Impact of thrombotic thrombocytopenic purpura on leukemic children undergoing bone marrow transplantation

C. Uderzo, M. Fumagalli, P. De Lorenzo, A. Busca, E. Vassallo, S. Bonanomi, E. Lanino, G. Dini, S. Varotto, C. Messina, R. Miniero, M. G. Valsecchi, A. Balduzzi

Research output: Contribution to journalArticle

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Abstract

Thrombotic thrombocytopenic purpura (TTP) has emerged as one of the main transplant-related complications over the last 15 years. The current study defines the incidence and the risk factors for the occurrence of TTP in 131 consecutive leukemic children who were transplanted between January 1994 and December 1997 at four Italian pediatric centers. Patients with ALL (101), AML (21), MDS (9), underwent an HLA-identical sibling BMT (82) or an HLA-identical unrelated BMT (49), receiving a conditioning regimen consisting of high-dose chemotherapy in 24 patients and of F-TBI combined with high-dose chemotherapy in 107 patients. The diagnosis of TTP was retrospectively evaluated on the basis of parallel criteria. TTP treatment varied according to the protocol of each treatment center. Twenty-eight of 131 patients (21.4%) developed TTP at a median of 46 days (range 21-80) after BMT. Multivariate analysis demonstrated that the risk of TTP was higher in patients who underwent unrelated BMT (P value = 0.02). Acute GVHD, stage of disease at BMT, conditioning with TBI, gender, age, did not appear to be associated with the occurrence of TTP. As to the outcome, TTP resolved in 19 patients while in nine it was the principal cause of death (32.1%). In patients with TTP, LDH peak value was the only statistically significant factor (P = 0.001) related to severe TTP. In conclusion, our experience demonstrates that leukemic children undergoing BMT, especially from an unrelated donor, should be carefully assessed for TTP which appears to be a severe and relatively common transplant-related complication when strict diagnostic criteria are applied.

Original languageEnglish
Pages (from-to)1005-1009
Number of pages5
JournalBone Marrow Transplantation
Volume26
Issue number9
Publication statusPublished - 2000

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Thrombotic Thrombocytopenic Purpura
Bone Marrow Transplantation
Transplants
Drug Therapy
Unrelated Donors
Clinical Protocols
Siblings
Cause of Death
Cohort Studies
Multivariate Analysis

Keywords

  • Allogeneic marrow transplant
  • Childhood leukemia
  • Thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Uderzo, C., Fumagalli, M., De Lorenzo, P., Busca, A., Vassallo, E., Bonanomi, S., ... Balduzzi, A. (2000). Impact of thrombotic thrombocytopenic purpura on leukemic children undergoing bone marrow transplantation. Bone Marrow Transplantation, 26(9), 1005-1009.

Impact of thrombotic thrombocytopenic purpura on leukemic children undergoing bone marrow transplantation. / Uderzo, C.; Fumagalli, M.; De Lorenzo, P.; Busca, A.; Vassallo, E.; Bonanomi, S.; Lanino, E.; Dini, G.; Varotto, S.; Messina, C.; Miniero, R.; Valsecchi, M. G.; Balduzzi, A.

In: Bone Marrow Transplantation, Vol. 26, No. 9, 2000, p. 1005-1009.

Research output: Contribution to journalArticle

Uderzo, C, Fumagalli, M, De Lorenzo, P, Busca, A, Vassallo, E, Bonanomi, S, Lanino, E, Dini, G, Varotto, S, Messina, C, Miniero, R, Valsecchi, MG & Balduzzi, A 2000, 'Impact of thrombotic thrombocytopenic purpura on leukemic children undergoing bone marrow transplantation', Bone Marrow Transplantation, vol. 26, no. 9, pp. 1005-1009.
Uderzo, C. ; Fumagalli, M. ; De Lorenzo, P. ; Busca, A. ; Vassallo, E. ; Bonanomi, S. ; Lanino, E. ; Dini, G. ; Varotto, S. ; Messina, C. ; Miniero, R. ; Valsecchi, M. G. ; Balduzzi, A. / Impact of thrombotic thrombocytopenic purpura on leukemic children undergoing bone marrow transplantation. In: Bone Marrow Transplantation. 2000 ; Vol. 26, No. 9. pp. 1005-1009.
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abstract = "Thrombotic thrombocytopenic purpura (TTP) has emerged as one of the main transplant-related complications over the last 15 years. The current study defines the incidence and the risk factors for the occurrence of TTP in 131 consecutive leukemic children who were transplanted between January 1994 and December 1997 at four Italian pediatric centers. Patients with ALL (101), AML (21), MDS (9), underwent an HLA-identical sibling BMT (82) or an HLA-identical unrelated BMT (49), receiving a conditioning regimen consisting of high-dose chemotherapy in 24 patients and of F-TBI combined with high-dose chemotherapy in 107 patients. The diagnosis of TTP was retrospectively evaluated on the basis of parallel criteria. TTP treatment varied according to the protocol of each treatment center. Twenty-eight of 131 patients (21.4{\%}) developed TTP at a median of 46 days (range 21-80) after BMT. Multivariate analysis demonstrated that the risk of TTP was higher in patients who underwent unrelated BMT (P value = 0.02). Acute GVHD, stage of disease at BMT, conditioning with TBI, gender, age, did not appear to be associated with the occurrence of TTP. As to the outcome, TTP resolved in 19 patients while in nine it was the principal cause of death (32.1{\%}). In patients with TTP, LDH peak value was the only statistically significant factor (P = 0.001) related to severe TTP. In conclusion, our experience demonstrates that leukemic children undergoing BMT, especially from an unrelated donor, should be carefully assessed for TTP which appears to be a severe and relatively common transplant-related complication when strict diagnostic criteria are applied.",
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AU - De Lorenzo, P.

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AU - Vassallo, E.

AU - Bonanomi, S.

AU - Lanino, E.

AU - Dini, G.

AU - Varotto, S.

AU - Messina, C.

AU - Miniero, R.

AU - Valsecchi, M. G.

AU - Balduzzi, A.

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