{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T04:47:28Z","timestamp":1777265248538,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81600147"],"award-info":[{"award-number":["81600147"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transplant-associated thrombotic microangiopathy (TA-TMA) is a severe and potentially fatal complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Early identification of patients at risk is essential for timely intervention and improved outcomes. This study aimed to identify biomarkers capable of predicting the early risk of TA-TMA in patients with severe aplastic anemia (SAA) undergoing allo-HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a prospective nested case\u2013control study of patients with SAA undergoing allo-HSCT, blood samples were collected before pretreatment, before infusion, and on days +7, +14, and +28. TA-TMA cases were matched 1:2 to controls. Biomarkers were compared, and predictive performance was assessed using Receiver operating characteristic analysis and Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TA-TMA was associated with markedly higher mortality (59% vs. 1.3%). Soluble tumor necrosis factor receptor 1 (sTNFR1) consistently showed the strongest predictive ability, including before pretreatment (area under the curve 0.76; 95% CI, 0.60\u20130.91). A cutoff of 1.93 ng\/mL yielded 0.88 specificity and 0.69 sensitivity. Elevated pretreatment sTNFR1 (\u22651.93 ng\/mL) predicted TA-TMA (hazard ratio, 6.78; 95% CI, 2.26-20.3; p &amp;lt; 0.001) and death (21.44; 95% CI, 2.57-179; p = 0.005). 19 had pre-transplant infections, of whom 11 (58%) developed TA-TMA versus 6 of 32 (19%) without infection. Infected patients also showed higher pretreatment sTNFR1 levels (1.93 vs. 1.64 ng\/ml, p = 0.0034).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pretreatment sTNFR1 is a strong early predictor of TA-TMA and mortality in patients with SAA undergoing allo-HSCT, suggesting Tumor Necrosis Factor-alpha\u2013driven inflammation precedes clinical onset. sTNFR1 may be a useful early-warning biomarker, and infection control before transplantation may reduce risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1807260","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T04:27:30Z","timestamp":1777264050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Infection-associated sTNFR1 elevation predicts post-transplant thrombotic microangiopathy in severe aplastic anemia"],"prefix":"10.3389","volume":"17","author":[{"given":"Ruiqing","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yumiao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangjun","family":"Liu","sequence":"additional","affiliation":[{"name":"Beijing Bo Fu Rui (BFR) Gene Diagnostics Co., Ltd.","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wengen","family":"Chen","sequence":"additional","affiliation":[{"name":"Beijing Bo Fu Rui (BFR) Gene Diagnostics Co., Ltd.","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjian","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Hematology, Guangzhou First People\u2019s Hospital, Institute of Blood Transfusion and Hematology, Guangzhou Medical University","place":["Guangzhou, 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