Complement-mediated thrombotic microangiopathy as a link between endothelial damage and steroid-refractory GVHD.

Wall SA, Zhao Q, Yearsley M, Blower L, Agyeman A, Ranganathan P, Yang S, Wu H, Bostic M, Jaglowski S, Brammer JE, William B, Choe H, Mims AS, Penza S, Efebera Y, Devine S, Cataland S, Davies SM, Vasu S
Blood Adv 2 2619-2628 10/23/2018

Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA), a complication of hematopoietic cell transplant (HCT), is associated with significant morbidity and mortality. The pathophysiology and overlap of TA-TMA with other posttransplant complications such as graft-versus-host disease (GVHD) is poorly understood. We retrospectively identified cases of TA-TMA among patients with grade 3/4 gastrointestinal (GI) GVHD, reviewed intestinal biopsy specimens, and performed correlative testing of biomarkers associated with TA-TMA. TA-TMA was more common in patients with steroid-refractory GVHD compared with steroid-responsive GVHD (79.3% vs 42.1%;

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