Back to Search
Start Over
Thrombotic microangiopathy associated with sirolimus level after allogeneic hematopoietic cell transplantation with tacrolimus/sirolimus-based graft-versus-host disease prophylaxis.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2013 Feb; Vol. 19 (2), pp. 298-304. Date of Electronic Publication: 2012 Oct 15. - Publication Year :
- 2013
-
Abstract
- Posttransplantation thrombotic microangiopathy (TMA) is a multifactorial complication of allogeneic hematopoietic cell transplantation (allo-HCT) whose incidence is increased with the use of a sirolimus plus tacrolimus (SIR/TAC) regimen for acute graft-versus-host disease (aGVHD) prophylaxis. We evaluated the incidence and possible risk factors for TMA in a case series of 177 patients who received allo-HCT using SIR/TAC-based GVHD prophylaxis. The patients received either a sibling donor graft (n = 82) or a matched unrelated donor graft (n = 95). Within the first 100 days post-HCT, 30 patients (17%) were diagnosed with TMA, and an additional 9 patients (5%) were classified as probable TMA cases. The median time to onset of TMA was 4.6 weeks (range, 1.6-10.6 weeks). Thirty-four patients developed both TMA and aGVHD, with the majority (81%) developing aGVHD first. Multivariate analysis identified the following factors as associated with increased risk of TMA: day 14 serum sirolimus level ≥9.9 ng/mL (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.13-4.27; P = .02), presence of previous aGVHD grade II-IV (HR, 3.04; 95% CI, 1.38-6.71; P < .01), and fully myeloablative conditioning (HR, 3.47; 95% CI, 1.60-7.53; P < .01). These risk factors for TMA suggest that when using a SIR/TAC regimen for GVHD prophylaxis, careful monitoring and adjustment of the sirolimus dosage is critical, particularly in patients with active aGVHD.<br /> (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Child
Female
Graft vs Host Disease drug therapy
Hematopoietic Stem Cell Transplantation methods
Humans
Incidence
Male
Middle Aged
Sirolimus administration & dosage
Tacrolimus administration & dosage
Thrombotic Microangiopathies chemically induced
Transplantation Conditioning methods
Transplantation, Homologous
Treatment Outcome
Young Adult
Graft vs Host Disease prevention & control
Hematopoietic Stem Cell Transplantation adverse effects
Sirolimus adverse effects
Tacrolimus adverse effects
Thrombotic Microangiopathies etiology
Transplantation Conditioning adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 19
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 23078784
- Full Text :
- https://doi.org/10.1016/j.bbmt.2012.10.006