Predictors of Transplant-Associated Thrombotic Microangiopathy in Patients With Overlap or Chronic Graft-vs-Host-Disease
Autor: | Evangelia Yannaki, Apostolia Papalexandri, Marianna Masmanidou, Despina Mallouri, Anna Vardi, Ioannis Batsis, Eleni Gavriilaki, Zoi Bousiou, Achilles Anagnostopoulos, Thomas Chatzikonstantinou, Eudoxia-Evaggelia Koravou, Tasoula Touloumenidou, Foteini Kika, Ioanna Sakellari |
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Rok vydání: | 2021 |
Předmět: |
Ruxolitinib
medicine.medical_specialty Thrombotic microangiopathy Multivariate analysis CD34 Graft vs Host Disease Transplants Gastroenterology immune system diseases Internal medicine medicine Humans In patient Host disease Retrospective Studies Transplantation Thrombotic Microangiopathies business.industry Hematopoietic Stem Cell Transplantation medicine.disease surgical procedures operative Etiology Surgery business medicine.drug |
Zdroj: | Transplantation Proceedings. 53:2261-2266 |
ISSN: | 0041-1345 |
DOI: | 10.1016/j.transproceed.2021.07.043 |
Popis: | Background Recent data suggest that novel biologic agents are associated with increased risk of thrombotic microangiopathy (TMA). Ruxolitinib, an approved treatment for graft-vs-host-disease (GVHD), has been associated with thrombocytopenia of unclear etiology. Methods We investigated factors and outcomes associated with transplant-associated thrombotic microangiopathy (TA-TMA) in patients with GVHD. We retrospectively enrolled consecutive allogeneic hematopoietic cell transplantation recipients with overlap or chronic GVHD at our Joint Accreditation Committee ISCT-Europe & EBMT-accredited unit (January 2016-June 2019). Ruxolitinib has been administered off-label since 2016. Results Among 160 patients with GVHD, 18 were diagnosed with TA-TMA. TA-TMA developed at a median of 150 posttransplant days (range, 98-3013). Among pre- and posttransplant factors, TA-TMA was associated only with ruxolitinib administration and severe GVHD. Interestingly, these 2 variables did not correlate with each other. In the multivariate analysis, both were independent predictors of TA-TMA. Time-dependent analysis confirmed ruxolitinib's association with TA-TMA. With a follow-up of 38.4 months (4.6-83.9) in surviving patients, 5-year overall survival was 52.9%, independently predicted by TA-TMA, severe acute GVHD, and CD34+ cells infused. Ruxolitinib was not associated with survival outcomes. Conclusions Our data suggest that ruxolitinib and GVHD severity are associated with TA-TMA. Given the expanding use of ruxolitinib in GVHD and ongoing trials on chronic GVHD, further studies are warranted to confirm these findings. |
Databáze: | OpenAIRE |
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