Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT.

Moiseev, Ivan S; Tsvetkova, Tatyana; Aljurf, Mahmoud; Alnounou, Randa M; Bogardt, Janet; Chalandon, Yves; Drokov, Mikhail Yu; Dvirnyk, Valentina; Faraci, Maura; Friis, Lone Smidstrup; Giglio, Fabio; Greinix, Hildegard T; Kornblit, Brian Thomas; Koelper, Christiane; Koenecke, Christian; Lewandowski, Krzysztof; Niederwieser, Dietger; Passweg, Jakob R; Peczynski, Christophe; Penack, Olaf; ... (2019). Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT. Bone marrow transplantation, 54(7), pp. 1022-1028. Nature Publishing Group 10.1038/s41409-018-0374-3

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Transplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study evaluated clinical and morphological practices of TA-TMA diagnosis in EBMT centers. Two questionnaires, one for transplant physician and one for morphologist, and also a set of electronic blood slides from 10 patients with TA-TMA and 10 control patients with various erythrocyte abnormalities, were implemented for evaluation. Seventeen EBMT centers participated in the study. Regarding criteria used for TA-TMA diagnosis, centers reported as follows: 41% of centers used the International Working Group (IWG) criteria, 41% used "overall TA-TMA" criteria and 18% used physician's decision. The threshold of schistocytes to establish TA-TMA diagnosis in the participating centers was significantly associated with morphological results of test cases evaluations (p = 0.002). The mean number of schistocytes reported from blood slide analyses were 4.3 ± 4.5% for TA-TMA cases (range 0-19.6%, coefficient of variation (CV) 0.7) and 1.3 ± 1.6% for control cases (range 0-8.3%, CV 0.8). Half of the centers reported schistocyte levels below 4% for 7/10 TA-TMA cases. The intracenter variability was low, indicating differences in the institutional practices of morphological evaluation. In conclusion, the survey identified the need for the standardization of TA-TMA morphological diagnosis.

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