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@ARTICLE{Zeisbrich:129194,
author = {M. Zeisbrich and N. Becker$^*$ and A. Benner$^*$ and A.
Radujkovic and K. Schmitt and J. Beimler and A. D. Ho and M.
Zeier and P. Dreger and T. Luft},
title = {{T}ransplant-associated thrombotic microangiopathy is an
endothelial complication associated with refractoriness of
acute {G}v{HD}.},
journal = {Bone marrow transplantation},
volume = {52},
number = {10},
issn = {0268-3369},
address = {London},
publisher = {Nature Publishing Group55086},
reportid = {DKFZ-2017-05199},
pages = {1399-1405},
year = {2017},
abstract = {There is increasing evidence that endothelial dysfunction
is involved in refractoriness of acute GvHD (aGvHD). Here we
investigated the hypothesis that another endothelial
complication, transplant-associated thrombotic
microangiopathy (TMA), contributes to the pathogenesis of
aGvHD refractoriness. TMA was retrospectively assessed in
771 patients after allogeneic stem cell transplantation
(alloSCT). Incidences of TMA and refractory aGvHD were
correlated with biomarkers of endothelial damage obtained
before alloSCT for patients receiving or not receiving
statin-based endothelial prophylaxis (SEP). Diagnostic
criteria for TMA and refractory aGvHD were met by 41
$(5.3\%)$ and 76 $(10\%)$ patients, respectively. TMA was
overrepresented in patients with refractory aGvHD (45.0 vs
$2.3\%$ in all other patients, P<0.001). TMA independently
increased mortality. Elevated pretransplant suppressor of
tumorigenicity-2 and nitrates along with high-risk variants
of the thrombomodulin gene were associated with increased
risk of TMA. In contrast, SEP abolished the unfavorable
outcome predicted by pretransplant biomarkers on TMA risk.
Patients on SEP had a significantly lower risk of TMA
(P=0.001) and refractory aGvHD (P=0.055) in a multivariate
multistate model. Our data provide evidence that TMA
contributes to the pathogenesis of aGvHD refractoriness.
Patients with an increased TMA risk can be identified
pretransplant and may benefit from pharmacological
endothelium protection.},
cin = {C060},
ddc = {610},
cid = {I:(DE-He78)C060-20160331},
pnm = {313 - Cancer risk factors and prevention (POF3-313)},
pid = {G:(DE-HGF)POF3-313},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:28650448},
doi = {10.1038/bmt.2017.119},
url = {https://inrepo02.dkfz.de/record/129194},
}