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Thrombotic microangiopathy associated with monoclonal gammopathy following autologous hematopoietic stem cell transplantation for neuroblastoma in a young child

Bone Marrow Transplantation volume 52, pages 1662–1664 (2017)Cite this article

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Thrombotic microangiopathy is a serious complication of hematopoietic stem cell transplant (HSCT). The etiology and pathogenesis of transplant-associated thrombotic microangiopathy (TA-TMA) following allogeneic HSCT appear to be quite different from that in cases seen after autologous HSCT.1 Calcineurin inhibitors are often the culprit in the setting of allogeneic HSCT. The involved mechanisms may be different in cases seen early after transplant from those occurring later. In fact, TA-TMA is very rare after autologous HSCT. One published series reported a few children with neuroblastoma and TMA after autologous HSCT.2

A 4-year-old Caucasian boy with high-risk neuroblastoma [left adrenal primary, stage IV (bone and bone marrow involvement), unfavorable histology, N-myc non-amplified] received induction chemotherapy per Children’s Oncology Group (COG) protocol ANBL12P1 followed by tandem autologous HSCT and radiotherapy to the primary site per COG ANBL0532 protocol. Preparative regimens were cyclophosphamide/thiotepa for the first HSCT and carboplatin/etoposide/melphalan for the second. A nucleated cell dose of 11.2 × 108/kg was infused with each HSCT. Tumor resection, which included left radical nephrectomy, occurred after the 4th cycle of chemotherapy.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Hematology/Oncology, Blood and Marrow Transplant Program, Children’s Hospital of Michigan, Barbara Ann Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MI, USA,

    M Henry & S Savaşan

  2. Department of Pediatrics, Division of Nephrology and Hypertension, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA,

    R P Valentini

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  1. M Henry
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  2. R P Valentini
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  3. S Savaşan
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Correspondence to M Henry.

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Henry, M., Valentini, R. & Savaşan, S. Thrombotic microangiopathy associated with monoclonal gammopathy following autologous hematopoietic stem cell transplantation for neuroblastoma in a young child. Bone Marrow Transplant 52, 1662–1664 (2017). https://doi.org/10.1038/bmt.2017.181

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