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Thrombotic microangiopathy in allogeneic stem cell transplantation in childhood
Fatih Erbey1, Ibrahim Bayram, Baris Kuskonmaz
1Cukurova University Faculty of Medicine, Department of Pediatric Oncology & Pediatric Bone Marrow Transplantation Unit, Adana, Turkey. erbeyfa@gmail.com
Insights
Peripheral blood stem cell transplants increase the risk of thrombotic microangiopathy in children. Bone marrow transplants were found to be a safer alternative, with no cases of thrombotic microangiopathy observed.
Area of Science:
- Pediatric Hematology
- Transplant Immunology
- Oncohematology
Background:
- Thrombotic microangiopathy (TMA) is a serious complication following hematopoietic stem cell transplantation (HSCT).
- Identifying risk factors for TMA is crucial for improving patient outcomes in pediatric HSCT.
Purpose of the Study:
- To determine the incidence, risk factors, and mortality of TMA in pediatric HSCT recipients.
- To compare outcomes between different stem cell sources.
Main Methods:
- Retrospective analysis of 50 children undergoing HSCT between 2006 and 2008.
- Diagnosis of TMA based on International Working Group criteria (2007).
- Comparison of TMA incidence based on stem cell source (bone marrow vs. peripheral blood).
Main Results:
- TMA occurred in 6% of pediatric HSCT patients (3 out of 50).
- TMA developed in 16.7% of patients receiving peripheral blood stem cells (3 out of 18).
- No TMA cases were observed in patients who received bone marrow stem cells (0 out of 32).
Conclusions:
- Peripheral blood stem cell infusion is a significant risk factor for developing TMA post-HSCT in children.
- Bone marrow stem cells appear to be a safer source, associated with a lower risk of TMA.
Objectives:
We define the incidence, risk factors, and mortality rates for the occurrence of thrombotic microangiopathy in 50 children who underwent transplants between January 2006 and June 2008 at 2 Turkish pediatric centers.
Materials And Methods:
The diagnosis of thrombotic microangiopathy was done according to the reports of International Working Group in 2007.
Results:
Fifty patients (27 male and 23 female; age range, 3 months to 18 years) were included. Patients with malignant and nonmalignant diseases were 13 (26%) and 37 (74%). Myeloablative and nonmyeloablative conditioning regimens were used in 29 (58%) and 21 patients (42%). Bone marrow was used as the source of stem cells in 32 patients (62%) and peripheral blood was used in 18 patients (36%). Thrombotic microangiopathy was seen in 3 of 50 cases (6%). Thrombotic microangiopathy developed in 3 of 18 patients in whom peripheral blood was used as the source of stem cells while none of 32 patients who had bone marrow as the source developed thrombotic microangiopathy (P < .05).
Conclusions:
Using peripheral blood as a source of stem cells is a risk factor for development of thrombotic microangiopathy.
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