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Gaume C, Moluçon Chabrot C, Chabrot P, Abergel A. Editorial: How often can we get the right diagnosis after bone marrow transplant in patients with abnormal liver function tests? Aliment Pharmacol Ther 2024; 59:705-706. [PMID: 38349701 DOI: 10.1111/apt.17840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
LINKED CONTENTThis article is linked to Dezan et al papers. To view these articles, visit https://doi.org/10.1111/apt.17756 and https://doi.org/10.1111/apt.17870
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Affiliation(s)
- C Gaume
- Médecine digestive et hépatobiliaire, CHU Clermont Ferrand, Clermont Ferrand, France
| | - C Moluçon Chabrot
- Service de thérapie cellulaire et hématologie clinique, CHU Clermont Ferrand, Clermont Ferrand, France
| | - P Chabrot
- Imagerie médicale et radiologie interventionnelle, CHU Clermont Ferrand, Clermont Ferrand, France
- Thérapies Guidées par l'Image, Institut Pascal, UMR 6602 CNRS UCA SIGMA, Clermont Ferrand, France
| | - A Abergel
- Médecine digestive et hépatobiliaire, CHU Clermont Ferrand, Clermont Ferrand, France
- Thérapies Guidées par l'Image, Institut Pascal, UMR 6602 CNRS UCA SIGMA, Clermont Ferrand, France
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Robin M, Gras L, Koster L, Gagelmann N, van Gorkom G, Ederr M, Itälä-Remes M, Zuckerman T, Beguin Y, Schaap N, Drozd-Sokolowska J, Raj K, Hayden PJ, de Wreede LC, Battipaglia G, Polverelli N, Czerw T, Hernandez Boluda JC, Kröger N, Yakoub-Agha I, McLornan DP. Early liver complications after allogeneic haematopoietic stem cell transplantation in patients with myelofibrosis: A study on behalf of the Chronic Malignancies Working Party of the EBMT. Br J Haematol 2024; 204:715-718. [PMID: 38014808 DOI: 10.1111/bjh.19214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Marie Robin
- Hôpital Saint Louis, APHP, Université de Paris Cité, Paris, France
| | - Luuk Gras
- EBMT Statistical Unit, Leiden, The Netherlands
| | | | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gwendolyn van Gorkom
- Department of Internal Medicine, Hematology and Oncology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Matthias Ederr
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Maija Itälä-Remes
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Yves Beguin
- Department of Hematology, CHU Liege, University of Liege, Liege, Belgium
| | - Nicolaas Schaap
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joanna Drozd-Sokolowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kavita Raj
- Department of Haematology, University College London Hospitals NHS Trust, London, UK
| | | | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Nicola Polverelli
- Unit of Bone Marrow Transplantation - Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Tomasz Czerw
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Juan Carlos Hernandez Boluda
- Department of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille LIRIC, INSERM U1286, Université de Lille, Lille, France
| | - Donal P McLornan
- Department of Haematology, University College London Hospitals NHS Trust, London, UK
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Kriege O, Kreft A, Hauptrock B, Wölfinger P, Theobald M, Wagner-Drouet EM. Diagnosis of sinusoidal obstruction syndrome: can biopsy be the key? Ann Hematol 2023; 102:3635-3637. [PMID: 37740063 PMCID: PMC10640494 DOI: 10.1007/s00277-023-05445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Oliver Kriege
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany.
| | - Andreas Kreft
- Department of Pathology, University Medical Center Mainz, Langenbeckstr 1, 55131, Mainz, Germany
| | - Beate Hauptrock
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Pascal Wölfinger
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Matthias Theobald
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Eva-Maria Wagner-Drouet
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
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Xiong Y, Xin Y, Qu L, Liu Y, Zhu J. Role of Multiparametric Ultrasound in Evaluating Hepatic Acute Graft-versus-Host Disease: An Animal Study. Ultrasound Med Biol 2023; 49:1449-1456. [PMID: 36948895 DOI: 10.1016/j.ultrasmedbio.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/13/2023] [Accepted: 02/16/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Hepatic acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is one of the leading causes of early non-recurrent death. The current diagnosis is based mainly based on clinical diagnosis, and there is a lack of non-invasive quantitative diagnosis methods. We propose a multiparametric ultrasound (MPUS) imaging method and explore its effectiveness in evaluating hepatic aGVHD. METHODS In this study, 48 female Wistar rats were used as receptors and 12 male Fischer 344 rats were used as donors for allo-HSCT to establish aGVHD models. After transplantation, 8 rats were randomly selected for ultrasonic examination weekly, including color Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and shear wave dispersion (SWD) imaging. The values of nine ultrasonic parameters were obtained. Hepatic aGVHD was subsequently diagnosed by histopathological analysis. A classification model for predicting hepatic aGVHD was established using principal component analysis and support vector machines. RESULTS According to the pathological results, the transplanted rats were categorized into the hepatic aGVHD and non-GVHD (nGVHD) groups. All parameters obtained by MPUS differed statistically between the two groups. The first three contributing percentages of principal component analysis results were resistivity index, peak intensity and shear wave dispersion slope, respectively. The accuracy of classifying aGVHD and nGVHD using support vector machines reached 100%. The accuracy of the multiparameter classifier was significantly higher than that of the single parameter. CONCLUSION The MPUS imaging method has proven to be useful in detecting hepatic aGVHD.
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Affiliation(s)
- Yu Xiong
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yuwei Xin
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Linlin Qu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
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Xiong Y, Xin Y, Liu F, Li W, Liu Y, Zhu J. Efficacy of shear wave dispersion imaging for viscoelastic assessment of the liver in acute graft-versus-host disease rats. Quant Imaging Med Surg 2022; 12:5044-5055. [PMID: 36330177 PMCID: PMC9622446 DOI: 10.21037/qims-22-374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/14/2022] [Indexed: 08/29/2023]
Abstract
BACKGROUND To investigate the feasibility of using shear wave dispersion (SWD) imaging to evaluate hepatic acute graft-versus-host disease (aGVHD) in a rat model. METHODS To establish an aGVHD model, 30 Wistar rats were subjected to bone marrow transplantation, 10 Fischer 344 rats were used as donors, and 6 Wistar rats were used as the control group. Each week, 6 rats were randomly chosen and divided into groups of 1 week (1 w) to 5 weeks (5 w). For each subgroup, the rats received a clinical index assessment and shear wave dispersion (SWD) examination with 2 quantitative values, shear wave (SW) speed and SWD slope. The histological characteristics were then used as the reference standard to divide the rats into the aGVHD group and the no aGVHD (nGVHD) group. RESULTS In the 2 weeks (2 w) group, only SWD slope [median: 7.26, interquartile range (IQR): 7.04 to 7.31] showed a significant increase in the measured value (P<0.05). The value of the 3 weeks (3 w) group (median: 7.88, IQR: 7.84 to 8.49) significantly increased compared with the 2 w value (P<0.05). Although the value increased gradually from week 3 to week 5, it had no statistical significance (P>0.05). The SW speed [mean ± standard deviation (SD): 1.54±0.11, 95% confidence interval (CI): 1.48 to 1.59] and SWD slope (mean ± SD: 8.29±0.56, 95% CI: 7.99 to 8.59) of the aGVHD group were higher than those of the control group and the nGVHD group (P<0.001). The correlation of SWD slope with pathological grade was the highest (r=0.798, P<0.01), followed by SW speed (r=0.785, P<0.01), and the correlation of clinical index with pathological grade was the lowest (r=0.751, P<0.01). In addition, the area under the receiver operating characteristic (ROC) curve (AUC) value of aGVHD using the SWD slope was 0.844 (95% CI: 0.67 to 0.95, sensitivity: 93.75%, specificity: 78.57%), which was higher than the AUC of both SW speed and clinical index, and the difference was statistically significant compared to the AUC of the clinical index. CONCLUSIONS The SWD slope could show significant abnormalities earlier than SW speed and clinical index and is also more consistent with the change in aGVHD severity level. The SWD slope may help in detecting hepatic aGVHD during ultrasound SWD examination.
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Affiliation(s)
- Yu Xiong
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Yuwei Xin
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Yiqun Liu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
| | - Jia’an Zhu
- Department of Ultrasound, Peking University People’s Hospital, Beijing, China
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6
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Bris PN, Gauchez P, Devillier R, Galicier L, Collignon A, Piana G, Poizat F, Faucher M, Hospital MA, Vey N, Gonzalez F, Servan L, Chow-Chine L, Sannini A, Mokart D, Saillard C, Bisbal M. Hepatic haemophagocytosis in haematology patients with hepatic dysfunction: prognostic impact and contribution of liver biopsy combined with the haemophagocytic syndrome diagnostic score (HScore). Br J Haematol 2022; 199:106-116. [PMID: 35968907 DOI: 10.1111/bjh.18382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Hepatic dysfunction (HD) is common in patients with haematological malignancies. Hepatic haemophagocytosis (HH) was detected in >50% of liver biopsies taken when HD remained unresolved after standard examination. We aimed to explore the contribution of liver biopsy in patients with both haematological malignancies and HD, describe the population of patients with HH, assess the prognostic impact of HH, and investigate haemophagocytic syndrome diagnostic score (HScore) utility in patients with HH. Between 2016 and 2019, 116 consecutive liver biopsies (76 transjugular, 40 percutaneous) were taken in 110 patients with haematological malignancy and HD (hyperbilirubinaemia, elevated transaminases, and/or cholestasis) and without a clear diagnosis. Liver biopsies were safe and diagnostically efficient. Predominant diagnoses included: HH (56%), graft-versus-host disease (55%), associated infections (24%), sinusoidal obstruction syndrome (15%), and tumoral infiltration (8%). Of patients, 35% were critically ill and 74% were allogeneic haematopoietic stem cell transplantation recipients, while 1-year overall survival (OS) was 35% with HH versus 58% without HH (p = 0.026). The 1-year OS was 24% with a HScore of ≥169 versus 50% with a HScore of <169 (p = 0.019). Liver biopsies are feasible in and contribute significantly to haematology patients with HD. HH occurred frequently and was associated with a poor prognosis. Combined with liver biopsy, the HScore may be helpful in refining haemophagocytic syndrome diagnosis.
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Affiliation(s)
- Pierre-Nicolas Bris
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Philippe Gauchez
- Pathology Department, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, France
| | | | | | - Aude Collignon
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Imagery Department, Institut Paoli Calmettes, Marseille, France
| | - Flora Poizat
- Pathology Department, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | | | - Norbert Vey
- Hematology Department, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Frederic Gonzalez
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Luca Servan
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Antoine Sannini
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Djamel Mokart
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Colombe Saillard
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | - Magali Bisbal
- Anaesthesia and Critical Care Department, Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
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Debureaux PE, Bourrier P, Rautou PE, Zagdanski AM, De Boutiny M, Pagliuca S, Sutra Del Galy A, Robin M, Peffault de Latour R, Plessier A, Sicre de Fontbrune F, Xhaard A, de Lima Prata PH, Valla D, Socié G, Michonneau D. Elastography improves accuracy of early hepato-biliary complications diagnosis after allogeneic stem cell transplantation. Haematologica 2021; 106:2374-2383. [PMID: 32732366 PMCID: PMC8409044 DOI: 10.3324/haematol.2019.245407] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
Significant morbidity and mortality have been associated with liver complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Causes and consequences of these hepato-biliary complications are various and might be life-threatening. A high misdiagnosis rate has been reported because of a weak correlation between clinical, laboratory and imaging data. Liver elastography, a liver stiffness measure, is able to assess liver fibrosis and portal hypertension in most liver diseases, but data after allo-HSCT are scarce. Our aim was to determine the interest of sequential liver stiffness measurements for the diagnosis of early hepatic complications after allo-HSCT. Over a 2-year time period, 161 consecutive adult patients were included and 146 were analyzed. Ultrasonography and elastography measurements were performed before transplantation, at day+7 and day+14 by three different experienced radiologists unaware of the patients’ clinical status. Eightyone (55%) patients had liver involvements within the first 100 days after allo-HSCT. Baseline elastography was not predictive for the occurrence of overall liver abnormalities. A significant increase in two-dimensional real-time shearwave elastography (2D-SWE) was found in patients with sinusoidal obstruction syndrome (SOS). Fifteen patients (10%) fulfilled European Society for Blood and Marrow Transplantation (EBMT) score criteria and twelve (8%) reached Baltimore criteria for SOS diagnosis, but only six (4%) had a confirmed SOS. 2D-SWE at day+14 allowed early detection of SOS (AUROC=0.84, P=0.004) and improved sensibility (75%), specificity (99%) and positive predictive value (60%) over the Seattle, Baltimore or EBMT scores. A 2D-SWE measurement above 8.1 kPa at day+14 after allo-HSCT seems a promising, non-invasive, and reproducible tool for early and accurate diagnosis of SOS.
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Affiliation(s)
| | | | - Pierre-Emmanuel Rautou
- DHU Unit, Pole des Maladies de Appareil Digestif, Service d'Hepatologie, Centre de Reference
| | | | | | - Simona Pagliuca
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | | | - Marie Robin
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | | | - Aurélie Plessier
- DHU Unit, Pole des Maladies Appareil Digestif, Service d'Hepatologie, Centre de Reference
| | | | - Aliénor Xhaard
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | | | - Dominique Valla
- DHU Unit, Pole des Maladies de Appareil Digestif, Service d'Hepatologie, Centre de Reference
| | - Gérard Socié
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | - David Michonneau
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
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8
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Debureaux PE, Darmon M, Bige N, Moreau AS, Mokart D, Morel G, Lacan C, Perez P, Pene F, Kouatchet A, Picard M, Murgier M, Wallet F, Mayaux J, Canet E, Azoulay E, Valade S. Sinusoidal Obstruction Syndrome in Critically Ill Patients in the Era of Defibrotide: A Retrospective Multicenter Study. Transplant Cell Ther 2020; 27:338.e1-338.e7. [PMID: 33836884 DOI: 10.1016/j.jtct.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
Sinusoidal obstruction syndrome (SOS) is a life-threatening liver complication of high- dose chemotherapy. Defibrotide is the only available therapeutic option approved for SOS. The prognosis of SOS in patients requiring intensive care unit (ICU) admission remains unknown. The primary objective of this study was to assess the outcome of SOS patients in ICU. This retrospective study was conducted between 2007 and 2019 in 13 French ICUs. Seventy-one critically ill adult patients with SOS defined according to European Society for Blood and Marrow Transplantation criteria and treated with defibrotide were included. The main reasons for ICU admission were respiratory failure and acute kidney injury. Mechanical ventilation, vasopressors, and renal replacement therapy were required in 59%, 52%, and 49% of patients, respectively. Twenty-three percent of patients experienced a bleeding event during defibrotide treatment. Hospital mortality was 54%, mainly related to multiorgan failure. Older age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00 to 1.04), mechanical ventilation (HR, 1.99; 95% CI, 1.00 to 3.99), renal replacement therapy (HR, 2.55; 95% CI, 1.32 to 4.91) were independent predictors of hospital mortality. Defibrotide prophylaxis (HR, 0.35; 95% CI, 0.13 to 0.92) was associated with better outcomes. Critically ill patients with SOS have a high mortality rate in the ICU, especially if organ support is required. Additional studies assessing the impact of defibrotide prophylaxis are warranted.
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Affiliation(s)
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, Paris, France
| | - Naïke Bige
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France
| | | | - Djamel Mokart
- Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Guillaume Morel
- Intensive Medicine-Resuscitation Department, Strasbourg University Hospital, Strasbourg, France
| | - Claire Lacan
- Intensive Medicine-Resuscitation Department, Strasbourg University Hospital, Strasbourg, France
| | - Pierre Perez
- Medical Intensive Care Unit, Brabois University Hospital, Nancy, France
| | - Frédéric Pene
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, University of Paris, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France
| | - Muriel Picard
- Intensive Care Unit, IUCT Oncopole, Toulouse, France
| | - Martin Murgier
- Medical-Surgical Intensive Care Unit, Saint-Priest-en-Jarez Hospital, Saint-Etienne, France
| | - Florent Wallet
- Medical Intensive Care Unit, Lyon Sud Teaching Hospital, Pierre Bénite, France
| | - Julien Mayaux
- Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Saint Louis Hospital, Paris, France
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9
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Bisbal M, Darmon M, Saillard C, Mallet V, Mouliade C, Lemiale V, Benoit D, Pene F, Kouatchet A, Demoule A, Vincent F, Nyunga M, Bruneel F, Lebert C, Renault A, Meert AP, Hamidfar R, Jourdain M, Azoulay E, Mokart D. Hepatic dysfunction impairs prognosis in critically ill patients with hematological malignancies: A post-hoc analysis of a prospective multicenter multinational dataset. J Crit Care 2020; 62:88-93. [PMID: 33310587 DOI: 10.1016/j.jcrc.2020.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Hyperbilirubinemia is frequent in patients with hematological malignancies admitted to the intensive care unit (ICU). Literature about hepatic dysfunction (HD) in this context is scarce. METHODS We investigated the prognostic impact of HD analyzing a prospective multicenter cohort of 893 critically ill hematology patients. Two groups were defined: patients with HD (total bilirubin ≥33 μmol/L at ICU admission) and patients without HD. RESULTS Twenty one percent of patients were found to have HD at ICU admission. Cyclosporine, antimicrobials before ICU admission, abdominal symptoms, ascites, history of liver disease, neutropenia, increased serum creatinine and myeloma were independently associated with HD. Etiology remained undetermined in 73% of patients. Hospital mortality was 56.3% and 36.3% respectively in patients with and without HD (p < 0.0001). Prognostic factors independently associated with hospital mortality in HD group were, performance status >1 (OR = 2.07, 95% CI = 1.49-2.87, p < 0.0001), invasive mechanical ventilation (OR = 3.92, 95% CI = 2.69-5.71, p < 0.0001), renal replacement therapy (OR = 1.74, 95% CI = 1.22-2.47, p = 0.002), vasoactive drug (OR = 1.81, 95% CI = 1.21-2.71, p = 0.004) and SOFA score without bilirubin level at ICU admission (OR = 1.09, 95% CI = 1.04-1.14, p < 0.0001). CONCLUSIONS HD is common, underestimated, infrequently investigated, and is associated with impaired outcome in critically ill hematology patients. HD should be considered upon ICU admission and managed as other organ dysfunctions.
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Affiliation(s)
- Magali Bisbal
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | - Colombe Saillard
- Departement of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Vincent Mallet
- Departement of Hepatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Charlotte Mouliade
- Departement of Hepatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | | | - Frederic Pene
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP) and University Paris Descartes, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France
| | - Alexandre Demoule
- Intensive Care Unit, Pitié Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | | | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, Versailles, France
| | - Christine Lebert
- Intensive Care Unit, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - Anne Renault
- Intensive Care Unit, Brest Hospital, Brest, France
| | | | - Rebecca Hamidfar
- Intensive Care Unit, Grenoble Teaching Hospital, Grenoble, France
| | - Merce Jourdain
- Intensive Care Unit, Roger Salengro Hospital, CHU, Lille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Diderot Sorbonne University, Paris, France
| | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
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de Lédinghen V, Villate A, Robin M, Decraecker M, Valla D, Hillaire S, Hernandez-Gea V, Dutheil D, Bureau C, Plessier A. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol 2020; 44:480-485. [PMID: 32253162 DOI: 10.1016/j.clinre.2020.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Abstract
Sinusoidal obstruction syndrome (SOS), previously known as veno-occlusive disease, is characterized by concentric and non-thrombotic obstruction of the sinusoid and central vein lumen with no identified primitive or thrombotic hepatic vein lesions. The initial lesion is a result of endothelial denudation, corresponding to the migration of damaged sinusoidal cells to the central veins of the hepatic lobules, leading to sinusoidal and veno-occlusive congestive obstruction. SOS may be associated with other lesions such as centrilobular perisinusoidal fibrosis, peliosis, or nodular regenerative hyperplasia. The first cases of SOS were documented in 1920 in South Africa, after ingestion of food sources contaminated by pyrrolizidine alkaloids. SOS is a well-known complication of hematopoietic stem cell transplantation (HSCT). Numerous toxins and drugs have been associated with SOS, mainly chemotherapies and immunosuppressive therapies, as well as total body or liver irradiation and ABO mismatch platelet transfusion. The pathogenesis of this entity remains unknown.
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Affiliation(s)
- Victor de Lédinghen
- Department of Hepatology and INSERM U1053, Haut-Lévêque Hospital, University Hospital of Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Alban Villate
- Department of Hematology, Bretonneau Hospital, University hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - Marie Robin
- Department of Hematology, Saint-Louis Hospital, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - Marie Decraecker
- Department of Hepatology and INSERM U1053, Haut-Lévêque Hospital, University Hospital of Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Dominique Valla
- Department of Hepatology, DHU Unity, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Sophie Hillaire
- Department of Internal Medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Danielle Dutheil
- Liver Vascular Disease Patient Organisation (AMVF), Beaujon Hospital, Department of Hepatology, 100, boulevard du Général-Leclerc, 92118 Clichy, France
| | - Christophe Bureau
- Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - Aurélie Plessier
- Department of Hepatology, DHU Unity, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Reference center of vascular liver diseases, European Reference Network (ERN) 'Rare-Liver', France
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Chan SS, Colecchia A, Duarte RF, Bonifazi F, Ravaioli F, Bourhis JH. Imaging in Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome. Biol Blood Marrow Transplant 2020; 26:1770-1779. [PMID: 32593647 DOI: 10.1016/j.bbmt.2020.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/17/2020] [Indexed: 12/12/2022]
Abstract
Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially life-threatening complication of hematopoietic cell transplantation. Early diagnosis and, subsequently, earlier intervention have been shown to be beneficial to clinical outcomes. Diagnostic criteria from the European Society for Blood and Marrow Transplantation include recommendations on the use of imaging for diagnosis. This review discusses evidence on the use of imaging in the management of VOD/SOS and how imaging biomarkers can contribute to earlier diagnosis/treatment.
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Affiliation(s)
- Sherwin S Chan
- Department of Radiology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Antonio Colecchia
- Department of General Medicine, University Hospital, Borgo-Trento, Verona, Italy
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Francesca Bonifazi
- Department of Hematology, "L and A Seràgnoli", St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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12
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Corbacioglu S, Kernan NA, Pagliuca A, Ryan RJ, Tappe W, Richardson PG. Incidence of Anicteric Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome and Outcomes with Defibrotide following Hematopoietic Cell Transplantation in Adult and Pediatric Patients. Biol Blood Marrow Transplant 2020; 26:1342-9. [PMID: 32200121 DOI: 10.1016/j.bbmt.2020.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/31/2022]
Abstract
Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially life-threatening complication of hematopoietic cell transplantation (HCT) that is traditionally diagnosed using Baltimore or modified Seattle criteria. Whereas the Baltimore criteria require the presence of hyperbilirubinemia (bilirubin ≥2 mg/dL) for a diagnosis of VOD/SOS, the modified Seattle criteria do not. Before approval by the US Food and Drug Administration, defibrotide was available in the United States through an expanded-access study (T-IND). The T-IND protocol initially required post-HCT diagnosis of VOD/SOS by the Baltimore criteria or biopsy but was later amended to include patients diagnosed using the modified Seattle criteria. This post hoc analysis examined the incidence of VOD/SOS with a bilirubin level <2 mg/dL before and after Day 21 post-HCT in T-IND patients enrolled following the amendment allowing for diagnosis by the modified Seattle criteria. Survival of adult and pediatric patients with or without hyperbilirubinemia and with or without multiorgan dysfunction (MOD) was also evaluated. Of 803 post-HCT patients with VOD/SOS enrolled following the protocol amendment, 181 (23%) had a bilirubin level <2 mg/dL and would not have been diagnosed if hyperbilirubinemia was required. The bilirubin level at diagnosis was <2 mg/dL in 165 of 331 patients (50%) diagnosed by the modified Seattle criteria and in 16 of 23 patients (70%) diagnosed by biopsy. VOD/SOS with a bilirubin level <2 mg/dL was more common in pediatric patients (29%), although it also occurred in adult patients (15%). Patients with hyperbilirubinemia had lower Day 100 survival (54% versus 87% in patients with bilirubin <2 mg/dL) and a higher incidence of MOD (41% versus 26% in patients with bilirubin <2 mg/dL). The incidence of treatment-emergent adverse events and serious adverse events was lower in patients with a bilirubin level <2 mg/dL. These results indicate that anicteric VOD/SOS occurs in both adult and pediatric patients post-HCT and can be diagnosed before and after Day 21 in both groups. The worse survival in patients with bilirubin ≥2 mg/dL suggests that requiring hyperbilirubinemia may result in a progressed disease stage associated with worse outcomes. Taken together, these results highlight the importance of awareness and the possibility of VOD/SOS in the absence of elevated bilirubin level.
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13
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Modi D, Ye JC, Surapaneni M, Singh V, Chen W, Jang H, Deol A, Ayash L, Alavi A, Ratanatharathorn V, Uberti JP. Liver Graft-Versus-Host Disease is associated with poor survival among allogeneic hematopoietic stem cell transplant recipients. Am J Hematol 2019; 94:1072-1080. [PMID: 31292984 DOI: 10.1002/ajh.25575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/03/2019] [Accepted: 07/07/2019] [Indexed: 12/17/2022]
Abstract
Liver Graft-versus-host disease (GVHD) is common in patients with post-transplant liver dysfunction following allogeneic hematopoietic stem cell transplantation (AHSCT). Oftentimes, the diagnosis is made clinically, and liver biopsy is deferred. Our objective was to evaluate the risk factors and clinical outcomes of liver GVHD among patients who developed post-transplant liver dysfunction. Additionally, we evaluated the feasibility of liver biopsy in this population. We compared outcomes between liver GVHD and a "non-liver GVHD" group, which consisted of other etiologies of post-transplant liver dysfunction. Between January 2003 and December 2010, 249 patients developed post-transplant liver dysfunction following AHSCT: 124 patients developed liver GVHD and 125 were in the "non-liver GVHD" group. The incidence of acute and chronic liver GVHD at one year was 15.7% and 31.0%, respectively. The competing risk analysis revealed full intensity conditioning regimen (Hazard ratio [HR], 1.76; P = .008) and related donor (HR, 1.68; P = .004) as independent risk factors for liver GVHD. The time-varying covariate Cox regression analysis with competing risk event, demonstrated that liver GVHD was independently associated with higher non-relapse mortality, and adverse relapse-free and overall survival. A total of 112 liver biopsies were performed in 100 patients. No major complications were observed. Liver biopsy confirmed prebiopsy hypotheses in 49% of cases, and led to treatment modification in 49% of patients. Our study shows that liver GVHD is associated with adverse survival. Liver biopsy is safe and often helps directing care in this setting.
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Affiliation(s)
- Dipenkumar Modi
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Jing Christine Ye
- Department of Internal Medicine, Division of Hematology Oncology, Rogel Cancer CenterUniversity of Michigan Ann Arbor Michigan
| | - Malini Surapaneni
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Vijendra Singh
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Wei Chen
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Hyejeong Jang
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Abhinav Deol
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Lois Ayash
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | - Asif Alavi
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
| | | | - Joseph P. Uberti
- Department of OncologyKarmanos Cancer Institute/Wayne State University Detroit Michigan
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Detrait M, de Berranger E, Dulery R, Ménard AL, Thépot S, Toprak SK, Turlure P, Yakoub-Agha I, Guillaume T. [Hepatobiliary complications following allogeneic hematopoietic cell transplantation: Recommendations of the Francophone Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)]. Bull Cancer 2019; 107:S18-S27. [PMID: 30952358 DOI: 10.1016/j.bulcan.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
Hepatobiliary complications are frequent in the context of allogeneic hematopoietic cell transplantation (allo-HCT) and contribute largely to the morbidity and mortality after transplantation. Within the framework of the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held in Lille in September 2018, diagnostic approaches and treatments of hepatobiliary dysfunctions prior to and following transplantation were reviewed according to the analysis of published studies.
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Affiliation(s)
- Marie Detrait
- CHU de Nancy, hôpitaux de Brabois, service d'hématologie, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Eva de Berranger
- CHRU de Lille, hôpital Jeanne-de-Flandres, service d'hématologie pédiatrique, avenue Eugène-Aviné, 59037 Lille cedex, France
| | - Remy Dulery
- Hôpital Saint-Antoine, service d'hématologie clinique, 184, rue de Faubourg-Saint-Antoine, 75012 Paris, France
| | - Anne-Lise Ménard
- Centre Henri-Becquerel, département d'hématologie clinique, rue d'Amiens, 76038 Rouen, France
| | - Sylvain Thépot
- CHU d'Angers, service d'hématologie, 4, rue Larrey, 49033 Angers, France
| | - Selami Kocak Toprak
- Hôpital Cebeci, université d'Ankara, faculté de médecine, service d'hématologie, Tip Fakultesi Caddesi, Dikimevi, 06620 Ankara, Turquie
| | - Pascal Turlure
- CHU de Limoges, service d'hématologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, LIRIC, Inserm U995, université de Lille, service d'hématologie, 59000 Lille, France
| | - Thierry Guillaume
- Hôtel-Dieu, CHU de Nantes, service d'hématologie clinique, 1, place Ricordeau, 44000 Nantes, France.
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