Journal article
Eculizumab in Transplant-Associated Thrombotic Microangiopathy
Clinical and applied thrombosis/hemostasis, Vol.23(2), pp.175-180
03/01/2017
DOI: 10.1177/1076029615599439
PMID: 26259912
Abstract
Introduction: Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare entity with no standard of care and high mortality, despite the use of plasma exchange.
Methods: Using specific search terms, all cases having TA-TMA treated with eculizumab and indexed in MEDLINE (English language only) by November 2014 were reviewed.
Results: A total of 26 cases, 53% men, had a median age of 33 years (range 2-61). Transplant-associated thrombotic microangiopathy occurred after stem-cell transplant (35%) or solid-organ transplant (65%), frequently associated with the use of cyclosporine or tacrolimus (96%). A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS 13) level was always >10%. After TA-TMA diagnosis, the following drug adjustments were made: discontinuation of cyclosporine or tacrolimus in 45%, dose reduction in another 27%, continuation of the drugs in 23%, and switch from cyclosporine to tacrolimus in remaining 5%. Plasma exchange was performed in approximate to 43%. The median interval between transplant and initiation of eculizumab was 63 days (range 11-512). A median of 5.5 doses (range 2-21) of eculizumab was utilized with 92% response occurring after a median of 2 doses (range 1-18). At a median follow-up of 52 weeks (range 3-113), the survivors (92%) were doing well.
Conclusion: Within the limits of this retrospective analysis, our study demonstrates that eculizumab use may result in high response rate and 1-year survival in patients with TA-TMA refractory to discontinuation of calcineurin inhibitor and plasma exchange.
Details
- Title: Subtitle
- Eculizumab in Transplant-Associated Thrombotic Microangiopathy
- Creators
- Prajwal Dhakal - Tribhuvan UniversitySmith Giri - University of Tennessee Health Science CenterRanjan Pathak - Reading HospitalVijaya Raj Bhatt - University of Nebraska Medical Center
- Resource Type
- Journal article
- Publication Details
- Clinical and applied thrombosis/hemostasis, Vol.23(2), pp.175-180
- Publisher
- Sage
- DOI
- 10.1177/1076029615599439
- PMID
- 26259912
- ISSN
- 1076-0296
- eISSN
- 1938-2723
- Number of pages
- 6
- Grant note
- University of Nebraska Medical Center, College of Medicine, Physician-Scientist Training Program
- Language
- English
- Date published
- 03/01/2017
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984360049002771
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