Abstract
TAM is associated with a poor prognosis and outcome. Reported incidence varies from 0.5 to 76%. Risk factors (RF) include use of calcineurin inhibitors(CNI), infections, conditioning chemotherapy regimen and graft versus host disease. Although treatment (TMT) modalities such as inmunosuppressive drugs withdrawal, plasma exchange or infusion are used to improve the outcome, optimal therapeutic strategies are not clearly defined.
OBJECTIVE: To compare the incidence, RF and outcome of patients (pts) with TAM after HSCT and SOTX.
PATIENTS AND METHODS: In 1172 consecutive pts transplanted between february 2000 and june 2006, 22 TAM episodes were diagnosed. TAM Dg was defined as evidence of hemolysis and schistocytes in blood smear. Thrombocytopenia (TCP), neurological (NRL) or renal (RNL) dysfunction were not included in the diagnostic criteria.
RESULTS: MAT incidence was 5,41% (11/203) in HSCT and 1,13% (11/969) in SOTX pts (p<0,0006). Median follow up of surviving pts was 1144 days (range: 281–2432). Overall mortality was 36,36% (8/22), 4/11 HSCT and 4/11 SOTX.
| . | HSCT m . | HSCT r . | SOTX m . | SOTX r . |
|---|---|---|---|---|
| m: media r: range | ||||
| Age (years) | 23,6 | 7–42 | 54 | 31–69 |
| Sex (male) (%) | 63,6 | 54,5 | ||
| Time to Dg (days) | 68,2 | 12–236 | 111,4 | 4–1097 |
| TCP at Dg (%) | 81,8 | 100 | ||
| NRL at Dg (%) | 18,2 | 40 | ||
| RNL at Dg (%) | 18,2 | 63,6 | ||
| Hematocrite at Dg/post TMT(%) | 26,9/34,3 | 20–35/25–48 | 18,5/32,8 | 18–28/29–37 |
| LDH at Dg/post TMT | 1186,4/946,4 | 607–2247/548–1629 | 1325,7/522 | 639–3960/295–630 |
| Platelets at Dg/post TMT (×10 3/ml) | 66,9/158 | 5–30/20–380 | 48/139 | 15–90/5–280 |
| Urea/creatinine at Dg | 66/1,2 | 17–95/0,6–2,3 | 124,8/3,4 | 41–190/0,9–6,5 |
| Total Bilirrubin/Indirect Bilirrubin at Dg | 6,2/2,3 | 0,7–14/0,4–5,5 | 3,2/1,9 | 0,4–13/0,2–7,7 |
| Cyclosporine/FK at Dg (%) | 81,8/18,2 | 9,1/90 | ||
| TMT response (%) | 72,7 | 80 | ||
| Days to last evaluation (all/survival pts) | 784,8/978,3 | 26–1584/281–1584 | 850,6/1310,6 | 26–2342/374–2237 |
| Days to death since TX | 391 | 26–908 | 58,7 | 26–96 |
| Days to death since MAT Dg | 361 | 6–862 | 12,8 | 7–20 |
| . | HSCT m . | HSCT r . | SOTX m . | SOTX r . |
|---|---|---|---|---|
| m: media r: range | ||||
| Age (years) | 23,6 | 7–42 | 54 | 31–69 |
| Sex (male) (%) | 63,6 | 54,5 | ||
| Time to Dg (days) | 68,2 | 12–236 | 111,4 | 4–1097 |
| TCP at Dg (%) | 81,8 | 100 | ||
| NRL at Dg (%) | 18,2 | 40 | ||
| RNL at Dg (%) | 18,2 | 63,6 | ||
| Hematocrite at Dg/post TMT(%) | 26,9/34,3 | 20–35/25–48 | 18,5/32,8 | 18–28/29–37 |
| LDH at Dg/post TMT | 1186,4/946,4 | 607–2247/548–1629 | 1325,7/522 | 639–3960/295–630 |
| Platelets at Dg/post TMT (×10 3/ml) | 66,9/158 | 5–30/20–380 | 48/139 | 15–90/5–280 |
| Urea/creatinine at Dg | 66/1,2 | 17–95/0,6–2,3 | 124,8/3,4 | 41–190/0,9–6,5 |
| Total Bilirrubin/Indirect Bilirrubin at Dg | 6,2/2,3 | 0,7–14/0,4–5,5 | 3,2/1,9 | 0,4–13/0,2–7,7 |
| Cyclosporine/FK at Dg (%) | 81,8/18,2 | 9,1/90 | ||
| TMT response (%) | 72,7 | 80 | ||
| Days to last evaluation (all/survival pts) | 784,8/978,3 | 26–1584/281–1584 | 850,6/1310,6 | 26–2342/374–2237 |
| Days to death since TX | 391 | 26–908 | 58,7 | 26–96 |
| Days to death since MAT Dg | 361 | 6–862 | 12,8 | 7–20 |
CONCLUSIONS: In our experience TAM was an uncommon complication and its incidence was higher during the first 3 months after transplantation. It was more frequent among HSCT recipients. At Dg all TAM pts were receiving CNI as part of the immunosuppressive protocol. Drug withdrawal improved laboratory results and pt outcome in both groups. NRL and renal symptoms were more frequently seen in SOTX. Survival after TAM Dg in SOTX was shorter compared to HSCT recipients. Both groups showed similar mortality rate (36,36%).
Disclosure: No relevant conflicts of interest to declare.
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