Journal
BONE MARROW TRANSPLANTATION
Volume 57, Issue 4, Pages 554-561Publisher
SPRINGERNATURE
DOI: 10.1038/s41409-022-01581-1
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Funding
- National Key Research and Development Program of China [2017YFA0105503]
- National Natural Science Foundation of China [81970113, 81800116]
- Key Program of National Natural Science Foundation of China [81730004]
- Beijing Natural Science Foundation [H2018206423]
- Beijing Municipal Science and Technology Commission [Z171100001017084]
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This study evaluated the efficacy and outcomes of therapeutic plasma exchange (TPE) for patients with transplant-associated thrombotic microangiopathy (TA-TMA). The results showed that TPE had a positive response in TA-TMA patients without gastrointestinal bleeding, and a higher volume of TPE was associated with better outcomes.
The efficacy and outcome of therapeutic plasma exchange (TPE) for transplant-associated thrombotic microangiopathy (TA-TMA) remain controversial. We therefore sought to evaluate the outcome and efficacy of TPE in patients with TA-TMA and to identify TA-TMA patients who would benefit from TPE management. Eighty-two patients with TA-TMA were treated with TPE. We reported a response rate of 52% and overall survival rates of 20% and 15% at 100 days and 1 year after TA-TMA, respectively, in TPE-treated patients, with a significantly lower survival in gastrointestinal (GI) bleeding patients (5% vs. 41% in non-GI bleeding patients, P = 0.003). Multivariate analysis revealed that patients with GI bleeding, grade III-IV aGVHD, severe anemia, and a lower cumulative volume of TPE were less likely to respond to TPE. GI bleeding, a lower initial volume of TPE, and elevated total bilirubin were independently associated with 100-day mortality. The leading causes of death were infection, active TA-TMA, and MODS. The results of this large cohort of real-world practice indicate that the efficacy and outcome of TPE for TA-TMA patients without GI bleeding are encouraging, and a higher volume of TPE is warranted to achieve favorable outcomes.
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