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Post-transplant Complications

Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus

Bone Marrow Transplantation volume 49, pages 684–690 (2014)Cite this article

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Abstract

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a feared complication of allogeneic hematopoietic SCT (HSCT) owing to its high mortality rate. The use of calcineurin inhibitors or sirolimus (SIR) for GVHD prophylaxis has been suggested as a potential risk factor. However, the impact of tacrolimus (TAC) and SIR combinations on the increased risk of TA-TMA is currently not well defined. We retrospectively analyzed the incidence of TA-TMA in 102 allogeneic HSCT recipients who consecutively received TAC plus SIR (TAC/SIR) (n=68) or plus MTX (TAC/MTX)±ATG (n=34) for GVHD prophylaxis. No significant differences were observed in the incidence of TA-TMA between patients receiving TAC/SIR vs TAC/MTX±ATG (7.4% vs 8.8%, P=0.8). Only grade III–IV acute GVHD, previous HSCT and serum levels of TAC >25 ng/mL were associated with a greater risk of TA-TMA. Patients developing TA-TMA have significantly poorer survival (P<0.001); however, TA-TMA ceased to be an independent prognostic factor when it was included in a multivariate model. In conclusion, the combination of TAC/SIR does not appear to pose a higher risk of TA-TMA. By contrast, we identified three different risk groups for developing TA-TMA.

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Acknowledgements

We would like to thank Manuela Salinero, Marta García-Blázquez and Manuel Delgado for their technical assistance, and Phil Mason for English language revision of the manuscript.

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Authors and Affiliations

  1. Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain

    J Labrador, L López-Corral, O López-Godino, L Vázquez, M Cabrero-Calvo, M Díez-Campelo, F Sánchez-Guijo, E Pérez-López, I Alberca, M C del Cañizo, J R González-Porras & D Caballero

  2. Centro de Investigación del Cáncer, IBMC/CSIC-USAL, Salamanca, Spain

    J Labrador, C Guerrero & M C del Cañizo

  3. Pharmacy Department, Hospital Universitario de Salamanca, Salamanca, Spain

    R Pérez-López

  4. Department of Hematology, Hospital Universitario/Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain

    J A Pérez-Simón

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  1. J Labrador
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Correspondence to J Labrador.

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Author contributions

DC and JL conceived the study; JL performed the statistical analysis; JL, LL-C and DC wrote the paper; JL, OL-G and RP-L collected the data and critically reviewed the paper; LL-C, LV, MC-C, MD-C, FS-G, EP-L, CG, IA, JAP-S and DC provided the patients and critically reviewed the paper; all authors approved the final version of the paper.

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Labrador, J., López-Corral, L., López-Godino, O. et al. Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus. Bone Marrow Transplant 49, 684–690 (2014). https://doi.org/10.1038/bmt.2014.17

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