Conversion from calcineurin inhibitors to sirolimus in transplant-associated thrombotic microangiopathy.

Clinical transplantation 2021 Feb

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Transplant-associated thrombotic microangiopathy (TA-TMA) is a specific complication of allogeneic hematopoietic cell transplantation with a multifactorial etiology. There is little evidence published regarding the efficacy and factors influencing the outcome of substitution of calcineurin inhibitors (CNIs) with other agentsas a widely accepted practice in this disorder; however, there are limited data on the options for immunosuppression manipulation (ISM). In our study, we retrospectively analyzed outcomes of 45 patients with TA-TMA with ISM and substitution either with steroids (steroid group) or anmTOR inhibitor sirolimus (sirolimus group). In our study, sirolimus was associated with significantly better 1-year overall survival (HR 0.3, 95% CI 0.13-0.7, p = .004) and faster time to normalization of LDH (HR 2.2, 95% CI 0.99-4.99, p = .044). Replacing CNIs with sirolimus could be an effective option in patients with TA-TMA. A multicenter confirmatory study of CNIs replacement with sirolimus is justified. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Citation

Mikhail M Kanunnikov, Zhemal Z Rakhmanova, Nikita V Levkovsky, Aliya I Vafina, Oleg V Goloshapov, Tatiana S Shchegoleva, Julia J Vlasova, Olesya V Paina, Elena V Morozova, Ludmilla S Zubarovskaya, Alexander D Kulagin, Ivan S Moiseev. Conversion from calcineurin inhibitors to sirolimus in transplant-associated thrombotic microangiopathy. Clinical transplantation. 2021 Feb;35(2):e14180