1. Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus.
- Author
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Labrador J, López-Corral L, López-Godino O, Vázquez L, Cabrero-Calvo M, Pérez-López R, Díez-Campelo M, Sánchez-Guijo F, Pérez-López E, Guerrero C, Alberca I, Del Cañizo MC, Pérez-Simón JA, González-Porras JR, and Caballero D
- Subjects
- Adult, Aged, Drug Therapy, Combination, Female, Graft vs Host Disease drug therapy, Graft vs Host Disease epidemiology, Hematopoietic Stem Cell Transplantation statistics & numerical data, Humans, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents blood, Incidence, Male, Methotrexate blood, Middle Aged, Multivariate Analysis, Prognosis, Retrospective Studies, Risk Factors, Sirolimus blood, Tacrolimus blood, Thrombotic Microangiopathies epidemiology, Transplantation, Homologous, Young Adult, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation adverse effects, Methotrexate administration & dosage, Sirolimus administration & dosage, Tacrolimus administration & dosage, Thrombotic Microangiopathies etiology
- 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.
- Published
- 2014
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