{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:06:27Z","timestamp":1789617987650,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100024140","name":"ASH Foundation","doi-asserted-by":"publisher","award":["HONORS (Hematology Opportunities for the Next Gene"],"award-info":[{"award-number":["HONORS (Hematology Opportunities for the Next Gene"]}],"id":[{"id":"10.13039\/100024140","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Transplant\u2010associated thrombotic microangiopathy (TA\u2010TMA) is an endothelial dysfunction syndrome observed after allogeneic hematopoietic cell transplant (alloHCT). Our aim was to externally validate the impact of high\u2010risk features on the clinical outcomes of adult patients meeting the updated TA\u2010TMA harmonizing criteria. Between 2005 and 2022, 99 patients were diagnosed with TA\u2010TMA at Mayo Clinic Rochester (incidence 6.2%) after a median of 137\u2009days post alloHCT (IQR: 34\u2013283\u2009days). The development of TA\u2010TMA was associated with an inferior overall survival posttransplant (HR: 3.8, 95% CI: 2.97\u20134.72). High\u2010risk features, including concomitant infection, acute graft\u2010versus\u2010host disease (GVHD), and organ dysfunction, were associated with poor survival, while LDH elevation was not associated with inferior outcomes. The most common treatment strategy for TA\u2010TMA was discontinuation of calcineurin or mTOR inhibitors in 80 (81%) patients. Thirty (37.5%) patients experienced worsening of GVHD with this strategy, of which 26 (86.7%) patients had died at last follow\u2010up. The most common cause of death among these patients was worsening GVHD (69%; <jats:italic>n<\/jats:italic>\u2009=\u200918), followed by infection (11%; <jats:italic>n<\/jats:italic>\u2009=\u20093), disease relapse (8%; <jats:italic>n<\/jats:italic>\u2009=\u20092), other\/unknown causes (8%; <jats:italic>n<\/jats:italic>\u2009=\u20092), or TA\u2010TMA (4%; <jats:italic>n<\/jats:italic>\u2009=\u20091). Objective response rate (ORR) to initial treatment for the cohort was 56.6%. Eculizumab was used in 11 patients with an observed ORR of 70%, including 5 complete responses. In conclusion, TA\u2010TMA remains a significant contributor to non\u2010relapse mortality and is associated with worse survival following alloHCT. Not all high\u2010risk features, particularly LDH elevation, have consistently demonstrated a negative impact in adult cohorts. Patients with TA\u2010TMA may benefit from immune suppression dose adjustment, rather than a discontinuation, and the addition of complement\u2010directed therapy, particularly among high\u2010risk patients.<\/jats:p>","DOI":"10.1002\/ajh.27651","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T21:26:07Z","timestamp":1741728367000},"page":"830-839","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Clinical Outcomes and Treatment Strategies of Adult Transplant\u2010Associated Thrombotic Microangiopathy: External Validation of Harmonizing Definitions and High\u2010Risk Criteria"],"prefix":"10.1002","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9414-9153","authenticated-orcid":false,"given":"Aldo A.","family":"Acosta\u2010Medina","sequence":"first","affiliation":[{"name":"Division of Hematology Mayo Clinic  Rochester Minnesota 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