{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:14:26Z","timestamp":1783602866273,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has expanded donor availability for patients with acute myeloid leukemia; however, it is associated with a high risk of endothelial complications. Among them, sinusoidal obstruction syndrome (SOS) and transplant-associated thrombotic microangiopathy (TA-TMA) are life-threatening conditions with overlapping clinical features, making early diagnosis and management challenging. Case Presentation: We report the case of a 47-year-old woman with acute myeloid leukemia who underwent haploidentical HSCT and developed sequential endothelial complications. On day +11 post-transplant, she presented with weight gain (&gt;5%), hyperbilirubinemia (44 \u03bcmol\/L), elevated liver enzymes (ALT 2228 U\/L and AST 3477 U\/L), and multi-organ dysfunction, consistent with probable SOS according to EBMT criteria. Intensive supportive care, glucocorticosteroids, and hemodiafiltration resulted in partial clinical improvement. Subsequently, on day +22, the patient developed progressive thrombocytopenia, hemolytic anemia (hemoglobin 71 g\/L), elevated lactate dehydrogenase (3129 U\/L), undetectable haptoglobin, and schistocytosis (up to 3.9%), accompanied by neurological symptoms, leading to the diagnosis of TA-TMA. Results: Management included discontinuation of tacrolimus, initiation of plasma exchange, and complement inhibition with eculizumab, along with ruxolitinib for graft-versus-host disease prophylaxis. This approach resulted in rapid clinical and laboratory improvement, including resolution of hemolysis, reduction in schistocytes (to 1%), normalization of lactate dehydrogenase, and regression of neurological symptoms. The patient was discharged in stable condition, although requiring ongoing renal replacement therapy. Conclusions: This case highlights the complexity of diagnosing and managing sequential endothelial complications after haplo-HSCT. SOS and TA-TMA may reflect overlapping manifestations of endothelial injury rather than entirely isolated complications.<\/jats:p>","DOI":"10.3390\/jcm15145385","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:55:32Z","timestamp":1783598132000},"page":"5385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequential Sinusoidal Obstruction Syndrome and TA-TMA After Haploidentical Hematopoietic Stem Cell Transplantation: Diagnostic and Therapeutic Challenges"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-6241","authenticated-orcid":false,"given":"Gulzhanat","family":"Zhunis","sequence":"first","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkitbayev","family":"Zhandos","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Bashayeva","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vadim","family":"Kemaykin","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9747-2095","authenticated-orcid":false,"given":"Nazgul","family":"Taskhyngali","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1990-0378","authenticated-orcid":false,"given":"Mukhambetiyar","family":"Karakoz","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandr","family":"Kolesnev","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aset","family":"Kuttymuratov","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5049-9257","authenticated-orcid":false,"given":"Ivan","family":"Mishutin","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruzal","family":"Vildanova","sequence":"additional","affiliation":[{"name":"National Research Oncology Center, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41409-023-02117-x","article-title":"Peripheral blood stem cell transplantation from haploidentical related donor could achieve satisfactory clinical outcomes for intermediate- or high-risk adult acute myeloid leukemia patients","volume":"59","author":"Cao","year":"2023","journal-title":"Bone Marrow Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1182\/hematology.2022000327","article-title":"In 2022, which is preferred: Haploidentical or cord transplant?","volume":"2022","author":"Nagler","year":"2022","journal-title":"Hematology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/bjh.18937","article-title":"Outcomes of haploidentical haematopoietic stem cell transplantation for adolescent and young adults with acute myeloid leukaemia","volume":"202","author":"Huo","year":"2023","journal-title":"Br. 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