Abstract
Factors predictive of response to plasma exchange (PE) in treatment of transplantation-associated thrombotic microangiopathy (TA-TMA) are generally poorly understood. To determine any clinical or laboratory factors predictive of response to PE in treatment of TA-TMA, we retrospectively reviewed all 11 cases of TA-TMA treated with PE at out institution between December 2001 and March 2008. Response to PE was correlated with associated clinical conditions, grade of TA-TMA, TA-TMA index and lactate dehydrogenase (LDH) level at diagnosis. Overall response to PE was 27%, with three complete responses (CRs) and eight non-responses (NRs) seen. Response to PE was significantly associated with the absence of acute GVHD at TA-TMA diagnosis, with three CR in four patients without active acute GVHD, and NR in seven patients with acute GVHD (P=0.024). There was no significant association seen between response to PE grade of TA-TMA (P=0.179), TA-TMA index (P=0.25) or LDH measurements (P=0.31). Our experience in use of therapeutic PE for management of TA-TMA suggests that PE may indeed be effective in the treatment of this disorder, depending on the clinical circumstance in which it develops. PE is potentially efficacious in the absence of active acute GVHD, and ineffective when acute GVHD is manifest.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
George JN, Xiaoning L, McMinn JR, Terrell DR, Vesely SK, Selby GB . Thrombotic thrombocytopenia purpura-hemolytic uremic syndrome following HPC transplantation: a diagnostic dilemma. Transfusion 2004; 44: 294–304.
Batts ED, Lazarus HM . Diagnosis and treatment of transplantation-associated thrombotic microangiopathy: real progress or are we still waiting? Bone Marrow Transplant 2007; 40: 709–719.
Daly AS, Xenocostas A, Lipton JH . Transplantation associated thrombotic microangiopathy: twenty-two years later. Bone Marrow Transplant 2002; 30: 709–715.
Pettitt AR, Clark RE . Thrombotic microangiopathy following bone marrow transplantation. Bone Marrow Transplant 1994; 14: 495–504.
Kanamori H, Takaishi Y, Takabayashi M, Tanaka M, Yamaji S, Tomita N et al. Clinical significance of fragmented red cells after allogeneic bone marrow transplantation. Int J Hematol 2003; 77: 180–184.
Kersting S, Koomans HA, Hene RJ, Verdonck LF . Acute renal failure after allogeneic myeloablative stem cell transplantation: retrospective analysis of incidence, risk factors and survival. Bone Marrow Transplant 2007; 34: 359–364.
Reece DE, Frei-Lahr DA, Shepherd JD, Dorovini-Zis K, Gascoyne RD, Graeb DA et al. Neurologic complications in allogeneic bone marrow transplant patients receiving cyclosporine. Bone Marrow Transplant 1991; 8: 393–401.
Elliot MA, Nichols WL, Plumhoff E, Ansell S, Dispenzieri A, Gastineau D et al. Post transplantation thrombocytopenic purpura: a single centre experience and a contemporary review. Mayo Clin Proc 2003; 78: 421–430.
Zeigler ZR, Shadduck RK, Nemunaitis J, Andrews DF, Rosenfeld CS . Bone marrow transplant-associated thrombotic microangiopathy: a case series. Bone Marrow Transplant 1995; 15: 247–253.
Chown SR, Goulden N, Cornish JM, Oakhill A, Pamphilon D, Potter MN . The role of plasma exchange for TTP / HUS post-bone marrow transplant. Bone Marrow Transplant 1996; 17: 898–899.
Milone J, Napal J, Bordone J, Etchegoyen O, Morales V . Complete response in severe thrombotic microangiopathy post bone marrow transplantation (BMT-TM) after multiple plasmaphereses. Bone Marrow Transplant 1998; 22: 1019–1021.
Llamas P, Romero R, Cabrera R, Sanjuan I, Fores R, Fernandez MN . Management of thrombotic microangiopathy following allogeneic transplantation: what is the role of plasma exchange? Bone Marrow Transplant 1997; 20: 305–306.
Uderzo C, Bonanomi S, Busca A, Renoldi M, Ferrari P, Iacobelli M et al. Risk factors and severe outcome in thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation. Transplantation 2006; 82: 638–644.
Uderzo C, Fumagalli M, De Lorenzo P, Busca A, Vassallo E, Bonanomi S et al. Impact of thrombotic thrombocytopenic pupura on leukemic children undergoing bone marrow transplantation. Bone Marrow Transplant 2000; 26: 1005–1009.
Dua A, Zeigler Z, Shadduck RK, Nath R, Andrews F, Agha M . Apheresis in grade 4 bone marrow transplant associated thrombotic microangiopathy: a case series. J Clin Apher 1996; 11: 176–184.
Martinez MT, Bucher CH, Stussi G, Heim D, Buser A, Tsakiris TA et al. Transplant associated microangiopathy in recipients of allogeneic hematopoietic stem cell transplants. Bone Marrow Transplant 2005; 36: 993–1000.
Roy V, Rizvi MA, Vesely SA, George JN . Thrombotic thrombocytopenic purpura-like syndromes following bone marrow transplantation: an analysis of associated conditions and clinical outcomes. Bone Marrow Transplant 2001; 27: 641–646.
Iacopino P, Pucci G, Arcese W, Bosi A, Falda M, Locatelli F et al. Severe thrombotic microangiopathy: an infrequent complication of bone marrow transplantation. Bone Marrow Transplant 1999; 24: 47–51.
Fuge R, Bird JM, Fraser A, Hart D, Hunt L, Cornish JM et al. The clinical features, risk factors and outcome of thrombotic thrombocytopenic purpura occurring after bone marrow transplantation. Br J Haematol 2001; 113: 58–64.
Nakamae H, Yamane T, Hasegawa T, Nakaemae M, Terada Y, Hagihara K et al. Risk factor analysis for thrombotic microangiopathy after reduced intensity or myeloablative allogeneic hematopoietic stem cell transplantation. Am J Hematol 2006; 81: 525–531.
Sarkodee-Adoo C, Sotirescu D, Sensenbrenner L, Rapoport A, Cottler-Fox M, Tricot G et al. Thrombotic microangiopathy in blood and marrow transplant patients receiving tacrolimus or cyclosporine A. Transfusion 2003; 43: 78–84.
Sarode R, McFarland JG, Flomenberg N, Casper JT, Cohen EP, Drobyski WR et al. Therapeutic plasma exchange does not appear to be effective n the management of thrombotic thrombocytopenic purpure/haemolytic uremic syndrome following bone marrow transplantation. Bone Marrow Transplant 1995; 16: 271–275.
Ruutu T, Hermans J, Niederwieser D, Gratwohl A, Kiehl M, Volin L et al. Thrombotic thrombocytopenic purpura after allogeneic stem cell transplantation: a survey of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 2002; 118: 1112–1119.
Ho VT, Cutler C, Carter S, Martin P, Adams R, Horowitz M et al. Blood and marrow transplant-clinical trials network toxicity committee consensus summary: thrombotic microangiopathy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2005; 11: 571–575.
Ruutu T, Barosi G, Benjamin RJ, Clark RE, George JN, Gratwohl A et al. Diagnostic criteria for hematopoietic stem transplant associated thrombotic microangiopathy: results of a consensus process by an International Working Group. Haematologica 2007; 92: 95–100.
Kennedy GA, Bleakley S, Butler J, Mudie K, Kearey N, Durrant S . Post-transplant thrombotic microangiopathy: sensitivity of proposed new diagnostic criteria. Transfusion 2009 (e-pub ahead of print 18 May 2009).
Van der Plas RM, Schiphorst ME, Huizinga EG, Hene RJ, Verdonck LF, Sixma JJ et al. von Willebrand factor proteolysis is deficient in classic, but not in bone marrow transplantation-associated thrombotic thrombocytopenic purpure. Blood 1999; 93: 3798–3802.
Kentouche K, Zinti F, Angerhaus D, Fuchs D, Hermann J, Schneppenheim R et al. von Willebrand factor-cleaving protease (ADAMTS13) in the course of stem cell transplantation. Semin Thromb Hemost 2006; 32: 98–104.
Peyvandi F, Siboni SM, Lambertenghi Deliliers D, Lavoretano S, De Fazip N et al. Prospective study on the behaviour of the metalloprotease ADAMTS13 and of von Willebrand factor after bone marrow transplantation. Br J Haematol 2006; 134: 187–195.
Kennedy GA, Butler J, Western R, Morton J, Durrant S, Hill GR . Combination anti-thymocyte globulin and soluble TNFα inhibitor (etanercept)+/−mycophenolate mofetil for treatment of sterois=d refractory acute graft versus host disease. Bone Marrow Transplant 2006; 37: 1143–1147.
Cho BS, Min CK, Eom KS, Kim YJ, Kim HJ, Lee S et al. Clinical impact of thrombotic microangiopathy on the outcome of patients with acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 813–820.
Rizvi MA, Vesely SK, George JN, Chandler GL, Duvall D, Smith JW et al. Complications of plasma exchange in 71 consecutive patients treated for clinically suspected thrombotic thrombocytopenic purpura—haemolytic-uremic syndrome. Transfusion 2000; 40: 896–901.
Howard MA, Williams LA, Terrell DR, Duvall D, Vesely SK, George JN . Complications of plasma exchange in patients treated for clinically suspected thrombotic thrombocytopenic purpura – haemolytic uremic syndrome. Transfusion 2006; 46: 154–156.
Swisher KK, Terrell DR, Vesely SK, Kremer Hovinga JA, Lammle B et al. Clinical outcomes after platelet transfusions in patients with thrombotic thrombocytopenic purpura. Transfusion 2009; 49: 837–887.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kennedy, G., Kearey, N., Bleakley, S. et al. Transplantation-associated thrombotic microangiopathy: effect of concomitant GVHD on efficacy of therapeutic plasma exchange. Bone Marrow Transplant 45, 699–704 (2010). https://doi.org/10.1038/bmt.2009.233
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2009.233
Keywords
This article is cited by
-
Comparison of multiple treatments in the management of transplant-related thrombotic microangiopathy: a network meta-analysis
Annals of Hematology (2023)
-
Treatment outcome and efficacy of therapeutic plasma exchange for transplant-associated thrombotic microangiopathy in a large real-world cohort study
Bone Marrow Transplantation (2022)
-
Hematopoietic stem cell transplant-associated thrombotic microangiopathy: current paradigm and novel therapies
Bone Marrow Transplantation (2018)
-
Thrombotic microangiopathy following haematopoietic stem cell transplant
Pediatric Nephrology (2018)
-
The potential role of HLA-DRB1*11 in the development and outcome of haematopoietic stem cell transplantation-associated thrombotic microangiopathy
Bone Marrow Transplantation (2015)