Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation

Bone Marrow Transplantation volume 36, pages 517–523 (2005)Cite this article

Summary:

Thrombotic microangiopathy (TMA) is a significant complication after hematopoietic stem-cell transplantation (HSCT); however, there is little information on it following reduced-intensity cord blood transplantation (RI-CBT). We reviewed the medical records of 123 adult patients who received RI-CBT at Toranomon Hospital between January 2002 and August 2004. TMA was diagnosed in seven patients based on intestinal biopsy (n=6) or autopsy results (n=1). While these patients showed some clinical symptoms such as diarrhea and/or abdominal pain, mental status alterations or neurological disorders were not observed in any of them. Laboratory results were mostly normal at the onset of TMA; >2% fragmented erythrocytes (n=1), <10 mg/dl haptoglobin (n=1), and >200 IU/dl lactic dehydrogenase (LD) (n=4). On endoscopic examination, TMA lesions, consisting of ulcers, erosions, and diffuse exfoliation, were distributed spottily from terminal ileum to rectum. Intestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) colitis were confirmed in five and four patients, respectively. With therapeutic measures including supportive care (n=4), fresh frozen plasma (n=1), and a reduction of immunosuppressive agents (n=1), TMA improved in four patients. The present study demonstrates that intestinal TMA is a significant complication after RI-CBT. Since conventional diagnostic criteria can overlook TMA, its diagnosis requires careful examination of the gastrointestinal tract using endoscopy with biopsy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Shimoni A, Yeshurun M, Hardan I et al. Thrombotic microangiopathy after allogeneic stem cell transplantation in the era of reduced-intensity conditioning: the incidence is not reduced. Biol Blood Marrow Transplant 2004; 10: 484–493.

    Article  PubMed  Google Scholar 

  2. 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 2004; 33: 1143–1150.

    Article  CAS  PubMed  Google Scholar 

  3. Pettitt AR, Clark RE . Thrombotic microangiopathy following bone marrow transplantation. Bone Marrow Transplant 1994; 14: 495–504.

    CAS  PubMed  Google Scholar 

  4. Zeigler ZR, Shadduck RK, Nemunaitis J et al. Bone marrow transplant-associated thrombotic microangiopathy: a case series. Bone Marrow Transplant 1995; 15: 247–253.

    CAS  PubMed  Google Scholar 

  5. Zeigler ZR, Shadduck RK, Nath R et al. Pilot study of combined cryosupernatant and protein A immunoadsorption exchange in the treatment of grade 3–4 bone marrow transplant-associated thrombotic microangiopathy. Bone Marrow Transplant 1996; 17: 81–86.

    CAS  PubMed  Google Scholar 

  6. Daly AS, Xenocostas A, Lipton JH . Transplantation-associated thrombotic microangiopathy: twenty-two years later. Bone Marrow Transplant 2002; 30: 709–715.

    Article  CAS  PubMed  Google Scholar 

  7. Zomas A, Saso R, Powles R et al. Red cell fragmentation (schistocytosis) after bone marrow transplantation. Bone Marrow Transplant 1998; 22: 777–780.

    Article  CAS  PubMed  Google Scholar 

  8. Barker JN, Weisdorf DJ, DeFor TE et al. Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning. Blood 2003; 102: 1915–1919.

    Article  CAS  PubMed  Google Scholar 

  9. Miyakoshi S, Yuji K, Kami M et al. Successful engraftment after reduced-intensity umbilical cord blood transplantation for adult patients with advanced hematological diseases. Clin Cancer Res 2004; 10: 3586–3592.

    Article  PubMed  Google Scholar 

  10. Kodera Y, Morishima Y, Kato S et al. Analysis of 500 bone marrow transplants from unrelated donors (UR-BMT) facilitated by the Japan Marrow Donor Program: confirmation of UR-BMT as a standard therapy for patients with leukemia and aplastic anemia. Bone Marrow Transplant 1999; 24: 995–1003.

    Article  CAS  PubMed  Google Scholar 

  11. Nishihira H, Kato K, Isoyama K et al. The Japanese cord blood bank network experience with cord blood transplantation from unrelated donors for haematological malignancies: an evaluation of graft-versus-host disease prophylaxis. Br J Haematol 2003; 120: 516–522.

    Article  PubMed  Google Scholar 

  12. Allford SL, Bird JM, Marks DI . Thrombotic thrombocytopenic purpura following stem cell transplantation. Leuk Lymphoma 2002; 43: 1921–1926.

    Article  PubMed  Google Scholar 

  13. Furlan M, Robles R, Galbusera M et al. von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. N Engl J Med 1998; 339: 1578–1584.

    Article  CAS  PubMed  Google Scholar 

  14. Trimarchi HM, Truong LD, Brennan S et al. FK506-associated thrombotic microangiopathy: report of two cases and review of the literature. Transplantation 1999; 67: 539–544.

    Article  CAS  PubMed  Google Scholar 

  15. Pham PT, Peng A, Wilkinson AH et al. Cyclosporine and tacrolimus-associated thrombotic microangiopathy. Am J Kidney Dis 2000; 36: 844–850.

    Article  CAS  PubMed  Google Scholar 

  16. Ballermann BJ . Endothelial cell activation. Kidney Int 1998; 53: 1810–1826.

    Article  CAS  PubMed  Google Scholar 

  17. Takatsuka H, Wakae T, Mori A et al. Endothelial damage caused by cytomegalovirus and human herpesvirus-6. Bone Marrow Transplant 2003; 31: 475–479.

    Article  CAS  PubMed  Google Scholar 

  18. Ertault-Daneshpouy M, Leboeuf C, Lemann M et al. Pericapillary hemorrhage as criterion of severe human digestive graft-versus-host disease. Blood 2004; 103: 4681–4684.

    Article  CAS  PubMed  Google Scholar 

  19. Goldberg J, Jacobsohn DA, Zahurak ML et al. Gastrointestinal toxicity from the preparative regimen is associated with an increased risk of graft-versus-host disease. Biol Blood Marrow Transplant 2005; 11: 101–107.

    Article  PubMed  Google Scholar 

  20. Iwata H, Kami M, Hori A et al. An autopsy-based retrospective study of secondary thrombotic thrombocytopenic purpura. Haematologica 2001; 86: 669–670.

    CAS  PubMed  Google Scholar 

  21. Martin PJ, McDonald GB, Sanders JE et al. Increasingly frequent diagnosis of acute gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2004; 10: 320–327.

    Article  PubMed  Google Scholar 

  22. Iqbal N, Salzman D, Lazenby AJ, Wilcox CM . Diagnosis of gastrointestinal graft-versus-host disease. Am J Gastroenterol 2000; 95: 3034–3038.

    Article  CAS  PubMed  Google Scholar 

  23. Meyers JD, Flournoy N, Thomas ED . Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 1986; 153: 478–488.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Dr Yoshihisa Morishita (JA Aichi Showa Hospital, Aichi, Japan) for his critical reading of the manuscript.

Author information

Authors and Affiliations

  1. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    H Narimatsu, T Matsumura, S Miyakoshi, E Kusumi, K Yuji, K Masuoka, A Yoneyama, A Wake, S Morinaga & S Taniguchi

  2. Hematopoietic Stem Cell Transplantation Unit, The National Cancer Center Hospital, Tokyo, Japan

    M Kami, Y Kishi & N Murashige

  3. Department of Pathology, Toranomon Hospital, Tokyo, Japan

    S Hara

  4. Endoscopy Division, The National Cancer Center Hospital, Tokyo, Japan

    Y Kakugawa

  5. Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan

    Y Kanda

Authors
  1. H Narimatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Kami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Miyakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E Kusumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y Kakugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Y Kishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N Murashige
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K Yuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. K Masuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A Yoneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. A Wake
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. S Morinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Y Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. S Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Kami.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Narimatsu, H., Kami, M., Hara, S. et al. Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation. Bone Marrow Transplant 36, 517–523 (2005). https://doi.org/10.1038/sj.bmt.1705099

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705099

Keywords

This article is cited by

Search

Advanced search

Quick links