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Transplant-Associated Microangiopathy in Patients Receiving Tacrolimus Following Allogeneic Stem Cell Transplantation: Risk Factors and Response to Treatment
- Source :
-
Biology of Blood & Marrow Transplantation . Apr2007, Vol. 13 Issue 4, p469-477. 9p. - Publication Year :
- 2007
-
Abstract
- Abstract: Transplant-associated microangiopathy (TAM) is a life-threatening complication after allogeneic HSCT, particularly with the use of calcineurin inhibitors as post-transplantation immunosuppressive therapy. We report our experience with TAM after HSCT with tacrolimus-based GVHD prophylaxis in a single-center study. Sixty-six of 1219 transplant recipients developed TAM with a cumulative incidence of 5.9%. Risk factors for TAM were female gender, lymphoid malignancy, receipt of a matched unrelated donor, and grade II-IV aGVHD. Most patients had infection and/or active GVHD at the diagnosis of TAM (82%). In the absence of renal dysfunction or encephalopathy, tacrolimus was generally continued, maintaining blood levels within the lower therapeutic range. Sixty-three patients were treated with plasma exchange. The cumulative incidence of response of TAM was 60%. Only 1 patient had a response of TAM without resolution of concomitant infections or GVHD. Six-month survivals were 0% and 50% for TAM nonresponders and responders, respectively. In conclusion, TAM is a common, life-threatening complication of allogeneic hematopoietic transplantation using tacrolimus prophylaxis. Control of TAM generally requires response of associated infections and GVHD. TMA response may occur despite continuation of tacrolimus treatment. [Copyright &y& Elsevier]
- Subjects :
- *GRAFT versus host disease
*STEM cell transplantation
*TACROLIMUS
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 10838791
- Volume :
- 13
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Biology of Blood & Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 24462478
- Full Text :
- https://doi.org/10.1016/j.bbmt.2006.11.020