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Transplant Toxicities

The potential role of HLA-DRB1*11 in the development and outcome of haematopoietic stem cell transplantation-associated thrombotic microangiopathy

Bone Marrow Transplantation volume 50, pages 1321–1325 (2015)Cite this article

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Abstract

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a serious complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) with high mortality rate. We retrospectively studied the frequency, clinical and genetic associations and prognostic effect of TA-TMA, in a total of 425 consecutive adult patients, who underwent allo-HSCT for a malignant haematological condition between 2007 and 2013 at our single centre. TA-TMA developed in 19% of the patients. Unrelated donor type (P<0.001), acute GvHD grades II–IV (P<0.001), myeloablative conditioning regimens (P=0.003), tacrolimus-based GvHD prophylaxis (P=0.003), CMV infection (P=0.003) and carriership for HLA-DRB1*11 (P=0.034) were associated with the development of TA-TMA. Survival was adversely affected by the presence of TA-TMA (P<0.001). Among patients with TA-TMA, the outcome of HLA-DRB1*11 carriers was significantly better compared with non-carriers (P=0.003). As a new finding, our observations suggest that the presence of HLA-DRB1*11 antigen contributes to the development of TA-TMA and affects the outcome.

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Acknowledgements

We thank Tatai Gabor for the data management. This work was supported by grants from OTKA (K104903).

Author contributions

KB, HA, AT, PR, ABat and TM co-ordinated the study; KB, HA, AT and TM wrote the manuscript; KB and HA performed the statistical analysis; PR, ABat, LL, ABar, LG, MR and TM provided patients, collected the clinical data and critically reviewed the manuscript; KR provided the data from HLA registry; ABo, KPK, AS and DI performed and authorised the laboratory work for this study; all authors approved the final version of the paper.

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Authors and Affiliations

  1. Laboratory of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, Hungary

    K Balassa, H Andrikovics, A Bors, K P Kiss & A Tordai

  2. Department of Haematology and Stem Cell Transplantation, St. Istvan and St. Laszlo Hospital, Budapest, Hungary

    P Remenyi, A Batai, L Gopcsa, L Lengyel, A Barta, M Reti & T Masszi

  3. Transplantation Immunogenetics Laboratory, Hungarian National Blood Transfusion Service, Budapest, Hungary

    A Szilvasi & D Inotai

  4. Hungarian Stem Cell Donor Registry, Hungarian National Blood Transfusion Service, Budapest, Hungary

    K Rajczy

  5. 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary

    T Masszi

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  1. K Balassa
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Correspondence to K Balassa.

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Balassa, K., Andrikovics, H., Remenyi, P. et al. The potential role of HLA-DRB1*11 in the development and outcome of haematopoietic stem cell transplantation-associated thrombotic microangiopathy. Bone Marrow Transplant 50, 1321–1325 (2015). https://doi.org/10.1038/bmt.2015.161

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