1.
Conversion from calcineurin inhibitors to sirolimus in transplant-associated thrombotic microangiopathy
Kanunnikov, M. M., Rakhmanova, J. Z., Levkovsky, N. V., Vafina, A. I., Goloshapov, O. V., Shchegoleva, T. S., Vlasova, Y. Y., Paina, O. V., Morozova, E. V., Zubarovskaya, L. S., et al
Clinical transplantation. 2020
Abstract
Transplant-associated thrombotic microangiopathy (TA-TMA) is a specific complication of allogeneic hematopoietic cell transplantation with a multifactorial etiology. There is little evidence published regarding the efficacy and factors influencing the outcome of substitution of calcineurin inhibitors (CNIs) with other agentsas a widely accepted practice in this disorder; however, there are limited data on the options for immunosuppression manipulation (ISM). In our study we retrospectively analyzed outcomes of 45 patients with TA-TMA with ISM and substitution either with steroids (steroid group) or anmTOR inhibitor sirolimus (sirolimus group). In our study, sirolimus was associated with significantly better 1-year overall survival (HR 0.3, 95%CI 0.13-0.7, p=0.004)and faster time to normalization of LDH (HR 2.2, 95%CI 0.99-4.99, p=0.044).Replacing CNIs with sirolimus could be an effective option in patients with TA-TMA. A multicenter confirmatory study ofCNIs replacement with sirolimus is justified.
2.
Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT
Moiseev, I. S., Tsvetkova, T., Aljurf, M., Alnounou, R. M., Bogardt, J., Chalandon, Y., Drokov, M. Y., Dvirnyk, V., Faraci, M., Friis, L. S., et al
Bone marrow transplantation. 2018
Abstract
Transplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study evaluated clinical and morphological practices of TA-TMA diagnosis in EBMT centers. Two questionnaires, one for transplant physician and one for morphologist, and also a set of electronic blood slides from 10 patients with TA-TMA and 10 control patients with various erythrocyte abnormalities, were implemented for evaluation. Seventeen EBMT centers participated in the study. Regarding criteria used for TA-TMA diagnosis, centers reported as follows: 41% of centers used the International Working Group (IWG) criteria, 41% used "overall TA-TMA" criteria and 18% used physician's decision. The threshold of schistocytes to establish TA-TMA diagnosis in the participating centers was significantly associated with morphological results of test cases evaluations (p = 0.002). The mean number of schistocytes reported from blood slide analyses were 4.3 +/- 4.5% for TA-TMA cases (range 0-19.6%, coefficient of variation (CV) 0.7) and 1.3 +/- 1.6% for control cases (range 0-8.3%, CV 0.8). Half of the centers reported schistocyte levels below 4% for 7/10 TA-TMA cases. The intracenter variability was low, indicating differences in the institutional practices of morphological evaluation. In conclusion, the survey identified the need for the standardization of TA-TMA morphological diagnosis.