Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 11, Issue 8, Pages 571-575Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2005.06.001
Keywords
hemolytic uremic syndrome; thrombotic thrombocytopenic purpura; microangiopathy anemia; thrombocytopenia; stem cell transport
Categories
Funding
- NCI NIH HHS [U24 CA076518] Funding Source: Medline
- NHLBI NIH HHS [U10 HL069249, U10 HL069294, U10 HL069330, U10 HL069254] Funding Source: Medline
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The syndrome of microangiopathic hemolysis associated with renal failure, neurologic impairment, or both is a recognized complication of hematopoietic stem cell transplantation. This entity is often called hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP), yet it is clear that the pathophysiology of transplant-associated HUS/TTP is different from that of classic HUS or TTP. Furthermore, the incidence of this syndrome varies from 0.5% to 76% in different transplant series, primarily because of the lack of a uniform definition. The toxicity committee of the Blood and Marrow Transplant Clinical Trials Network has reviewed the current literature on transplant-related HUS/TTP and recommends that it be henceforth renamed posttransplantation thrombotic microangiopathy (TMA). An operational definition for TMA based on the presence of microangiopathic hemolysis and renal and/or neurologic dysfunction is proposed. The primary intervention after diagnosis of TMA should be withdrawal of calcineurin inhibitors. Plasma exchange, although frequently used in this condition, has not been proven to be effective. In the absence of definitive trials, plasma exchange cannot be considered a standard of care for TMA. It is hoped that these positions will improve the identification and reporting of this devastating complication after hematopoietic stem cell transplantation and facilitate future clinical studies for its prevention and treatment. (c) 2005 American Society for Blood and Marrow Transplantation.
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