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Early coagulation disorder after allogeneic stem cell transplantation is a strong prognostic factor for transplantation-related mortality, and intervention with recombinant human thrombomodulin improves the outcome: a single-center experience

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Abstract

We retrospectively analyzed 60 cases of pediatric patients who received allogeneic stem cell transplantation (SCT) between 2000 and 2008, using the tentative scoring system for evaluation of early (<30 days) coagulation disorders. In the 41 patients who survived, d-dimer levels showed a transient increase 2 weeks after SCT and normalized thereafter, but these levels were persistently elevated in the 19 patients who died. Of 19 patients with a positive score, 11 died of transplantation-related complications [transplantation-related mortality (TRM) = 0.579] within 1 year, while none of the 41 with a negative score died during the same period. Since 2009, 12 of 30 patients had positive scores within 30 days after SCT. Intervention with recombinant human thrombomodulin (rhTM) was introduced for patients with a positive score, and 10 of these patients survived (TRM = 0.167) along with a dramatic improvement of d-dimer level. Although the effects of this treatment were observed in a limited number of patients, our observations suggest that early coagulation disorder after allogeneic SCT is a strong prognostic factor for TRM, and that intervention with rhTM improves TRM.

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Abbreviations

rhTM:

Recombinant human thrombomodulin

AT:

Antithrombin

TMA:

Thrombotic microangiopathy

VOD:

Veno-occlusive disease

SCT:

Stem cell transplantation

TRM:

Transplantation-related mortality

SIRS:

Systemic inflammatory syndrome

FDP:

Fibrin degradation products

AML:

Acute myeloid leukemia

ALL:

Acute lymphocytic leukemia

CML:

Chronic myeloid leukemia

SCID:

Severe combined immunodeficiency

WAS:

Wiskott-Aldrich syndrome

HIM:

Hyper IgM syndrome

DKC:

Dyskeratosis congenita

ID:

Immunodeficiency

CAEBV:

Chronic active EB virus infection

TBI:

Total body irradiation

Bu:

Busulfan

CY:

Cyclophosphamide

ATG:

Anti-thymocyte globulin

Flu:

Fludarabine

LPAM:

Melphalan

VP16:

Etoposide

MSB:

Matched sibling bone marrow

RMBM:

Related mismatched bone marrow

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Acknowledgments

This work was supported by a Grant-in-Aid from the Ministry of Education, Science, and Culture, Japan (MN) and the Japan Leukemia Research Fund (MN).

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Pediatrics and Developmental Biology, Post Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan

    Masayuki Nagasawa, Teppei Ohkawa, Akifumi Endo, Noriko Mitsuiki, Toshiaki Ono, Yuki Aoki, Takeshi Isoda, Daisuke Tomizawa, Masatoshi Takagi, Michiko Kajiwara, Tomohiro Morio & Shuki Mizutani

  2. Department of Hematology Oncology and Immunology, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan

    Masayuki Nagasawa & Teppei Ohkawa

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  1. Masayuki Nagasawa
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Correspondence to Masayuki Nagasawa.

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Nagasawa, M., Ohkawa, T., Endo, A. et al. Early coagulation disorder after allogeneic stem cell transplantation is a strong prognostic factor for transplantation-related mortality, and intervention with recombinant human thrombomodulin improves the outcome: a single-center experience. Int J Hematol 98, 533–542 (2013). https://doi.org/10.1007/s12185-013-1443-4

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  • DOI: https://doi.org/10.1007/s12185-013-1443-4

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