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Histologic features of hematopoietic stem cell transplant-associated thrombotic microangiopathy are best percepted in deep skin biopsies and renal biopsies, while showing a significant overlap with changes related to severe acute graft-versus-host disease in gastrointestinal biopsies

Bone Marrow Transplantation volume 55, pages 1847–1850 (2020)Cite this article

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Allogeneic hematopoietic cell transplantation (allo-HCT) is mainly used in patients with neoplastic hematolymphoid diseases. The success of allo-HCT is limited by the occurrence of early complications such as acute graft-versus-host disease (aGvHD) and transplant-associated thrombotic microangiopathy (TA-TMA) [1].

Results from our and other groups support the hypothesis of a common microangiopathic pathogenesis of steroid-refractory aGvHD and TA-TMA that runs a more subacute course in the former and a particularly severe one in the latter [2]. The endothelial injury in aGvHD results from circulating cytokines, coagulation pathway activation, low levels of VEGF, and direct endothelial damage by cytotoxic donor T cells, which differs from the central role of complement activation in TA-TMA [3], which may be counteracted by the complement inhibitor eculizumab [4, 5].

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Fig. 1: Histologic features of gastrointestinal GvHD and putative correlates of TMA.

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Acknowledgements

The study was supported by a grant from the Krebsliga beider Basel (grant no. KLbB-4176-03-2017) to MM.

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  1. These authors contributed equally: Michelle Anna Ehmann, Michael Medinger, Benjamin Bodenmann

Authors and Affiliations

  1. Division of Hematology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Michelle Anna Ehmann, Michael Medinger, Benjamin Bodenmann, Sarah Kraft, Noémie Bollinger, Dominik Heim, Claudia Lengerke, Dimitrios A. Tsakiris & Jakob Passweg

  2. Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Michael Medinger

  3. Institute of Medical Genetics and Pathology, University Hospital Basel, Schoenbeinstrasse 40, 4031, Basel, Switzerland

    Alexandar Tzankov & Thomas Menter

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Contributions

MM, AT, and TM designed the study. TM and AT evaluated the pathological specimens. MAE, MM, BB, AT, and TM wrote the paper. SK, NB, DH, CL, DAT, and JP provided the clinical data and critically revised the paper.

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Correspondence to Michael Medinger.

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Ehmann, M.A., Medinger, M., Bodenmann, B. et al. Histologic features of hematopoietic stem cell transplant-associated thrombotic microangiopathy are best percepted in deep skin biopsies and renal biopsies, while showing a significant overlap with changes related to severe acute graft-versus-host disease in gastrointestinal biopsies. Bone Marrow Transplant 55, 1847–1850 (2020). https://doi.org/10.1038/s41409-020-0880-y

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