Serum neutrophil extracellular trap levels predict thrombotic microangiopathy after allogeneic stem cell transplantation

Biol Blood Marrow Transplant. 2013 Dec;19(12):1683-9. doi: 10.1016/j.bbmt.2013.09.005. Epub 2013 Sep 19.


Transplantation-associated thrombotic microangiopathy (TA-TMA) is a devastating complication of hematopoietic stem cell transplantation. TA-TMA likely represents the final stage of vascular endothelial injury; however, its pathophysiology is largely unknown, making clinical management difficult. Recently, the association of neutrophil extracellular traps (NETs) with the development of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome has been reported. Thus, we explored whether NETs are also relevant to the occurrence of TA-TMA. We retrospectively analyzed post-transplant trends of serum NET levels in 90 patients, 11 of whom developed TA-TMA. Relative to baseline (before the conditioning regimen), elevated serum NET levels either at 4 weeks after transplantation or as early as the day of transplantation were associated with significantly increased risk of TA-TMA. In contrast, thrombomodulin, a potential marker for TA-TMA, was not helpful to predict the occurrence of TA-TMA in our study. In addition, we directly detected glomerular deposition of NETs in 2 TA-TMA patients. Increased NET levels are a significant risk factor for TA-TMA, suggesting that NET level is a useful biomarker for TA-TMA.

Keywords: Allogeneic stem cell transplantation; Neutrophil extracellular traps; Predictive biomarker; Thrombotic microangiopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Male
  • Middle Aged
  • Neutrophils / cytology
  • Neutrophils / metabolism*
  • Predictive Value of Tests
  • Retrospective Studies
  • Thrombotic Microangiopathies / blood*
  • Thrombotic Microangiopathies / etiology
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods
  • Transplantation, Autologous
  • Treatment Outcome
  • Young Adult