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 mHSCT rSOTX mSOTX 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 mHSCT rSOTX mSOTX 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 
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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%).

Topics:
hematopoietic stem cell transplantation, stem cells, thrombotic microangiopathies, transplantation, brachial plexus neuritis, blood smear, calcineurin inhibitors, chemotherapy regimen, creatinine, cyclosporine

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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