期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 19, 期 12, 页码 1683-1689出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2013.09.005
关键词
Neutrophil extracellular traps; Thrombotic microangiopathy; Allogeneic stem cell transplantation; Predictive biomarker
资金
- Ministry of Education, Science, Sports, and Culture in Japan
- SENSHIN Medical Research Foundation
- Grants-in-Aid for Scientific Research [24591600] Funding Source: KAKEN
Transplantation-associated thrombotic microangiopathy (TA-TMA) is a devastating complication of hematopoietic stem cell transplantation. TA-TMA likely represents the final stage of vascular endothelial injury; however, its pathophysiology is largely unknown, making clinical management difficult. Recently, the association of neutrophil extracellular traps (NETs) with the development of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome has been reported. Thus, we explored whether NETs are also relevant to the occurrence of TA-TMA. We retrospectively analyzed post-transplant trends of serum NET levels in 90 patients, 11 of whom developed TA-TMA. Relative to baseline (before the conditioning regimen), elevated serum NET levels either at 4 weeks after transplantation or as early as the day of transplantation were associated with significantly increased risk of TA-TMA. In contrast, thrombomodulin, a potential marker for TA-TMA, was not helpful to predict the occurrence of TA-TMA in our study. In addition, we directly detected glomerular deposition of NETs in 2 TA-TMA patients. Increased NET levels are a significant risk factor for TA-TMA, suggesting that NET level is a useful biomarker for TA-TMA. (C) 2013 American Society for Blood and Marrow Transplantation.
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