Thrombotic microangiopathy including TTP/HUS has been reported after bone marrow transplant in autologous as well as in allogeneic settings. The etiology of BMT-TA is still unclear. Conditioning regimen, CSA, GVHD, and CMV infection has been attributed as causative factors which ultimately lead to endothelial damage and to thrombotic microangiopathy. We performed retrospective analysis on 14 patients who underwent HLA identical peripheral stem cell transplant. Six patients developed thrombotic microangiopathy of varying degree. Five patients were conditioned with CTX/TBI regimen and one patient received STAMP V regimen. GVHD prophylaxis was with CSA alone. Fragmented red cells, increased LDH, renal failure and thrombocytopenia were present in all 6 patients. Time to the development of angiopathy was 52 days range (18-107). Two patients were CMV+. Two patients had toxic CSA level at the time of diagnosis. Three patients had hyperacute GVHD. Multimodality treatment was given including IVIG, steroids and staph column A, with no response. Two patients developed pulmonary hemorrhage and died of multi-organ failure. One patient developed DIC like picture and died of multi-organ failure. One patient died of systemic aspergillosis. One patient died of refractory hemorrhagic cystitis. We conclude that: 1. Thrombotic microangiopathy is a potentially fatal complication of allogeneic stem cell transplant. 2. Conditioning regimen, CSA, GVHD may be an etiologic agent. 3. CMV status probably has no relation with the development of this syndrome. 4. Further therapeutic strategies need to be explored.
Full conference title:
39th meeting of the American Society for Haemotology
- ASH 39th (1998)