Poster Presentation Advances in Neuroblastoma Research Congress 2016

Clinical characteristics and risk factor of transplantation-associated microangiopathy (TAM) in high-tisk neuroblastoma undergoing autologous peripheral blood stem cell transplantation (auto-PBSCT) (#167)

Noritaka Miyazawa 1 , Kimikazu Matsumoto 1 , Chikako Kiyotani 1 , Yoko Shioda 1 , Keita Terashima 1 , Daisuke Tomizawa 1 , Motohiro Kato 1 , Tomoo Osumi 1 , Yutaka Kanamori 2 , Yasushi Fuchimoto 2 , Atsuko Nakazawa 3 , Takako Yoshioka 3 , Hiroshi Fuji 4 , Masayuki Kitamura 4
  1. Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
  2. Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo, Japan
  3. Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
  4. Department of Radiology, National Center for Child Health and Development, Tokyo, Japan

Background:

Transplantation-associated microangiopathy (TAM) is a severe complication which occur after stem cell transplantation. TAM in high-risk neuroblastoma (NB) patients with autologous peripheral blood stem cell transplantation (PBSCT) is not yet well described in literature.

 

Patients and Method:

We retrospectively reviewed the medical record of 32 NB patients who received single auto-PBSCT from March 2002 to September 2014 at our institution. In this study, we defined TAM as all following criteria met;(1)twice elevation of creatinine(Cr) from  baseline before PBSCT, (2)elevated lactate dehydrogenase(LDH) above the upper limit of normal, (3)hematuria, (4)increased transfusion requirements without other cause. Clinical characteristics and risk factors of TAM were analyzed and compared with other solid tumor patients received single auto-PBSCT.

 

Result:

Seven out of 32 NB patients experienced TAM (21.9%) which developed 7-90 days (mean = 39days) after PBSCT, comparing the incidence of 1 out of 27 patients of solid tumors other than NB (P=0.23). Three out of  4 patients with early onset (TAM occurred by day30) needed to receive hemodialysis more than that with late onset (TAM occurred after day30;0/3) (P=0.047).After hemodialysis, none required chronic hemodialysis, and six out of seven TAM patients were alive. To elucidate the risk factors for the occurrence of TAM, we compared clinical characteristics between TAM and non-TAM group. There were no significant differences between TAM and non-TAM group in patients characteristics, include age, sex, total dose of cisplatin and cyclophosphamide, radiotherapy and enucleation of kidney, and high dose chemotherapy (HDC) regimens. Mean systolic blood pressure (P=0.39), level of Cr (0.88) and 24-hr Cr clearance(P=0.31) before PBSCT weren’t different, respectively.

 

Conclusion:

We could not identify risk factors of TAM after PBSCT in high-risk NB treatment. Although it is difficult to predict TMA before PBSCT, prognosis of TAM In NB patients is better than TAM after allogeneic transplantation previously reported.