Early vascular toxicity after pediatric allogeneic hematopoietic stem cell transplantation
Treatment-related mortality and morbidity remain a challenge in hematopoietic stem cell transplantation (HSCT). In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vasc...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2022-05, Vol.57 (5), p.705-711 |
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| creator | Leimi, Lilli Jahnukainen, Kirsi Olkinuora, Helena Meri, Seppo Vettenranta, Kim |
| description | Treatment-related mortality and morbidity remain a challenge in hematopoietic stem cell transplantation (HSCT). In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vascular complications and graft-versus-host disease among 122 pediatric patients with an allogeneic HSCT between 2001 and 2013. The spectrum and frequency of acute adverse events emerging ≤100 days post transplant were graded according to the CTCAE 4.03 and analyzed. We identified a total of 19/122 (15.6%) patients with vascular complications, fulfilling the criteria of capillary leak syndrome, veno-occlusive disease/sinusoidal obstruction syndrome or thrombotic microangiopathy. The patients had a poorer overall survival (77% versus 26%,
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| doi_str_mv | 10.1038/s41409-022-01607-8 |
| format | Article |
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p
< 0.001). Nearly one half (56/122, 45.9%) had at least one, severe (grade 3 or 4) adverse event. Patients with vascular complications had more often edema/effusions (
p
= 0.023), thrombocytopenia (
p
= 0.001), gastrointestinal bleeding (
p
< 0.001), acute kidney injury (
p
< 0.001), ascites (
p
< 0.001) or bilirubin increase (
p
= 0.027). These endotheliopathy-related adverse events appeared early post HSCT, varied in their clinical phenotype and predicted a poor outcome. An unrelated donor but not previous exposure to leukemia or irradiation-based conditioning was identified as a risk factor for vascular complications and endotheliopathy.</description><identifier>ISSN: 0268-3369</identifier><identifier>ISSN: 1476-5365</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/s41409-022-01607-8</identifier><identifier>PMID: 35177827</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/250/1904 ; 692/699/1541 ; 692/699/249 ; 692/699/67/1990 ; 692/700/1720 ; Adverse events ; Ascites ; Bilirubin ; Cardiovascular Diseases - etiology ; Cell Biology ; Child ; Complications ; Edema ; Graft vs Host Disease ; Graft-versus-host reaction ; Hematology ; Hematopoietic Stem Cell Transplantation - adverse effects ; Hematopoietic stem cells ; Hepatic Veno-Occlusive Disease - etiology ; Humans ; Internal Medicine ; Irradiation ; Leukemia ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Morbidity ; Patients ; Pediatrics ; Phenotypes ; Public Health ; Radiation ; Retrospective Studies ; Risk analysis ; Risk factors ; Stem cell transplantation ; Stem Cells ; Thrombocytopenia ; Thrombotic Microangiopathies - etiology ; Thrombotic microangiopathy ; Toxicity ; Transplantation ; Transplantation Conditioning - adverse effects ; Veno-occlusive disease</subject><ispartof>Bone marrow transplantation (Basingstoke), 2022-05, Vol.57 (5), p.705-711</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/. (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c562t-f992d6cf14b0091fcba47b039f6291c7c96d802bdd5d28076a75b8a1ae8da8b33</citedby><cites>FETCH-LOGICAL-c562t-f992d6cf14b0091fcba47b039f6291c7c96d802bdd5d28076a75b8a1ae8da8b33</cites><orcidid>0000-0002-0774-7110</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,553,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35177827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:148834635$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Leimi, Lilli</creatorcontrib><creatorcontrib>Jahnukainen, Kirsi</creatorcontrib><creatorcontrib>Olkinuora, Helena</creatorcontrib><creatorcontrib>Meri, Seppo</creatorcontrib><creatorcontrib>Vettenranta, Kim</creatorcontrib><title>Early vascular toxicity after pediatric allogeneic hematopoietic stem cell transplantation</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>Treatment-related mortality and morbidity remain a challenge in hematopoietic stem cell transplantation (HSCT). In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vascular complications and graft-versus-host disease among 122 pediatric patients with an allogeneic HSCT between 2001 and 2013. The spectrum and frequency of acute adverse events emerging ≤100 days post transplant were graded according to the CTCAE 4.03 and analyzed. We identified a total of 19/122 (15.6%) patients with vascular complications, fulfilling the criteria of capillary leak syndrome, veno-occlusive disease/sinusoidal obstruction syndrome or thrombotic microangiopathy. The patients had a poorer overall survival (77% versus 26%,
p
< 0.001). Nearly one half (56/122, 45.9%) had at least one, severe (grade 3 or 4) adverse event. Patients with vascular complications had more often edema/effusions (
p
= 0.023), thrombocytopenia (
p
= 0.001), gastrointestinal bleeding (
p
< 0.001), acute kidney injury (
p
< 0.001), ascites (
p
< 0.001) or bilirubin increase (
p
= 0.027). These endotheliopathy-related adverse events appeared early post HSCT, varied in their clinical phenotype and predicted a poor outcome. An unrelated donor but not previous exposure to leukemia or irradiation-based conditioning was identified as a risk factor for vascular complications and endotheliopathy.</description><subject>631/250/1904</subject><subject>692/699/1541</subject><subject>692/699/249</subject><subject>692/699/67/1990</subject><subject>692/700/1720</subject><subject>Adverse events</subject><subject>Ascites</subject><subject>Bilirubin</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cell Biology</subject><subject>Child</subject><subject>Complications</subject><subject>Edema</subject><subject>Graft vs Host Disease</subject><subject>Graft-versus-host reaction</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Hematopoietic stem cells</subject><subject>Hepatic Veno-Occlusive Disease - etiology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Irradiation</subject><subject>Leukemia</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Phenotypes</subject><subject>Public Health</subject><subject>Radiation</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Thrombocytopenia</subject><subject>Thrombotic Microangiopathies - 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In this retrospective, single-center study, we analyzed endothelial damage as a potential, common denominator and mechanism for the adverse effects. We evaluated the prevalence of key vascular complications and graft-versus-host disease among 122 pediatric patients with an allogeneic HSCT between 2001 and 2013. The spectrum and frequency of acute adverse events emerging ≤100 days post transplant were graded according to the CTCAE 4.03 and analyzed. We identified a total of 19/122 (15.6%) patients with vascular complications, fulfilling the criteria of capillary leak syndrome, veno-occlusive disease/sinusoidal obstruction syndrome or thrombotic microangiopathy. The patients had a poorer overall survival (77% versus 26%,
p
< 0.001). Nearly one half (56/122, 45.9%) had at least one, severe (grade 3 or 4) adverse event. Patients with vascular complications had more often edema/effusions (
p
= 0.023), thrombocytopenia (
p
= 0.001), gastrointestinal bleeding (
p
< 0.001), acute kidney injury (
p
< 0.001), ascites (
p
< 0.001) or bilirubin increase (
p
= 0.027). These endotheliopathy-related adverse events appeared early post HSCT, varied in their clinical phenotype and predicted a poor outcome. An unrelated donor but not previous exposure to leukemia or irradiation-based conditioning was identified as a risk factor for vascular complications and endotheliopathy.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>35177827</pmid><doi>10.1038/s41409-022-01607-8</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0774-7110</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0268-3369 |
| ispartof | Bone marrow transplantation (Basingstoke), 2022-05, Vol.57 (5), p.705-711 |
| issn | 0268-3369 1476-5365 1476-5365 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_455401 |
| source | MEDLINE; SWEPUB Freely available online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | 631/250/1904 692/699/1541 692/699/249 692/699/67/1990 692/700/1720 Adverse events Ascites Bilirubin Cardiovascular Diseases - etiology Cell Biology Child Complications Edema Graft vs Host Disease Graft-versus-host reaction Hematology Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic stem cells Hepatic Veno-Occlusive Disease - etiology Humans Internal Medicine Irradiation Leukemia Medicin och hälsovetenskap Medicine Medicine & Public Health Morbidity Patients Pediatrics Phenotypes Public Health Radiation Retrospective Studies Risk analysis Risk factors Stem cell transplantation Stem Cells Thrombocytopenia Thrombotic Microangiopathies - etiology Thrombotic microangiopathy Toxicity Transplantation Transplantation Conditioning - adverse effects Veno-occlusive disease |
| title | Early vascular toxicity after pediatric allogeneic hematopoietic stem cell transplantation |
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