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Autografting

Early clinical indicators of transplant-associated thrombotic microangiopathy in pediatric neuroblastoma patients undergoing auto-SCT

Bone Marrow Transplantation volume 46, pages 682–689 (2011)Cite this article

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Abstract

Patients undergoing auto-SCT for neuroblastoma present a unique population to study transplant-associated thrombotic microangiopathy (TA-TMA), due to standardized chemotherapy and later exposure to radiation and cis-retinoic acid (cis-RA). We retrospectively analyzed 20 patients after auto-SCT to evaluate early clinical indicators of TA-TMA. A total of 6 patients developing TA-TMA (30% prevalence) were compared with 14 controls. Four of six patients were diagnosed with TA-TMA by 25 days after auto-SCT. Compared with controls, TA-TMA patients had higher average systolic and diastolic blood pressure levels during high-dose chemotherapy and developed hypertension by day 13 after auto-SCT. Proteinuria was a significant marker for TA-TMA, whereas blood and platelet transfusion requirements were not. Serum creatinine did not differ between groups post transplant. However, patients with TA-TMA had a 60% decrease in renal function from baseline by nuclear glomerular filtration rate, compared with a 25% decrease in those without TA-TMA (P=0.001). There was no TA-TMA-related mortality. Significant complications included end-stage renal disease (n=1) and polyserositis (n=3). Patients with TA-TMA were unable to complete cis-RA therapy after auto-SCT. We suggest that careful attention to blood pressure and urinalysis will assist in the early diagnosis of TA-TMA, whereas serum creatinine seems to be an insensitive marker for this condition.

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Acknowledgements

We thank the Hoxworth Blood Center team at the University of Cincinnati for their assistance and Sarah Kotila, RN, CPON and Mark Mueller, RN for coordinating patient care.

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Authors and Affiliations

  1. Divisions of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    B L Laskin & J Goebel

  2. Department of Pediatrics, Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    S M Davies, J J Bleesing, P A Mehta, A H Filipovich, Z N Paff, J M Lawrence & S Jodele

  3. Department of Pediatrics, Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    J C Khoury

  4. Department of Pediatrics, Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    H J Yin

  5. Department of Donor Operations, Hoxworth Blood Center, University of Cincinnati, Cincinnati, OH, USA

    S L Pinkard

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  1. B L Laskin
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Correspondence to B L Laskin.

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Laskin, B., Goebel, J., Davies, S. et al. Early clinical indicators of transplant-associated thrombotic microangiopathy in pediatric neuroblastoma patients undergoing auto-SCT. Bone Marrow Transplant 46, 682–689 (2011). https://doi.org/10.1038/bmt.2010.182

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