Abstract
Transplantation-associated thrombotic microangiopathy (TA-TMA) is occasionally described as a serious complication after allogeneic and, more rarely, autologous stem cell transplantation (SCT). It is characterized by poor outcome with high mortality rate. Plasma exchange (PE) has been reported as successful first-line therapy in other thrombotic microangiopathies. However, unlike to idiopathic forms, response to PE are usually suboptimal in TA-TMA and the use of PE remains controversial, because the exact mechanism of injury is not yet understood. The kidney is the most commonly affected organ and injury has rarely been reported elsewhere in the body, such as in lungs and gastrointestinal tract. Although several case reports have documented myocardial infarctions in patients presenting classic thrombotic thrombocytopenic purpura (TTP), there are no reports documenting cardiac involvement in TA-TMA. We describe a case of a 66-year-old man who experienced TA-TMA accompanied by cardiac ischemia after autologous SCT for multiple myeloma, successfully treated with PE. The immediate start of PE induced a complete remission of TA-TMA and disappearance of cardiac ischemic signs and symptoms except of a residual chronic renal failure.
References
Ruutu T, Barosi G, Benjamin RJ et al (2007) Diagnostic criteria for hematopoietic stem cell transplant-associated microangiopathy: results of a consensus process by an International Working Group. Haematologica 92:95
Ho VT, Cutler C, Carter S, Martin P, Adams R, Horowitz M et al (2005) Blood and marrow transplant clinical trials network toxicity committee consensus summary: thrombotic microangiopathy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 11:571–575
Tsai HM (2010) Pathophysiology of thrombotic thrombocytopenic purpura. Int J Hematol 91:1–19
Elliott MA, Nichols WL Jr, Plumhoff EA, Ansell SM, Dispenzieri A, Gastineau DA et al (2003) Posttransplantation thrombotic thrombocytopenic purpura: a single-center experience and a contemporary review. Mayo Clin Proc 78:421–430
Teruya J, Styler M, Verde S, Topolsky D, Crilley P (2001) Questionable efficacy of plasma exchange for thrombotic thrombocytopenic purpura after bone marrow transplantation. J Clin Apher 16:169–174
Jodele S, Laskin BL, Goebel J, Khoury JC, Pinkard SL, Carey PM et al (2013) Does early initiation of therapeutic plasma exchange improve outcome in pediatric stem cell transplant-associated thrombotic microangiopathy? Transfusion 53(3):661–667
Laskin BL, Goebel J, Davies SM, Jodele S (2011) Small vessels, big trouble in the kidneys and beyond: hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Blood 118(6):1452–1462
Hewamana S, Austen B, Murray J, Johnson S, Wilson K (2009) Intestinal perforation secondary to haematopoietic stem cell transplant associated thrombotic microangiopathy. Eur J Haematol 83(3):277
Gami AS, Hayman SR, Grande JP, Garovic VD (2005) Incidence and prognosis of acute heart failure in the thrombotic microangiopathies. Am J Med 118(5):544–547
Wahla AS, Ruiz J, Noureddine N, Upadhya B, Sane DC, Owen J (2008) Myocardial infarction in thrombotic thrombocytopenic purpura: a single-center experience and literature review. Eur J Haematol 81:311–316
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Paviglianiti, A., Tomarchio, V., Spurio, S. et al. A Case of Transplantation-Associated Thrombotic Microangiopathy with Cardiac Involvement Successfully Treated with Plasma Exchange. Indian J Hematol Blood Transfus 30 (Suppl 1), 369–371 (2014). https://doi.org/10.1007/s12288-014-0418-9
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DOI: https://doi.org/10.1007/s12288-014-0418-9