What is transplant associated microangiopathy?

What is transplant associated microangiopathy?

Transplant-associated thrombotic microangiopathy (TA-TMA) is an endothelial damage syndrome that is increasingly identified as a complication of both autologous and allogeneic hematopoietic cell transplantation (HCT) in children.

Are allogeneic transplants curative?

Allogeneic (allo)-SCT may be a curative option with the advantage of a tumor-free graft and the benefit of a graft-versus-lymphoma (GVL) effect. This GVL effect has been well demonstrated by the fact that some patients who experience relapse after ASCT will be cured with allo-SCT.

How is transplant associated TMA treated?

Aggressive supportive care including minimizing transfusions, aggressive hypertension management, and treatment of any underlying infection are central to TA-TMA treatment. Additional approaches include withdrawal of CNI/mTORi, therapeutic plasma exchange (TPE), rituximab, defibrotide, and eculizumab (Fig. 1).

Is TMA treatable?

For example, infectious causes of TMA might be treated with antibiotics and supportive care. At times, plasma exchange, immune suppression, and/or complement blocking therapies may be used to treat other causes of TMA. Individuals with severe kidney injury may require dialysis.

Is TMA life-threatening?

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic SCT (HSCT). Particularly, prognosis of the TA-TMA with multiorgan impairment is poor because there is no definitive therapy.

What is TMA after bone marrow transplant?

Thrombotic microangiopathy (TMA) is a systemic disease characterized by microangiopathic hemolytic anemia, thrombocytopenia and organ failure. Post-bone marrow transplant TMA (post-BMT TMA) is a life-threatening condition that has been reported to afflict between 0.5 and 63.6% of BMT patients.

What organs can Microangiopathy affect?

Diabetic microangiopathy refers to the abnormal small vessels found in many organs and tissues in diabetes mellitus. The kidneys, eyes, skin, and muscles are particularly affected by this disease process, which is the principal factor determining the prognosis of individuals with diabetes mellitus.

Why is hematopoietic stem cell transplantation important?

A bone marrow transplant is also called a stem cell transplant or, more specifically, a hematopoietic stem cell transplant. Transplantation can be used to treat certain types of cancer, such as leukemia, myeloma, and lymphoma, and other blood and immune system diseases that affect the bone marrow.

What is VOD and TMA?

VOD is related to a clinical syndrome characterized by tender hepatomegaly, jaundice, fluid retention, and unexplained weight gain. When TMA is described in patients who have undergone HSCT, it is often implied that the clinical diagnosis of TMA is similar to that of thrombotic thrombocytopenic purpura.

What is allogeneic transplantation?

Allogeneic Transplantation. The new cells come from a donor or from donated umbilical cord blood. Chemotherapy or a combination of chemotherapy and radiation therapy is given before the transplant. This therapy kills the cancer cells, stops the patient’s immune system from working like it normally does, or both.

What happens before an allogeneic stem cell transplant?

There are 2 types of conditioning before an allogeneic transplant. With a myeloablative transplant, you’ll get high doses of chemotherapy with or without radiation. These treatments aim to kill your cancer, but they’ll also kill (myeloablate) all the stem cells in your bone marrow.

Can Allo-SCT provide sustained remission in graft-versus-myeloma?

A study by Michele L Donato and colleaguesshowed allo-SCT could provide sustained remissions in a small cohort of 57 patients who had received one prior ASCT. In this study, chronic graft-versus-host disease (GvHD) had a favorable impact on OS and PFS indicating a graft-versus-myeloma effect.3

What is the difference between PBSC harvesting and allogeneic transplant?

For an allogeneic transplant, the donor’s stem cells are harvested (collected) from their body, then given to the person receiving the transplant. PBSC harvesting is the procedure used to collect stem cells from the donor’s blood.