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Post-Transplant Complications

Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease

Bone Marrow Transplantation volume 33, pages 1143–1150 (2004)Cite this article

Summary:

Thrombotic microangiopathy after bone marrow transplantation (post-BMT TMA) is a serious transplant-related complication. We identified 16 patients with TMA after allogeneic BMT who showed histopathological evidence of intestinal TMA in their gut specimens (six autopsies, 10 biopsies). In all, 14 patients had grade II–IV acute graft-versus-host disease (GVHD). The first seven patients were retrospectively diagnosed with TMA. Since six of them were diagnosed with progressive GVHD at that time because there was no awareness of the existence of intestinal TMA, they received more intensive treatment for GVHD, but all died between days +49 and +253. In contrast, the remaining nine patients were recently diagnosed with intestinal TMA on the basis of colonoscopic biopsies. For eight of these patients, the immunosuppressants were reduced, and the patients’ intestinal symptoms improved gradually. Six of the nine patients were still alive 12 months after the diagnosis of TMA. Our findings suggest that the gut may be a site involved in post-BMT TMA, presenting as ischemic enterocolitis. Differentiating intestinal TMA from acute GVHD is important in patients suffering from severe and refractory diarrhea after BMT.

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Acknowledgements

We thank Dr Takeo Yamaguchi, Dr Junichi Haruta and Dr Masafumi Ito for their helpful comments. This study was supported by Grants-in-Aid for Cancer Research (7-3) from the Ministry of Health and Welfare, Japan.

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Authors and Affiliations

  1. Department of Internal Medicine, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan

    T Nishida, M Hamaguchi, M Haneda, S Terakura, Y Atsuta, S Imagama, T Kanie, M Murata, H Taji, R Suzuki & Y Kodera

  2. Department of Molecular Medicine and Clinical Science, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    T Nishida, T Kanie & M Murata

  3. Department of Hematology and Clinical Research Center, Nagoya National Hospital, Nagoya, Aichi, Japan

    M Hamaguchi

  4. Department of Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan

    N Hirabayashi

  5. Department of Hematology and Chemotherapy, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan

    H Taji

  6. Department of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan

    R Suzuki

  7. Department of Hematology and Oncology, JA Aichi Showa Hospital, Kounan, Japan

    Y Morishita

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  1. T Nishida
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Correspondence to T Nishida.

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Nishida, T., Hamaguchi, M., Hirabayashi, N. et al. Intestinal thrombotic microangiopathy after allogeneic bone marrow transplantation: a clinical imitator of acute enteric graft-versus-host disease. Bone Marrow Transplant 33, 1143–1150 (2004). https://doi.org/10.1038/sj.bmt.1704512

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