Thrombotic microangiopathy with concomitant GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome.
Thrombotic microangiopathy with concomitant GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome.
复制标题
异基因造血干细胞移植后并发胃肠道 aGVHD 的血栓性微血管病：危险因素和结果。
DOI：
10.1111/ejh.12996
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发表时间：
2018
影响因子：
3.1
通讯作者：
Huang Xiao-Jun
中科院分区：
文献类型：
--
作者：
Zhang Xiao-Hui;Liu Xiao;Wang Qian-Ming;He Yun;Zhu Xiao-Lu;Zhang Jia-Min;Han Wei;Chen Huan;Chen Yu-Hong;Wang Feng-Rong;Wang Jing-Zhi;Zhang Yuan-Yuan;Mo Xiao-Dong;Chen Yao;Wang Yu;Fu Hai-Xia;Chang Ying-Jun;Xu Lan-Ping;Liu Kai-Yan;Huang Xiao-Jun
目的探讨血栓性微血管病（TMA）并发急性移植物抗宿主病（aGVHD）的可能危险因素方法从2008年至2016年接受allo-HSCT的3992例患者组成的队列中确定了50例诊断为TMA伴aGVHD的患者和150例对照。III-IV aGVHD（P= 0.000）、急性肾损伤（阿基）（P= 0.033）和高血压（P= 0.028）是与TMA伴aGVHD发生相关的显著独立危险因素。在单变量和多变量分析中，触珠蛋白水平低于正常值（P= 0.013）、最大腹泻量>2500 mL/d（P= 0.015）和血性腹泻（P= 0.049）是死亡的重要标志。诊断为TMA伴aGVHD的患者总生存率（OS）较低，非复发死亡率（NRM）较高，但复发风险较低。结论血栓性微血管病伴aGVHD是allo‐HSCT后的一个重要并发症，预后较差，包括OS显著降低和NRM较高。存在与该并发症的发生率和死亡率相关的特定风险因素。
ObjectivesTo explore the possible risk factors for the occurrence and mortality of thrombotic microangiopathy (TMA) with concomitant acute graft‐vs‐host disease (aGVHD) and to investigate outcomes and treatments of this disorder after allo‐HSCT.MethodsFifty cases diagnosed with TMA with concomitant aGVHD and 150 controls were identified from a cohort composed of 3992 patients who underwent allo‐HSCT from 2008 to 2016.ResultsGrade III‐IV aGVHD (P= .000), acute kidney injury (AKI) (P= .033), and hypertension (P= .028) were significant independent risk factors associated with the occurrence of TMA with concomitant aGVHD. A haptoglobin level below normal (P= .013), a maximum volume of diarrhea >2500 mL/d (P= .015), and bloody diarrhea (P= .049) were significant markers for death in both univariate and multivariate analyses. Patients diagnosed with TMA with concomitant aGVHD had a lower overall survival (OS), a higher non‐relapse mortality (NRM), but a lower risk of relapse.ConclusionsThrombotic microangiopathy with concomitant aGVHD is a significant complication after allo‐HSCT, with a worse outcome, including significantly lower OS and higher NRM. There are specific risk factors associated with occurrence and mortality of this complication.