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Hematopoietic cell transplantation–associated thrombotic microangiopathy (TMA) is a complication associated with higher nonrelapse mortality (NRM) in patients who undergo allogeneic transplant (HCT). Current classification criteria are not generally agreed on or validated, and the presence of confounding factors after transplant contribute to underdiagnosis or delayed diagnosis of TMA. We studied risk factors, incidence, and biomarkers of TMA in 119 adult allogeneic HCT recipients. Twenty-seven patients developed a clinically actionable phenotype of TMA (CA-TMA) and the incidence of CA-TMA was 22% by day 180. Among the 27 patients who developed CA-TMA, 10 developed it before the onset of acute graft-versus-host disease (aGVHD), and 17 patients developed it after the onset of aGVHD. We report for the first time that age >50 years, BK hemorrhagic cystitis, and other viral infections (CMV, HHV-6, or adenovirus) are risk factors for adult CA-TMA. Even after adjustment for aGVHD, CA-TMA was independently associated with significantly higher NRM. These data illustrate relationships between CA-TMA and aGVHD, describe new risk factors for CA-TMA and emphasizes the need to develop validated set of criteria for timely diagnosis.

Hematopoietic cell transplantation associated thrombotic microangiopathy (TMA) is a complication associated with higher non-relapse mortality (NRM) in allogeneic transplant (HCT) patients. Current classification criteria are not generally agreed upon or validated, and presence of confounding factors post-transplant contribute to under-diagnosis or delayed diagnosis of TMA. We studied risk factors, incidence and biomarkersof TMA in 119 adult allogeneic HCT recipients.Twenty-seven patients developed clinically actionable phenotype of TMA (CA-TMA) and the incidence of CA-TMA was 22% by day 180. Among the 27 patients that developed CA-TMA, 10 patients developed CA-TMA prior to onset of acute graft-versus-host disease (aGVHD) and 17 patients developed CA-TMA after the onset of aGVHD. We report for the first time that age > 50, BK hemorrhagic cystitis) and other viral infections (CMV, HHV-6, Adenovirus) are risk factors for adult CA-TMA. Even after adjusting for aGVHD, CA-TMA was independently associated with significantly higher non-relapse mortality.These data illustrate relationships between CA-TMA and aGVHD, describe new risk factors for CA-TMA and emphasizes theneed to develop validated set of criteria for timely diagnosis.