{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T05:01:27Z","timestamp":1789880487005,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,1,28]],"date-time":"2014-01-28T00:00:00Z","timestamp":1390867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Thrombotic microangiopathy (TMA) is a complication that developed in some patients receiving 12 Gy total body irradiation (TBI) in addition to lymphodepleting preparative chemotherapy prior to infusion of autologous tumor\u2010infiltrating lymphocytes (TIL) with high\u2010dose aldesleukin (IL\u20102). This article describes the incidence, presentation, and course of radiation\u2010associated TMA.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The data for patients with metastatic melanoma who received ACT with TIL plus aldesleukin following myeloablative chemotherapy and 12\u2010Gy TBI was examined, in order to look at patient characteristics and the natural history of TMA.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The median time to presentation was approximately 8 months after completing TBI. The estimated cumulative incidence of TMA was 31.2% (median follow\u2010up of 24 months). Noninvasive criteria for diagnosis included newly elevated creatinine levels, new\u2010onset hypertension, new\u2010onset anemia, microscopic hematuria, thrombocytopenia, low haptoglobin, and elevated lactate dehydrogenase values. Once diagnosed, patients were managed with control of their hypertension with multiple agents and supportive red blood cell transfusions. TMA typically stabilized or improved and no patient progressed to dialysis. TMA was associated with a higher probability of an antitumor response.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>TMA occurs in approximately a third of patients treated with a lymphodepleting preparative chemotherapy regimen with TBI prior to autologous T cell therapy. The disease has a variable natural history, however, no patient developed end\u2010stage renal failure. Successful management with supportive care and aggressive hypertension control is vital to the safe application of a systemic therapy that has shown curative potential for patients with disseminated melanoma. <jats:bold><jats:italic>Cancer<\/jats:italic> 2014;120:1426\u20131432<\/jats:bold>. <jats:italic>Published 2014. This article is a U.S. Government work and is in the public domain in the USA<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.28547","type":"journal-article","created":{"date-parts":[[2014,1,28]],"date-time":"2014-01-28T14:41:10Z","timestamp":1390920070000},"page":"1426-1432","source":"Crossref","is-referenced-by-count":22,"title":["Thrombotic microangiopathy in metastatic melanoma patients treated with adoptive cell therapy and total body irradiation"],"prefix":"10.1002","volume":"120","author":[{"given":"Jennifer","family":"Tseng","sequence":"first","affiliation":[{"name":"National Cancer Institute Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah E.","family":"Citrin","sequence":"additional","affiliation":[{"name":"National Cancer Institute Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryl","family":"Waldman","sequence":"additional","affiliation":[{"name":"National Institute of Diabetes and 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