Plasmapheresis‐Refractory Transplantation‐Associated Thrombotic Microangiopathy Successfully Treated With Pravastatin and Limaprost Alfadex

Uesawa, Mitsuyo; Muroi, Kazuo; Ozawa, Keiya

doi:10.1111/1744-9987.12015

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…Plasma exchange has not been proven to be effective in randomized trials. Several other interventions, including rituximab, recombinant thrombomodulin, defibrotide, and pravastatin in combination with limaprost, have been reported to be beneficial, but their precise roles remain unclear at this time (78)(79)(80)(81). The involvement of complement in the pathogenesis of transplant-associated TMA has led to the use of eculizumab with evidence of improved survival (82).…”

Section: Specific Treatments For Prevention and Treatment Of Akimentioning

confidence: 99%

Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

Renaghan

Jaimes

Małyszko

et al. 2019

CJASN

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Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies. Kidney injury directly associated with stem cell transplantation includes a wide range of structural and functional abnormalities, which may be vascular (hypertension, thrombotic microangiopathy), glomerular (albuminuria, nephrotic glomerulopathies), and/or tubulointerstitial. AKI occurs commonly after stem cell transplant, affecting 10%–73% of patients. The cause is often multifactorial and can include sepsis, nephrotoxic medications, marrow infusion syndrome, hepatic sinusoidal obstruction syndrome, thrombotic microangiopathy, infections, and graft versus host disease. The risk of post-transplant kidney injury varies depending on patient characteristics, type of transplant (allogeneic versus autologous), and choice of chemotherapeutic conditioning regimen (myeloablative versus nonmyeloablative). Importantly, AKI is associated with substantial morbidity, including the need for KRT in approximately 5% of patients and the development of CKD in up to 60% of transplant recipients. AKI has been associated universally with higher all-cause and nonrelapse mortality regardless of transplant type, and studies have consistently shown extremely high (>80%) mortality rates in those patients requiring acute dialysis. Accordingly, prevention, early recognition, and prompt treatment of kidney injury are essential to improving kidney and patient outcomes after hematopoietic stem cell transplantation, and for realizing the full potential of this therapy.

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Section: Specific Treatments For Prevention and Treatment Of Akimentioning

confidence: 99%

Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

Renaghan

Jaimes

Małyszko

et al. 2019

CJASN

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“…Vincristine, an antimicrotubular agent, is well known for its clinical utility in lymphomas and acute lymphoblastic leukemia. The proposed mechanism of action of vincristine in TA‐TMA is extrapolated from its more defined role in idiopathic thrombocytopenia purpura and TTP: inhibition of autoantibody production, immunomodulation of endothelium, and alteration of PLT membrane glycoprotein preventing the binding to VWF . The two most frequent AEs associated with vincristine are peripheral neuropathy and constipation.…”

Section: Resultsmentioning

confidence: 99%

“…It is a low‐potency 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitor, and its most common AEs include myalgia and transaminitis. Based on the data that showed pravastatin's potential role in restoring blood flow in diabetic microangiopathy, Uesawa and colleagues treated an allo‐HSCT recipient with pravastatin, in combination with limaprost alfadex, after unsuccessful treatment with steroid and TPE. Normalization of laboratory variables occurred approximately 251 days after pravastatin therapy was initiated (Day +642).…”

Section: Resultsmentioning

confidence: 99%

“…However, recent data have demonstrated improved outcomes with a greater than 50% response rate when TPE is initiated early in the disease progression, suggesting that delayed TPE therapy is responsible for its poor response rates shown in previous studies of TA‐TMA . A limited number of pharmacologic agents have been explored for the management of TA‐TMA including rituximab, vincristine, defibrotide, pravastatin, and eculizumab . In this article, current evidence‐based pharmacologic therapies for the treatment of TA‐TMA will be reviewed (Table ).…”

Section: Diagnostic Criteria For Ta‐tmamentioning

confidence: 99%

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Hematopoietic stem cell transplant–associated thrombotic microangiopathy: review of pharmacologic treatment options

et al. 2014

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice–Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue

Schwartz

Padmanabhan

Aqui

et al. 2016

J of Clinical Apheresis

601

1,181

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.

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Plasmapheresis‐Refractory Transplantation‐Associated Thrombotic Microangiopathy Successfully Treated With Pravastatin and Limaprost Alfadex

Cited by 8 publications

References 4 publications

Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

Hematopoietic stem cell transplant–associated thrombotic microangiopathy: review of pharmacologic treatment options

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice–Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue

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