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von Willebrand Factor as a Predictor for Transplant-Associated Thrombotic Microangiopathy
oleh: Zhenzhen Xu MS, Chengwei Luo MD, Peilong Lai MD, Wei Ling MD, Suijing Wu MD, Xin Huang MD, Lisi Huang MD, Guanrong Zhang MS, Xin Du PhD, Jianyu Weng PhD
Format: | Article |
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Diterbitkan: | SAGE Publishing 2020-02-01 |
Deskripsi
Transplant-associated thrombotic microangiopathy (TA-TMA) after hematopoietic stem cell transplantation (HSCT) is a severe complication associated with underlying endothelial damage. Secreted and released von Willebrand factor (vWF) correlates with endothelial cell injury, but its role in predicting prognosis for TA-TMA is unclear. In this prospective study, we evaluated the relationship between vWF and the incidence of TA-TMA after HSCT. A total of 79 consecutive patients undergoing HSCT from August 2016 to June 2018 were enrolled. Twenty-three (29%) patients met the established diagnostic criteria. Patients with TA-TMA had significantly higher nonrelapse mortality compared with those without TA-TMA (78.3% vs 8.9%; P < .001). Multivariable analysis demonstrated that vWF was a predictive biomarker for TA-TMA. The vWF value was higher for the TA-TMA group (mean ± standard deviation, 380.7% ± 78.8% vs 284.9% ± 104.5%; P < .001), and the area under the curve for vWF in the diagnosis of TA-TMA was 0.756. Furthermore, patients with ≥325% vWF had a higher 2-year cumulative hazard of TA-TMA (53.1% ± 8.2% vs 7.5% ± 4.2%; P < .001) and a lower 2-year survival (32.1% ± 9.1% vs 83.7% ± 6.2%; P < .001) compared with those with <325% vWF. Conclusion: von Willebrand factor is a useful predictor and prognostic measure for TA-TMA, which may help clinicians identify and manage this life-threatening disease earlier.