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Title: Risk factors and appropriate therapeutic strategies for thrombotic microangiopathy after allogeneic HSCT
Authors: Matsui, Hiroyuki
Arai, Yasuyuki  kyouindb  KAKEN_id  orcid (unconfirmed)
Imoto, Hiroharu
Mitsuyoshi, Takaya
Tamura, Naoki
Kondo, Tadakazu
Kanda, Junya  kyouindb  KAKEN_id  orcid (unconfirmed)
Ishikawa, Takayuki
Imada, Kazunori
Ueda, Yasunori
Toda, Yusuke
Anzai, Naoyuki
Yago, Kazuhiro
Nohgawa, Masaharu
Yonezawa, Akihito
Tsunemine, Hiroko
Itoh, Mitsuru
Yamamoto, Kazuyo
Tsuji, Masaaki
Moriguchi, Toshinori
Takaori-Kondo, Akifumi
Kyoto Stem Cell Transplantation Group (KSCTG)
Author's alias: 松井, 宏行
新井, 康之
光吉, 貴哉
田村, 直紀
近藤, 忠一
諫田, 淳也
今田, 和典
上田, 恭典
戸田, 有亮
安齋, 尚之
野吾, 和宏
直川, 匡晴
米澤, 昭仁
常峰, 紘子
伊藤, 満
山本, 和代
辻, 將公
森口, 寿徳
髙折, 晃史
Keywords: Platelets and Thrombopoiesis
Issue Date: 14-Jul-2020
Publisher: American Society of Hematology
Journal title: Blood Advances
Volume: 4
Issue: 13
Start page: 3169
End page: 3179
Abstract: Transplant-associated thrombotic microangiopathy (TA-TMA) is a fatal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, so far, no large cohort study determined the risk factors and the most effective therapeutic strategies for TA-TMA. Thus, the present study aimed to clarify these clinical aspects based on a large multicenter cohort. This retrospective cohort study was performed by the Kyoto Stem Cell Transplantation Group (KSCTG). A total of 2425 patients were enrolled from 14 institutions. All patients were aged ≥16 years, presented with hematological diseases, and received allo-HSCT after the year 2000. TA-TMA was observed in 121 patients (5.0%) on day 35 (median) and was clearly correlated with inferior overall survival (OS) (hazard ratio [HR], 4.93). Pre- and post-HSCT statistically significant risk factors identified by multivariate analyses included poorer performance status (HR, 1.69), HLA mismatch (HR, 2.17), acute graft-versus-host disease (aGVHD; grades 3-4) (HR, 4.02), Aspergillus infection (HR, 2.29), and veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS; HR, 4.47). The response rate and OS significantly better with the continuation or careful reduction of calcineurin inhibitors (CNI) than the conventional treatment strategy of switching from CNI to corticosteroids (response rate, 64.7% vs 20.0%). In summary, we identified the risk factors and the most appropriate therapeutic strategies for TA-TMA. The described treatment strategy could improve the outcomes of patients with TA-TMA in the future.
Description: 移植後血栓性微小血管障害の発症リスク因子を発見 --KSCTGコホート研究に基づく新たな最適治療戦略--. 京都大学プレスリリース. 2020-07-14.
Rights: © 2020 by The American Society of Hematology
DOI(Published Version): 10.1182/bloodadvances.2020002007
PubMed ID: 32658984
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