Diagnosis and management of endothelial disorders following haematopoietic stem cell transplantation

Ashley McEwan; Matthew Greenwood; Christopher Ward; David Ritchie; Jeff Szer; Elizabeth Gardiner; Andriana Colic; Julija Sipavicius; Yvonne Panek-Hudson; Ian Kerridge

doi:10.1111/imj.16188

Diagnosis and management of endothelial disorders following haematopoietic stem cell transplantation

Intern Med J. 2023 Dec;53(12):2162-2174. doi: 10.1111/imj.16188. Epub 2023 Aug 1.

Authors

Ashley McEwan^{1

2

3}, Matthew Greenwood^{1

4

5}, Christopher Ward^{1

4

5}, David Ritchie^{6

7

8}, Jeff Szer^{6

7

8}, Elizabeth Gardiner⁹, Andriana Colic¹, Julija Sipavicius¹, Yvonne Panek-Hudson^{6

7}, Ian Kerridge^{1

4

5}

Affiliations

¹ Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.
² Haematology Department, Liverpool Hospital, Sydney, New South Wales, Australia.
³ South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
⁶ Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Haematology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁸ University of Melbourne, University of Melbourne, Melbourne, Victoria, Australia.
⁹ John Curtin School of Medical Research at the Australian National University, Canberra, Australian Capital Territory, Australia.

PMID: 37528613
DOI: 10.1111/imj.16188

Abstract

Haematopoietic stem cell transplantation is a mainstay of therapy for numerous malignant and nonmalignant diseases. Endothelial activation and dysfunction occur after stem cell transplantation, driven by various patient- and transplant-specific factors. This can manifest as one of the relatively uncommon endothelial injury syndromes, such as sinusoidal obstruction syndrome, transplant-associated thrombotic microangiopathy, idiopathic pneumonia syndrome, capillary leak syndrome, engraftment syndrome or posterior reversible encephalopathy syndrome. This review focuses on the pathogenesis, classification and diagnosis of these disorders, as well as provides guidance on risk mitigation and treatment.

Keywords: endothelial dysfunction; endothelial injury syndrome; haematopoietic stem cell transplant; sinusoidal obstruction syndrome.

Publication types

Review

MeSH terms

Hematologic Diseases*
Hematopoietic Stem Cell Transplantation* / adverse effects
Humans
Pneumonia*
Posterior Leukoencephalopathy Syndrome* / complications
Thrombotic Microangiopathies* / diagnosis
Thrombotic Microangiopathies* / etiology
Thrombotic Microangiopathies* / therapy