BackgroundTransplant-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.MethodsIn a prospective nested case–control 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.ResultsTA-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, 0.60–0.91). A cutoff of 1.93 ng/mL yielded 0.88 specificity and 0.69 sensitivity.
Elevated pretreatment sTNFR1 (≥1.93 ng/mL) predicted TA-TMA (hazard ratio, 6.78; 95% CI, 2.26-20.3; p < 0.001) and death (21.44; 95% CI, 2.57-179; p = 0.005).
Frontiers in Immunology published a clinical update in Infectious Disease on 27 Apr 2026.
The item focuses on Infection-associated sTNFR1 elevation predicts post-transplant thrombotic microangiopathy in severe aplastic anemia.
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