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EBMT 2026 | Incidence & management of TA-TMA in settings with limited access to biomarkers and targeted therapy
Nour Ben Abdeljelil, MD, National Bone Marrow Transplantation Centre, Tunis, Tunisia, discusses the incidence and management of transplantation-associated thrombotic microangiopathy (TA-TMA) in settings with limited access to biomarkers and targeted therapies, highlighting the challenges of diagnosis and treatment. Dr Ben Abdeljelil notes that a retrospective study using data from her institution reported a 5% incidence of TA-TMA among 243 patients with hematological disorders who underwent transplantation, with a multivariable analysis identifying acute graft-versus-host disease (GvHD) and microbiologically documented infections as significant risk factors for this complication. This interview took place at the 52nd Annual Meeting of the EBMT in Madrid, Spain.
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Transcript
During this EBMT annual meeting, we are presenting data from our retrospective analysis at the National Bone Marrow Transplantation Centre in Tunisia. In this study, we analysed the incidence and outcomes of transplantation-associated thrombotic microangiopathy, or TA-TMA, in two hundred and forty patients transplanted with hematological disorders. In fact, the diagnosis and management of this severe endothelial complication remain challenging, especially in transplant centers like ours where access to specific biomarkers and targeted therapy is limited...
During this EBMT annual meeting, we are presenting data from our retrospective analysis at the National Bone Marrow Transplantation Centre in Tunisia. In this study, we analysed the incidence and outcomes of transplantation-associated thrombotic microangiopathy, or TA-TMA, in two hundred and forty patients transplanted with hematological disorders. In fact, the diagnosis and management of this severe endothelial complication remain challenging, especially in transplant centers like ours where access to specific biomarkers and targeted therapy is limited. So, we use a Jodele clinical criteria except for the soluble C5b-9 parameter. We also explored the EASIX score across different times post-transplantation. The EASIX score is an endothelial activation and Thrombotic Index, it is a simple biomarker that may predict TA-TMA after transplantation.
So in this study, we have 5% of patients who developed TA-TMA after a median time of two months post-transplantation. We identified acute GVHD and microbiologically documented infections as significant factors associated with the occurrence of TA-TMA. So this finding supports the concept that TA-TMA results from a cumulative endothelial injury in the early post-transplantation period. On the other hand, the three-year overall survival was significantly higher in patients without TA-TMA, whereas non-relapse mortality and EASIX score were significantly higher in patients with TA-TMA. However, TA-TMA-related mortality was 22%.
Finally, two key conclusions emerge from this study. First, the diagnosis and the incidence of TA-TMA in our study is probably underestimated because specific biomarkers, especially the soluble C5b-9, are not available. Second, limited access to complement-targeted therapy, especially eculizumab, may contribute to higher TA-TMA-related mortality.
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