000010034 001__ 10034
000010034 005__ 20240125143603.0
000010034 0247_ $$2DOI$$a10.6083/9g54xj45n
000010034 037__ $$aIR
000010034 245__ $$aIncidence and outcomes from transplant-associated thrombotic microangiopathy in pediatric hematopoietic stem cell transplant recipients before and after the introduction of Eculizumab
000010034 260__ $$bOregon Health and Science University
000010034 269__ $$a2023
000010034 336__ $$aCapstone
000010034 502__ $$gMedicine (Undergraduate Medical Education)
000010034 502__ $$bM.D.
000010034 520__ $$aTransplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplant (HSCT). The introduction of eculizumab, a complement inhibitor, represented an advancement in the treatment of TA-TMA and impacted practice at Oregon Health and Science University (OHSU) since July 2015. In this study, we performed a retrospective review of pediatric allogeneic HSCTs occurring between August 2008 -September 2019 at OHSU to describe the incidence of TA-TMA over time and eculizumab utilization. We used a modified diagnostic criteria permitting retrospective disease evaluation across disparate periods. The four criteria defining TA-TMA were adapted from the Bone Marrow Transplant Clinical Trials Network 2005 and City of Hope Criteria 2013: 1) Anemia with schistocytes, 2) LDH > 2x the upper limit of normal, 3) Serum creatinine > 1.5x baseline, 4) Negative indirect coombs OR platelets <50 x 109/ml. We found that 17 of 142 patients undergoing HSCT met all four criteria (incidence 12.0%). Of those, 6 out of 85 patients (7%) were identified between 2008 to 2015 (pre-eculizumab era) while 11 out of 57 patients (19%) were identified between 2015 to 2019 (post-eculizumab era). Patients with TA-TMA were more likely to be admitted to the pediatric intensive care unit in the post-eculizumab era (82% vs 24%, P=0.006). TA-TMA had no significant impact on diagnosis of GVHD. Our single center experience demonstrated an increased incidence of TA-TMA since the introduction of eculizumab in 2015 at OHSU. This increase coincides with an increase in TA-TMA in non-malignant transplants.
000010034 540__ $$fCC BY
000010034 650__ $$aThrombotic Microangiopathies$$038803
000010034 650__ $$aComplement Inactivating Agents$$036693
000010034 650__ $$aChild$$016462
000010034 650__ $$aHematopoietic Stem Cell Transplantation$$030755
000010034 6531_ $$aeculizumab
000010034 691__ $$aSchool of Medicine$$041369
000010034 7001_ $$aLerner, Kimberly$$uOregon Health and Science University$$041354$$10009-0003-5406-9142
000010034 7001_ $$aHulme, Rebecca$$uOregon Health and Science University$$041354
000010034 7001_ $$aShereck, Evan$$uOregon Health and Science University$$041354
000010034 7001_ $$aNemecek, Eneida$$uOregon Health and Science University$$041354
000010034 7201_ $$aChang, Bill$$uOregon Health and Science University$$041354$$7Personal$$eMentor
000010034 7201_ $$aDeMartino, Patrick$$uOregon Health and Science University$$041354$$7Personal$$eMentor
000010034 8564_ $$9b858df22-9026-489a-af2d-c3a67b231cf1$$s485444$$uhttps://digitalcollections.ohsu.edu/record/10034/files/Lerner.Kimberly.2023.pdf
000010034 905__ $$a/rest/prod/9g/54/xj/45/9g54xj45n
000010034 909CO $$ooai:digitalcollections.ohsu.edu:10034$$pstudent-work
000010034 980__ $$aScholarly Project Capstones