent aHCT from 2000 to 2017. Ten patients (7%) developed TA-TMA. The patients in the TA-TMA group were similar to the rest of the subjects in demographics, disease burden, prior therapies, renal function, and timing of transplant. The type of conditioning regimen was the only statistically significant pretransplant variable (P < .001). Six of 15 patients (40%) intended to receive tandem transplants (cyclophosphamide/thiotepa and then carboplatin/etoposide/melphalan (CEM)), 4 of 68 patients (6%) who received conditioning with single CEM, and none of the 56 patients who received busulfan/melphalan were diagnosed with TA-TMA. Patients with TA-TMA were more likely to require intensive care unit transfer, have a longer length of stay in the hospital, and experience a delay or change in their subsequent therapy. In our cohort overall, patients with a delay in therapy after transplant appeared to have a worse overall survival, although the difference was not statistically significant. Because of this high incidence and significant morbidity, we have implemented standardized screening for TA-TMA during and after transplant. We anticipate that screening will lead to earlier intervention and decreased severity of disease.
(Copyright © 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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