Thrombotic microangiopathy with concomitant GI GI aGVHD after allogeneic hematopoietic stem cell transplantation: Risk factors and outcome

摘要

Abstract Objectives To 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 . Methods Fifty 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. Results Grade 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. Conclusions Thrombotic 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.