Conversion from calcineurin inhibitors to sirolimus in transplant-associated thrombotic microangiopathy.

Autor: Kanunnikov MM; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Rakhmanova ZZ; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Levkovsky NV; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Vafina AI; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Goloshapov OV; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Shchegoleva TS; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Vlasova JJ; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Paina OV; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Morozova EV; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., S Zubarovskaya L; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., Kulagin AD; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia., S Moiseev I; RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2021 Feb; Vol. 35 (2), pp. e14180. Date of Electronic Publication: 2020 Dec 20.
DOI: 10.1111/ctr.14180
Abstrakt: Transplant-associated thrombotic microangiopathy (TA-TMA) is a specific complication of allogeneic hematopoietic cell transplantation with a multifactorial etiology. There is little evidence published regarding the efficacy and factors influencing the outcome of substitution of calcineurin inhibitors (CNIs) with other agentsas a widely accepted practice in this disorder; however, there are limited data on the options for immunosuppression manipulation (ISM). In our study, we retrospectively analyzed outcomes of 45 patients with TA-TMA with ISM and substitution either with steroids (steroid group) or anmTOR inhibitor sirolimus (sirolimus group). In our study, sirolimus was associated with significantly better 1-year overall survival (HR 0.3, 95% CI 0.13-0.7, p = .004) and faster time to normalization of LDH (HR 2.2, 95% CI 0.99-4.99, p = .044). Replacing CNIs with sirolimus could be an effective option in patients with TA-TMA. A multicenter confirmatory study of CNIs replacement with sirolimus is justified.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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