The Cincinnati Children's Hospital and Medical Center Institutional Review Board exempted this study from obtaining informed consent from the patient and family.
Does early initiation of therapeutic plasma exchange improve outcome in pediatric stem cell transplant–associated thrombotic microangiopathy?
Article first published online: 15 JUL 2012
© 2012 American Association of Blood Banks
Volume 53, Issue 3, pages 661–667, March 2013
How to Cite
Jodele, S., Laskin, B. L., Goebel, J., Khoury, J. C., Pinkard, S. L., Carey, P. M. and Davies, S. M. (2013), Does early initiation of therapeutic plasma exchange improve outcome in pediatric stem cell transplant–associated thrombotic microangiopathy?. Transfusion, 53: 661–667. doi: 10.1111/j.1537-2995.2012.03776.x
- Issue published online: 8 MAR 2013
- Article first published online: 15 JUL 2012
- Received for publication March 1, 2012; revision received May 20, 2012, and accepted May 20, 2012.
BACKGROUND: The use of therapeutic plasma exchange (TPE) in hematopoietic stem cell transplant–associated thrombotic microangiopathy (TA-TMA) is controversial because the exact mechanism of injury in TA-TMA is not yet understood.
STUDY DESIGN AND METHODS: The study objective was to retrospectively review the outcome of children receiving TPE for TA-TMA at our institution. We hypothesized that patients initiating TPE earlier in their disease course would receive a greater benefit than those starting later, regardless of the therapeutic mechanism.
RESULTS: We identified 10 consecutive pediatric patients with TA-TMA treated with TPE. Nine of these patients showed normalization of the laboratory variables associated with microangiopathy during their TPE course, but only five patients recovered renal function and survived TA-TMA. The five survivors started TPE a median of 17 days (range, 4-25 days) after TA-TMA diagnosis while the five patients who died started TPE a median of 32 days (range, 17-73 days) after TA-TMA was diagnosed. Three of the five survivors had multiorgan failure at TA-TMA diagnosis and completely recovered with early institution of TPE. These three survivors were able to discontinue renal replacement therapy, and all achieved a normal posttreatment creatinine. The five patients with later institution of TPE progressed to end-stage renal disease and all died. There were no serious TPE-related complications in either group.
CONCLUSION: This is the first report evaluating TPE response in regard to procedure initiation time after TA-TMA diagnosis. Our data suggests that early initiation of TPE might be beneficial even in patients with multiorgan failure due to TA-TMA.