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Kayser S, Sartor C, Giglio F, Bruno A, Webster J, Chiusolo P, Saraceni F, Guerzoni S, Pochintesta L, Borlenghi E, Marconi G, Zacheo I, Cerrano M, Salutari P, Restuccia F, Abbenante M, Levis MJ, Schlenk RF, Papayannidis C. Impact of inotuzumab ozogamicin on outcome in relapsed or refractory acute B-cell lymphoblastic leukemia patients prior to allogeneic hematopoietic stem cell transplantation and risk of sinusoidal obstruction syndrome/venous occlusive disease. Haematologica 2024; 109:1385-1392. [PMID: 38058184 PMCID: PMC11063861 DOI: 10.3324/haematol.2023.284310] [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] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Abstract
We evaluated 58 patients with relapsed or refractory (r/r) acute B-lymphoblastic leukemia (B-ALL; median age 42.5 years; range, 16-69 years), treated with inotuzumab ozogamicin (INO) between 2016-2022 and who received an allogeneic hematopoietic stem cell transplantation (allo-HCT) consecutively. Forty-seven (81%) of the 58 patients were heavily pretreated receiving intensive chemotherapy +/- tyrosine kinase inhibitor, blinatumomab in 24 (41%) and allo-HCT at first-line in 11 (19%) patients. Complete remission rate prior to allo-HCT was 84%. Median follow-up was 30.5 months and median overall survival (OS) measured from start of INO was 11.2 months. One- and 2-year OS rates were 50% (95% confidence interval [CI]: 38.4-56.1) and 36.7% (95% CI: 25.5-52.9), respectively. Sinusoidal obstruction syndrome/venous occlusive disease (SOS/ VOD) after allo-HCT occurred in 17 (29%) patients. Of those, nine (53%) patients died due to SOS/VOD and multi-organ failure. Two had received >2 INO cycles (3 cycles, 5 cycles, N=1, each), all others ≤2 INO cycles prior to allo-HCT. Logistic regression analysis revealed conditioning with double alkylators (P=0.038) and allo-HCT during first-line therapy (P=0.050) as significant risk factors for SOS/VOD and in trend allo-HCT ≤60 days from last INO application (P=0.07), whereas number of INO cycles before allo-HCT and time between last INO application and allo-HCT were not significant. Relapse/progressive disease occurred in 20 (34%) patients. Of those, five (25%) patients are still alive, whereas 15 succumbed of their disease. Treatment with INO seems to be an effective approach with successful bridge-to-transplant. However, risk of SOS/VOD is high, necessitating continuous monitoring and recognition of SOS/VOD risk factors.
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Affiliation(s)
- Sabine Kayser
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg.
| | | | - Fabio Giglio
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; Onco-Hematology Division, IEO European Institute of Oncology IRCCS, Milano
| | - Alessandro Bruno
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano
| | - Jonathan Webster
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Patrizia Chiusolo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Roma
| | - Francesco Saraceni
- Department of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria delle Marche, Ancona
| | - Selene Guerzoni
- Department of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria delle Marche, Ancona
| | - Lara Pochintesta
- Hematology and Bone Marrow Transplant (BMT) Unit, "Guglielmo da Saliceto" Piacenza Hospital, Piacenza
| | | | - Giovanni Marconi
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC
| | - Irene Zacheo
- Hematology Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC
| | - Marco Cerrano
- Deptartment of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e Della Scienza, Torino
| | | | | | - Mariachiara Abbenante
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna
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Ichikawa H, Yakushijin K, Kurata K, Tsuji T, Takemoto N, Joyce M, Okazoe Y, Takahashi R, Matsumoto S, Sakai R, Kitao A, Miyata Y, Saito Y, Kawamoto S, Yamamoto K, Ito M, Murayama T, Matsuoka H, Minami H. Utility of the refined EBMT diagnostic and severity criteria 2023 for sinusoidal obstruction syndrome/veno-occlusive disease. Bone Marrow Transplant 2024; 59:518-525. [PMID: 38287083 PMCID: PMC10994840 DOI: 10.1038/s41409-024-02215-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT). Early diagnosis of SOS/VOD is associated with improved clinical outcomes. In 2023, the refined European Society for Blood and Marrow Transplantation diagnostic and severity criteria (refined EBMT criteria 2023) have been advocated. The revision has introduced new diagnostic categories, namely; probable, clinical, and proven SOS/VOD. In addition, the Sequential Organ Failure Assessment (SOFA) score has been newly incorporated into the SOS/VOD severity grading. We performed a retrospective analysis to evaluate the utility of these criteria. We analyzed 161 cases who underwent allogeneic HSCT. We identified 53 probable, 23 clinical, and 4 proven SOS/VOD cases. Probable SOS/VOD was diagnosed a median of 5.0 days earlier (interquartile range: 2-13 days, P < 0.001) than that of clinical SOS/VOD. The development of probable SOS/VOD alone was associated with a significantly inferior survival proportion compared to non-SOS/VOD (100-day survival, 86.2% vs. 94.3%, P = 0.012). The SOFA score contributed to the prediction of prognosis. Consequently, the refined EBMT criteria 2023 demonstrated the utility of SOS/VOD diagnosis and severity grading. Further investigations and improvements in these criteria are warranted.
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Affiliation(s)
- Hiroya Ichikawa
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan.
| | - Keiji Kurata
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Takahiro Tsuji
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Naoko Takemoto
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Miki Joyce
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Yuri Okazoe
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Ruri Takahashi
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Sakuya Matsumoto
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Rina Sakai
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Akihito Kitao
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Department of Oncology and Hematology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Yoshiharu Miyata
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Department of Artificial Intelligence and Digital Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuyuki Saito
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Division of Molecular and Cellular Signaling, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Kawamoto
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Transfusion Medicine and Cell Therapy, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Katsuya Yamamoto
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Mitsuhiro Ito
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tohru Murayama
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Department of Hematology, Hyogo Cancer Center, Akashi, Japan
| | - Hiroshi Matsuoka
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Department of Integrated Analyses of Bioresource and Health Care, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironobu Minami
- Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
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Kabat M, Gill S, Kim K, Omidvari K, Lee R. Hepatic veno-occlusive disease complicated with extreme hyperammonaemia (920 µmol/L) treated with defibrotide, lactulose, rifampin and haemodialysis. BMJ Case Rep 2024; 17:e258876. [PMID: 38514165 PMCID: PMC10961531 DOI: 10.1136/bcr-2023-258876] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Hepatic veno-occlusive disease (VOD)/sinusoidal obstructive syndrome (SOS) is a severe complication that can occur following haematopoietic stem cell transplant (HSCT) with high-intensity conditioning chemotherapy regimens. Severe VOD/SOS, often characterised by multiorgan failure, is associated with a high mortality rate. This case report details the complex clinical course of a male patient in his mid-20s, recently diagnosed with B cell acute lymphoblastic leukaemia, who underwent allogeneic HSCT. Based on the 2023 European Society for Blood and Marrow Transplantation (EBMT) criteria, the patient developed very severe VOD/SOS, prompting immediate treatment with defibrotide. Unexpectedly, he developed profound hyperammonaemia exceeding 900 µmol/L, leading to encephalopathy and cerebral oedema. Despite aggressive interventions including defibrotide, lactulose, rifampin and haemodialysis, the patient passed away due to cerebral oedema and pulseless electrical activity arrest. We theorise the hyperammonaemia is disproportionate to his hepatic dysfunction and is possibly secondary to an acquired defect of the urea synthesis consistent with idiopathic hyperammonaemia, a rare complication in patients receiving intense conditioning chemotherapy.
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Affiliation(s)
- Maciej Kabat
- Internal Medicine, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sarvarinder Gill
- Hematology and Oncology, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Kevin Kim
- Pulmonary and Critical Care Medicine, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Karan Omidvari
- Pulmonary and Critical Care Medicine, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Robert Lee
- Pulmonary and Critical Care Medicine, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
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Sun R, Li T, Ren WH. [Role of liver sinusoidal endothelial cell damage in the developmental process of hepatic sinusoidal obstruction syndrome: a focus on the research progress of immune inflammatory mechanisms]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:279-283. [PMID: 38584115 DOI: 10.3760/cma.j.cn501113-20231129-00248] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Hepatic sinusoidal obstruction syndrome (HSOS) is a type of secondary vascular disease of the liver that is mainly associated with the ingestion of pyrrole alkaloids (PAs) and hematopoietic stem cell transplantation (HSCT) treatment, resulting in severe liver dysfunction, multiple organ failure, and even death. Hepatic sinusoidal dilatation and obstruction, hepatocyte coagulative necrosis, and hepatic lobular inflammation are the main pathological manifestations of HSOS. The key initiating process for the pathogenesis of HSOS is damage to liver sinusoidal endothelial cells (LSECs). Currently, it is believed that LSECs are damaged by the involvement of multiple etiologies and mechanisms, and secondary coagulation and fibrinolysis disorders, oxidative stress, and inflammatory responses are the occurrence contributors to HSOS; however, the mechanism has not been fully elucidated. Therefore, the role of immune-inflammatory mechanisms has received increasing attention in LSEC damage. This article provides an overview of the epidemiology, etiology, and pathological changes of HSOS and reviews the physiological functions, common etiological damage mechanisms, and the key role of LSEC damage in the pathogenesis of HSOS, with a special focus on the role and research progress of immune-inflammatory mechanisms for LSEC damage in recent years. Furthermore, we believe that in-depth study and elucidation of the role of immune-inflammatory mechanisms in LSEC damage and the pathogenesis of HSOS and diagnosis will provide feasible research and development ideas for the screening and identification of new markers and drug treatment targets for HSOS.
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Affiliation(s)
- R Sun
- Department of Infectious Diseases, Shandong Provincial Hospital, Shandong University, Jinan 250021, China
| | - T Li
- Department of Infectious Diseases, Shandong Provincial Hospital, Shandong University, Jinan 250021, China
| | - W H Ren
- Department of Infectious Diseases, Shandong Provincial Hospital, Shandong University, Jinan 250021, China
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Zheng Q, Zhang H. Gynura segetum induces hepatic sinusoidal obstruction syndrome in a child: A case report. Medicine (Baltimore) 2024; 103:e37341. [PMID: 38489699 PMCID: PMC10939675 DOI: 10.1097/md.0000000000037341] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024] Open
Abstract
RATIONALE Hepatic sinusoidal obstruction syndrome (HSOS), which includes hepatic stasis and portal hypertension, is a rare vascular disorder of the liver. It is often associated with hematopoietic stem cell transplantation. It is also possible to treat this disease using Chinese herbal medicines that contain pyrrolizidine alkaloids (PAs). This disease is extremely rare in children and poses a serious threat to their health. To our knowledge, this is the first case of HSOS in a child with PAs. PATIENT CONCERNS We report a 4-year-old boy suffering from abdominal pain, hepatomegaly, massive ascites, elevated liver enzyme level, and severe portal hypertension as a result of the consumption of Gynura segetum (also known as Tusanqi in Chinese, a traditional herbal medicine containing PAs). DIAGNOSES The child was finally diagnosed with PA-HSOS based on pathological diagnosis and imaging examination. INTERVENTION With active symptomatic and supportive care and sequential anticoagulation therapy, the abdominal distension and liver function improved in the patient. OUTCOMES The patient was eventually recovered. The levels of liver enzymes, hemoglobin, and bilirubin were normal, and the international normalized ratio fluctuated between 2.0 and 3.0 during 1-year follow-up after discharge. LESSONS This case report emphasizes the prevention of Chinese herb-induced liver injury in children and the importance of active long-term sequential anticoagulant therapy to reduce the progressive damage of PA-HSOS in the liver.
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Affiliation(s)
- Qian Zheng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haiyang Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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Terao T, Horikawa K, Matsuoka KI. Bile cast nephropathy after sinusoidal obstruction syndrome. Kidney Int 2024; 105:640. [PMID: 38388151 DOI: 10.1016/j.kint.2023.08.027] [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: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Toshiki Terao
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Kyosuke Horikawa
- Department of Pathology and Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
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Tan Y, Zhou X. Anticoagulant therapy likely increases risk of bleeding in Gynura segetum-induced hepatic sinus obstruction syndrome. Medicine (Baltimore) 2024; 103:e35914. [PMID: 38335400 PMCID: PMC10861010 DOI: 10.1097/md.0000000000035914] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 02/12/2024] Open
Abstract
This study aimed to analyze the clinical characteristics of Gynura segetum (Tusanqi)-induced hepatic sinusoidal obstruction syndrome (HSOS) and the benefits and risks of anticoagulant therapy for Tusanqi-induced HSOS. This was a retrospective analysis of 49 patients with Tusanqi-induced HSOS who were treated with anticoagulation or standard therapy between July 2006 and December 2022. Clinical manifestations included abdominal pain (n = 47) and peritoneal or pleural effusion (n = 46); 2 patients died. Nineteen patients requested standard medical treatment, while 30 were treated with anticoagulants. HSOS resolved within 6 months in 22 patients but did not resolve in 27 patients. The resolution rate was higher in the anticoagulant than standard treatment group (P = .037). Logistic regression analysis revealed that a history of chronic liver disease or treatment increased the risk of poor outcomes. Bleeding complications occurred in 6 patients in the anticoagulant treatment group. Early diagnosis and anticoagulant treatment are beneficial for rapid recovery after Tusanqi-induced HSOS. However, anticoagulant treatment is associated with the risk of multisite bleeding.
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Affiliation(s)
- Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Daijiamen, Runzhou Distinct, Zhenjiang, China
| | - Xingbei Zhou
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Daijiamen, Runzhou Distinct, Zhenjiang, China
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Johann L, Gruhn B. Analysis of laboratory parameters before the occurrence of hepatic sinusoidal obstruction syndrome in children, adolescents, and young adults after hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2024; 150:9. [PMID: 38206490 PMCID: PMC10784366 DOI: 10.1007/s00432-023-05561-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Hepatic sinusoidal obstruction syndrome (SOS) is a serious complication following hematopoietic stem cell transplantation (HSCT) in which early diagnosis improves patient outcome. The aim of our study was to detect laboratory parameters following HSCT that can predict the occurrence of SOS. METHODS This retrospective study included 182 children, adolescents, and young adults who underwent allogeneic or autologous HSCT for the first time (median age 7.2 years). The diagnosis of SOS was based on the pediatric criteria of European Society for Blood and Marrow Transplantation (EBMT). We investigated 15 laboratory parameters after HSCT before the onset of SOS. RESULTS The overall incidence of SOS was 14.8%. SOS developed in 24 of 126 allogeneic (19.1%) and in 3 of 56 autologous (5.4%) HSCT patients at a median time of 13 days after HSCT. We observed a low SOS mortality rate of 11.1% within 100 days after HSCT. International normalized ratio (INR) ≥ 1.3, activated partial thromboplastin time (aPTT) ≥ 40 s, reptilase time ≥ 18.3 s, factor VIII ≤ 80%, antithrombin III ≤ 75%, protein C ≤ 48%, D-dimer ≥ 315 µg/L, bilirubin ≥ 9 µmol/L, and ferritin ≥ 3100 µg/L showed significant associations with the onset of SOS in the univariate analyses. In the multivariate analysis, INR ≥ 1.3 [odds ratio (OR) = 8.104, p = 0.006], aPTT ≥ 40 s (OR = 10.174, p = 0.001), protein C ≤ 48% (OR = 5.215, p = 0.014), and ferritin ≥ 3100 µg/L (OR = 7.472, p = 0.004) could be confirmed as independent risk factors after HSCT before SOS. If three of the four significant cut-off values were present, the probability of developing SOS was more than 70%. The probability of SOS was 96%, if all four laboratory parameters were changed according to the cut-off values. The values of factor XIII, von Willebrand factor (vWF), von Willebrand factor activity (vWF activity), protein S, fibrinogen, and alanine aminotransferase (ALT) were not relevant for the occurrence of SOS. CONCLUSION In summary, the laboratory parameters INR, aPTT, protein C, and ferritin were very useful to predict the occurrence of SOS. In addition, this is the first report on a significant association between SOS and high values of INR and aPTT after HSCT before SOS.
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Affiliation(s)
- Lorena Johann
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Germany.
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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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Saeki M, Munesue S, Higashi Y, Harashima A, Takei R, Takada S, Nakanuma S, Ohta T, Yagi S, Tajima H, Yamamoto Y. Assaying ADAMTS13 Activity as a Potential Prognostic Biomarker for Sinusoidal Obstruction Syndrome in Mice. Int J Mol Sci 2023; 24:16328. [PMID: 38003518 PMCID: PMC10671412 DOI: 10.3390/ijms242216328] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Sinusoidal obstruction syndrome (SOS) is a serious liver disorder that occurs after liver transplantation, hematopoietic stem cell transplantation, and the administration of anticancer drugs. Since SOS is a life-threatening condition that can progress to liver failure, early detection and prompt treatment are required for the survival of patients with this condition. In this study, female CD1 mice were divided into treatment and control groups after the induction of an SOS model using monocrotaline (MCT, 270 mg/kg body weight intraperitoneally). The mice were analyzed at 0, 12, 24, and 48 h after MCT administration, and blood and liver samples were collected for assays and histopathology tests. SOS was observed in the livers 12 h after MCT injection. In addition, immunohistochemical findings demonstrated CD42b-positive platelet aggregations, positive signals for von Willebrand factor (VWF), and a disintegrin-like metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) in the MCT-exposed liver sinusoid. Although ADAMTS13's plasma concentrations peaked at 12 h, its enzyme activity continuously decreased by 75% at 48 h and, inversely and proportionally, concentrations in the VWF-A2 domain, in which the cleavage site of ADAMTS13 is located, increased after MCT injection. These findings suggest that the plasma concentration and activity of ADAMTS13 could be useful biomarkers for early detection and therapeutic intervention in patients with SOS.
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Affiliation(s)
- Masakazu Saeki
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8640, Japan; (S.M.); (A.H.)
| | - Seiichi Munesue
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8640, Japan; (S.M.); (A.H.)
| | - Yuri Higashi
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8640, Japan; (S.M.); (A.H.)
| | - Ai Harashima
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8640, Japan; (S.M.); (A.H.)
| | - Ryohei Takei
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
| | - Satoshi Takada
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
| | - Shinichi Nakanuma
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
| | - Tetsuo Ohta
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
| | - Shintaro Yagi
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
| | - Hidehiro Tajima
- Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8641, Japan; (M.S.); (Y.H.); (R.T.); (S.N.); (T.O.); (S.Y.); (H.T.)
- Department of Gastroenterological Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City 343-8555, Japan
| | - Yasuhiko Yamamoto
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa 920-8640, Japan; (S.M.); (A.H.)
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11
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Ruutu T, Peczynski C, Houhou M, Polge E, Mohty M, Kröger N, Moiseev I, Penack O, Salooja N, Schoemans H, Duarte RF, Schroeder T, Passweg J, Wulf GG, Ganser A, Sica S, Arat M, Salmenniemi U, Broers AEC, Bourhis JH, Rambaldi A, Maertens J, Halaburda K, Zuckerman T, Labussière-Wallet H, Basak G, Koenecke C, Perić Z. Current incidence, severity, and management of veno-occlusive disease/sinusoidal obstruction syndrome in adult allogeneic HSCT recipients: an EBMT Transplant Complications Working Party study. Bone Marrow Transplant 2023; 58:1209-1214. [PMID: 37573397 PMCID: PMC10622315 DOI: 10.1038/s41409-023-02077-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
The current incidence, diagnostic policy, management, and outcome of VOD/SOS at EBMT centers were studied. All centers that had performed allogeneic HSCTs in adult patients within one defined year were invited to the study. Seventy-one centers participated with a total of 2886 allogeneic transplantations and 93 cases of VOD/SOS in 2018. The cumulative incidence of VOD/SOS at day 21 was 1.8% and at day 100 2.4%. Of 67 cases with detailed data, 52 were classical and 15 (22%) late onset (>day 21). According to the EBMT criteria, 65/67 patients had at least two VOD/SOS risk factors. The severity grades were: mild 0, moderate 3, severe 29, very severe 35. Fifty-four patients were treated with defibrotide. VOD/SOS resolved in 58% of the patients, 3/3 with moderate, 22/28 with severe, and 12/33 with very severe grade (p < 0.001). By day 100, 57% of the patients were alive; 3/3 with moderate, 22/29 with severe, and 13/35 with very severe VOD/SOS (p = 0.002). In conclusion, the incidence of VOD/SOS was low. Severe and very severe grades dominated. Very severe grade predicted poor outcome compared to severe grade further supporting the concept of early diagnosis and treatment to avoid a dismal outcome.
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Affiliation(s)
- Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Christophe Peczynski
- EBMT, Transplant Complications Working Party, Hopital Saint Antoine, Department of Hematology, Paris, France
| | - Mohamed Houhou
- EBMT, Sorbonne University, Hopital Saint Antoine, Department of Hematology, Paris, France
| | - Emmanuelle Polge
- EBMT, Sorbonne University, Hopital Saint Antoine, Department of Hematology, Paris, France
| | - Mohamad Mohty
- EBMT, Sorbonne University, Hopital Saint Antoine, Department of Hematology, Paris, France
| | | | - Ivan Moiseev
- RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russian Federation
| | - Olaf Penack
- Medical Clinic, Department of Haematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Salooja
- Centre for Haematology, Imperial College, London, UK
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Thomas Schroeder
- University Hospital, Department of Hematology and Stem Cell Transplantation, Essen, Germany
| | | | - Gerald G Wulf
- University Medicine Goettingen, Department of Haematology and Medical Oncology, Goettingen, Germany
| | - Arnold Ganser
- Hannover Medical School, Department of Hematology, Hemostasis, and Oncology, Hannover, Germany
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mutlu Arat
- Demiroglu Bilim University, Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Annoek E C Broers
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jean Henri Bourhis
- Gustave Roussy Cancer Campus, BMT Service, Department of Hematology, Villejuif, France
| | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Johan Maertens
- University Hospital Gasthuisberg, Department of Hematology, Leuven, Belgium
| | | | - Tsila Zuckerman
- Rambam Medical Center, Department of Hematology and Bone Marrow Transplantation, Haifa, Israel
| | | | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Zinaida Perić
- Department of Hematology, University Hospital Center Zagreb, Zagreb, Croatia
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12
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Phansalkar R, Kambham N, Charu V. Liver Pathology After Hematopoietic Stem Cell Transplantation. Surg Pathol Clin 2023; 16:519-532. [PMID: 37536886 DOI: 10.1016/j.path.2023.04.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Hematopoietic stem cell transplantation is used to treat a variety of hematologic malignancies and autoimmune conditions. The immunosuppressive medications as well as other therapies used both before and after transplantation leave patients susceptible to a wide spectrum of complications, including liver injury. Causes for liver damage associated with stem cell transplantation include sinusoidal obstruction syndrome, graft-versus-host disease, iron overload, and opportunistic infection. Here, the authors review the clinical and pathological findings of these etiologies of liver injury and provide a framework for diagnosis.
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Affiliation(s)
- Ragini Phansalkar
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Vivek Charu
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Medicine, Quantitative Sciences Unit, Stanford, CA, USA.
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13
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Mohty M, Malard F, Alaskar AS, Aljurf M, Arat M, Bader P, Baron F, Bazarbachi A, Blaise D, Brissot E, Ciceri F, Corbacioglu S, Dalle JH, Dignan F, Huynh A, Kenyon M, Nagler A, Pagliuca A, Perić Z, Richardson PG, Ruggeri A, Ruutu T, Yakoub-Agha I, Duarte RF, Carreras E. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a refined classification from the European society for blood and marrow transplantation (EBMT). Bone Marrow Transplant 2023; 58:749-754. [PMID: 37095231 DOI: 10.1038/s41409-023-01992-8] [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] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
Sinusoidal obstruction syndrome, also known as veno-occlusive disease (SOS/VOD), is a potentially life-threatening complication that can develop after hematopoietic cell transplantation (HCT). A new definition for diagnosis, and a severity grading system for SOS/VOD in adult patients, was reported a few years ago on behalf of the European Society for Blood and Marrow Transplantation (EBMT). The aim of this work is to update knowledge regarding diagnosis and severity assessment of SOS/VOD in adult patients, and also its pathophysiology and treatment. In particular, we now propose to refine the previous classification and distinguish probable, clinical and proven SOS/VOD at diagnosis. We also provide an accurate definition of multiorgan dysfunction (MOD) for SOS/VOD severity grading based on Sequential Organ Failure Assessment (SOFA) score.
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Affiliation(s)
- Mohamad Mohty
- Hematology Department, Hôpital Saint-Antoine, and Université Pierre & Marie Curie, Paris, France.
| | - Florent Malard
- Hematology Department, Hôpital Saint-Antoine, and Université Pierre & Marie Curie, Paris, France
| | - Ahmed S Alaskar
- King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences, Dept. of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mutlu Arat
- Sisli Florence Nightingale Hospital, HSCT Unit, Istanbul, Turkey
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Frederic Baron
- Department of Hematology, University of Liege, Liege, Belgium
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Didier Blaise
- Aix-Marseille Univ, MSC Lab, Institut Paoli-Calmettes, Department of Hematology, Marseille, France
| | - Eolia Brissot
- Hematology Department, Hôpital Saint-Antoine, and Université Pierre & Marie Curie, Paris, France
| | - Fabio Ciceri
- San Raffaele Scientific Institute, Hematology and Bone marrow Transplantation Unit, Milan, Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Jean-Hugues Dalle
- Department of Hematology and Immunology, Hospital Robert Debre, Paris 7-Paris Diderot University, Paris, France
| | - Fiona Dignan
- Department of Clinical Haematology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anne Huynh
- Hematology Department, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, UK
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical center, Tel-Hashomer, Israel
| | | | - Zinaida Perić
- Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Annalisa Ruggeri
- San Raffaele Scientific Institute, Hematology and Bone marrow Transplantation Unit, Milan, Italy
| | - Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland
| | | | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Enric Carreras
- Josep Carreras Foundation & Leukemia Research Institute, (Hospital Clínic/Barcelona University Campus), Barcelona, Spain
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Gupta V, Chopde A, Patkar S, Deodhar K, Goel M. Oxaliplatin-Induced Sinusoidal Obstruction Syndrome Masquerading as Colorectal Liver Metastasis: A Case Report. J Gastrointest Cancer 2023; 54:682-686. [PMID: 35666356 DOI: 10.1007/s12029-022-00835-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Oxaliplatin-based chemotherapy is commonly used in adjuvant treatment of colon cancer as well as in neoadjuvant setting in patients with liver metastases. However oxaliplatin can cause damage to non-tumor bearing liver which presents as sinusoidal obstructive syndrome (SOS). These changes are difficult to differentiate from metastasis clinic-radiologically and manifests as sinusoidal dilatation, peliosis and nodular regenerative hyperplasia. CASE The present study reports the case of a patient with oxaliplatin-induced SOS which mimicked colo-rectal liver metastasis on follow up imaging studies after receiving neoadjuvant oxaliplatin based chemotherapy. After multidisciplinary discussion, patient was planned for simultaneous resection of rectal primary and right hepatectomy for metastasis. Final histopathology revealed no tumour in liver but the liver lesions seen radiologically were actually changes of oxaliplatin induced focal SOS and mimicked metastatic nodules. CONCLUSION In patients with colo-rectal cancer having received oxaliplatin-based chemotherapy, SOS may be considered as one of the causes of newly developed liver lesions, and should be subjected to additional radio-pathologic evaluation to prevent overtreatment and avoiding potentially morbid surgeries.
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Affiliation(s)
- Vipul Gupta
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
| | - Amit Chopde
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India.
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India
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15
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Mangada KL, Moffet J, Nishitani M, Albuquerque S, Duncan CN. Interprofessional Team-based Care of the Hematopoietic Cell Transplantation Patient With Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome. J Pediatr Hematol Oncol 2023; 45:12-17. [PMID: 36598959 PMCID: PMC9809996 DOI: 10.1097/mph.0000000000002594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a well-recognized complication of allogeneic and autologous hematopoietic cell transplantation (HCT). The diagnosis and treatment of VOD/SOS require the involvement of multiple specialists covering a wide range of expertise. Interprofessional team-based medical care is standard practice for patients undergoing HCT and has been shown to improve patient and provider satisfaction, enhance efficiency, and improve patient outcomes, particularly for patients in complex medical situations like those with VOD/SOS post-HCT. Interdisciplinary team-based models focus on the synthesis and harmonization of knowledge and methods from different disciplines to create an integrative approach to patient care that both maximizes the expertise of each involved specialist and encourages thought beyond each specialist's discipline. Multidisciplinary team members provide additive support and work collaboratively with the core team to provide knowledge from their field. The composition of the interdisciplinary HCT team should center on the needs of the patient and institutional resources and involve the expertise of additional multidisciplinary team members based on clinical needs. This review focuses on interdisciplinary and multidisciplinary team-based care of patients with VOD/SOS post-HCT and provides an example of a collaborative VOD/SOS team that includes transplant physicians, nurses, pharmacists, nutrition/dietary specialists, and intensive care teams.
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16
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Wang X, Zhang W, Zhang M, Zhang F, Xiao J, Yin Q, Han H, Li T, Lin G, Zhuge Y. Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome. Hepatol Int 2022; 16:669-679. [PMID: 35023026 PMCID: PMC9174127 DOI: 10.1007/s12072-021-10293-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/21/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS There has been no reliable severity system based on the prognosis to guide therapeutic strategies for patients with pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS). We aimed to create a novel Drum Tower Severity Scoring (DTSS) system for these patients to guide therapy. METHODS 172 Patients with PA-HSOS who received supportive care and anticoagulation therapy in Nanjing Drum Tower Hospital from January 2008 to December 2020 were enrolled and analyzed retrospectively. These patients were randomized into a training or validation set in a 3:1 ratio. Next, we established and validated the newly developed DTSS system. RESULTS Analysis identified a predictive formula: logit (P) = 0.004 × aspartate aminotransferase (AST, U/L) + 0.019 × total bilirubin (TB, μmol/L) - 0.571 × fibrinogen (FIB, g/L) - 0.093 × peak portal vein velocity (PVV, cm/s) + 1.122. Next, we quantified the above variables to establish the DTSS system. For the training set, the area under the ROC curve (AUC) (n = 127) was 0.787 [95% confidence interval (CI) 0.706-0.868; p < 0.001]. With a lower cut-off value of 6.5, the sensitivity and negative predictive value for predicting no response to supportive care and anticoagulation therapy were 94.7% and 88.0%, respectively. When applying a high cut-off value of 10.5, the specificity was 92.9% and the positive predictive value was 78.3%. For the validation set, the system performed stable with an AUC of 0.808. CONCLUSIONS The DTSS system can predict the outcome of supportive care and anticoagulation in PA-HSOS patients with satisfactory accuracy by evaluating severity, and may have potential significance for guiding therapy.
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Affiliation(s)
- Xuan Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Wei Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Ming Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Feng Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Jiangqiang Xiao
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Qin Yin
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Hao Han
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Taishun Li
- Medical Statistical Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
| | - Ge Lin
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Yuzheng Zhuge
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, 210008 Jiangsu China
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17
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Chinese Society of Hematology, Chinese Medical Association. [Chinese expert consensus on the diagnosis and management of sinusoidal obstruction syndrome after hematopoietic stem cell transplantation (2022)]. Zhonghua Xue Ye Xue Za Zhi 2022; 43:177-83. [PMID: 35405774 DOI: 10.3760/cma.j.issn.0253-2727.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/11/2022]
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18
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Zhang XY, Li LT, Wang JS, Xie XB. [Hepatic sinusoidal obstruction syndrome in a child]. Zhonghua Er Ke Za Zhi 2022; 60:246-247. [PMID: 35240748 DOI: 10.3760/cma.j.cn112140-20210718-00589] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- X Y Zhang
- Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - L T Li
- Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - J S Wang
- Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - X B Xie
- Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
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19
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Park SK, Ji YS, Kim SH. Challenges to be addressed in management of patients with sinusoidal obstruction syndrome after hematopoietic cell transplantation. Korean J Intern Med 2022; 37:48-50. [PMID: 35000373 PMCID: PMC8747927 DOI: 10.3904/kjim.2021.537] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Seong Kyu Park
- Division of Hematooncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Correspondence to Seong Kyu Park, M.D. Division of Hematooncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5185 Fax: +82-32-621-5018 E-mail:
| | - Young Sok Ji
- Division of Hematooncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Se Hyung Kim
- Division of Hematooncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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20
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Kong SG, Lee JH, Lim YT, Lee JH, Eom HS, Lee H, Kim DY, Lim SN, Yoon SS, Kim SY, Lee HS. Influence of creatinine levels on survival in patients with veno-occlusive disease treated with defibrotide. Korean J Intern Med 2022; 37:179-189. [PMID: 34902236 PMCID: PMC8747908 DOI: 10.3904/kjim.2021.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is one of the most fatal complications of hematopoietic cell transplantation (HCT), and defibrotide is the only curative drug. We conducted this study to confirm the survival rate of VOD/SOS patients diagnosed in Korea and assess the efficacy of defibrotide. METHODS Patients diagnosed with VOD/SOS after allogenic HCT between 2003 and 2020 were enrolled. We investigated day +100 survival rates and associated risk factors in patients who satisfied the modified Seattle criteria within 50 days of HCT. RESULTS A total of 110 patients satisfied the modified Seattle criteria, of which 65.5% satisfied the Baltimore criteria. Thirty-seven patients were treated with defibrotide. The day +100 survival rate of the 110 patients was 65.3%. The survival rates in patients who did not meet the Baltimore criteria and in those who did were 86.8% and 53.7%, respectively (p = 0.001). The day +100 survival rate of patients treated with defibrotide was 50.5%. Among the patients receiving defibrotide, those whose creatinine levels were more than 1.2 times the baseline had a significantly lower survival rate at 26.7% (p = 0.014). On multivariate regression analysis, the hazard ratio of satisfaction of the Baltimore criteria was 4.54 (95% confidence interval [CI], 1.69 to 12.21; p = 0.003). In patients treated with defibrotide, the hazard ratio was 8.70 (95% CI, 2.26 to 33.45; p = 0.002), when creatinine was more than 1.2 times the baseline on administration. CONCLUSION The day +100 survival rate was significantly lower when the Baltimore criteria were satisfied, and when there was an increase in creatinine at the time of defibrotide administration.
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Affiliation(s)
- Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan,
Korea
| | - Je-Hwan Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan,
Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan,
Korea
| | - Hyeon-Seok Eom
- Department of Internal Medicine, National Cancer Center, Goyang,
Korea
| | - Hyewon Lee
- Department of Internal Medicine, National Cancer Center, Goyang,
Korea
| | - Do Young Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Sung-Nam Lim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan,
Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sung-Yong Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul,
Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
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21
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Cai X, Zhang XH. [Advances in the diagnosis and management of sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation]. Zhonghua Xue Ye Xue Za Zhi 2021; 42:1052-1056. [PMID: 35045684 PMCID: PMC8770882 DOI: 10.3760/cma.j.issn.0253-2727.2021.12.020] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- X Cai
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
| | - X H Zhang
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
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22
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Yoon JH, Choi CW, Won JH. Hepatic sinusoidal obstruction syndrome/veno-occlusive disease after hematopoietic cell transplantation: historical and current considerations in Korea. Korean J Intern Med 2021; 36:1261-1280. [PMID: 34555279 PMCID: PMC8588980 DOI: 10.3904/kjim.2021.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a rare but severe complication of hematopoietic cell transplantation (HCT) showing high mortality. Multiple risk factors for SOS/VOD were identified, but it is often confused with other hepatic complications due to nonspecific clinical features. Therefore, diagnostic and severity criteria have been revised several times. The European Society of Blood and Marrow Transplantation suggested a new guideline that excludes the standard duration of development within 21 days, emphasizes late-onset SOS/VOD, and suggests the importance of Doppler ultrasonography. The severity criteria were further subdivided for guidance to begin active treatment using defibrotide which was approved in Korea since 2016. In a phase 3 trial, defibrotide had superior 100-day survival, compared to best available treatments (38.2% vs. 25.0%). Although several studies of SOS/VOD in Korean patients have been performed after the implementation of HCT, most involved small number of pediatric patients. Recently, the Korean Society of Blood and Marrow Transplantation investigated the incidence of SOS/VOD in the Korean population, and several influential studies of adult patients were published. Here, we summarize recent issues regarding the mechanism, diagnosis, severity criteria, prevention, and treatments of SOS/VOD in Korean patients, as well as recent analyses of nationwide incidence.
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Affiliation(s)
- Jae-Ho Yoon
- Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Chul Won Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul,
Korea
| | - Jong-Ho Won
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul,
Korea
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23
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Kloehn J, Brodt G, Ernst J, Gruhn B. Analysis of risk factors for hepatic sinusoidal obstruction syndrome following allogeneic hematopoietic stem cell transplantation in pediatric patients. J Cancer Res Clin Oncol 2021; 148:1447-1455. [PMID: 34255148 PMCID: PMC9114040 DOI: 10.1007/s00432-021-03732-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023]
Abstract
Purpose Hepatic sinusoidal obstruction syndrome (SOS) represents a serious complication following hematopoietic stem cell transplantation (HSCT). Our study aimed to investigate important risk factors of SOS in a pediatric population. Methods This retrospective study analyzed 105 children, adolescents and young adults who underwent allogeneic HSCT at our pediatric HSCT center in Jena. The observation period was 12 years and SOS was defined by the pediatric criteria of the European Society for Blood and Marrow Transplantation (EBMT). Results 15 out of all 105 patients developed SOS (14.3%). The median time from HSCT to SOS diagnosis was 12 days. The mortality rate of SOS was 20.0%. In univariate analyses, we identified the significant risk factors of patient age < 1 year [odds ratio (OR) = 7.25, p = 0.037], prior treatment with gemtuzumab ozogamicin (OR = 11.00, p = 0.020), high pretransplant ferritin levels above 1500 ng/mL (OR = 4.00, p = 0.033), 2000 ng/mL (OR = 4.69, p = 0.016), and 2400 ng/mL (OR = 5.29, p = 0.005) as well as international normalized ratio (INR) ≥ 1.3 (OR = 5.91, p = 0.009). The following risk factors could be confirmed in multivariate analysis: treatment with gemtuzumab ozogamicin (OR = 9.24, p = 0.048), ferritin > 2400 ng/mL (OR = 5.74, p = 0.023), and INR ≥ 1.3 (OR = 8.02, p = 0.007). Conclusion Our study confirms several risk factors from the current literature. Additionally, this is the first report on the risk factor of high pretransplant INR.
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Affiliation(s)
- Jaspar Kloehn
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Grit Brodt
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Jana Ernst
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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24
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Lee TB, Yang K, Ko HJ, Shim JR, Choi BH, Lee JH, Ryu JH. Successful defibrotide treatment of a patient with veno-occlusive disease after living-donor liver transplantation: A case report. Medicine (Baltimore) 2021; 100:e26463. [PMID: 34160449 PMCID: PMC8238349 DOI: 10.1097/md.0000000000026463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Veno-occlusive disease (VOD) is characterized by painful hepatomegaly, ascites, weight gain, and jaundice with nonthrombotic, fibrous obliteration of the centrilobular hepatic veins. VOD after liver transplantation is a rare complication, with an incidence of approximately 2%; however, it can be life-threatening in severe cases. The precise etiology and mechanism of VOD after liver transplantation remains unclear. Acute cellular rejection, antibody-mediated rejection, and treatment with tacrolimus or azathioprine may be associated with the development of VOD after liver transplantation. Additionally, the optimal treatment of VOD after liver transplantation has not yet been established and focuses on supportive care. Defibrotide is an anti-ischemic and antithrombotic drug with no systemic anticoagulant effects. Moreover, only a few reports have investigated the use of defibrotide for VOD after liver transplantation, which has shown promising results. PATIENT CONCERNS A 39-year-old woman with primary biliary cholangitis underwent living-donor liver transplantation at our center. She experienced right upper quadrant pain with increased ascites, pleural effusion, and weight gain on postoperative day 14. DIAGNOSES Imaging and pathological tests showed no evidence of rejection or vessel complications. VOD was diagnosed clinically based on the findings of weight gain, ascites, jaundice, and pathological biopsy. INTERVENTIONS Defibrotid, 25 mg/kg/day, was administered intravenously for 21 days. OUTCOMES She showed complete clinical resolution of the VOD. LESSONS Herein, we report a case of successful defibrotide treatment of VOD after living-donor liver transplantation.
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Affiliation(s)
- Tae Beom Lee
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
| | - Kwangho Yang
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
- Research Institute for Convergence of Biomedical Science and Technology
| | - Hyo Jung Ko
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
| | - Jae Ryong Shim
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
| | - Byung Hyun Choi
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
| | - Jung Hee Lee
- Department of Pathology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Republic of Korea
| | - Je Ho Ryu
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery
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25
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Tissot N, Montani D, Seronde MF, Degano B, Soumagne T. Venoocclusive Disease With Both Hepatic and Pulmonary Involvement. Chest 2021; 157:e107-e109. [PMID: 32252933 DOI: 10.1016/j.chest.2019.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022] Open
Abstract
Pulmonary venoocclusive disease (PVOD) is a rare form of pulmonary vascular disease with pulmonary hypertension characterized by preferential involvement of the pulmonary venous system. Hepatic venoocclusive disease (HVOD), also known as sinusoidal obstruction syndrome, is a condition that occurs in 13% to 15% of patients after hematopoietic stem cell transplantation (HSCT). Although hepatic and pulmonary venoocclusive diseases may share some pathologic features as well as some etiologies such as HSCT, these two disorders have never been described together in a single adult patient. We report the case of a patient who received HSCT and developed HVOD and PVOD within 9 months. Despite their differences, PVOD and HVOD share common risk factors and associated conditions, suggesting that in the context of HSCT, the two diseases share common pathophysiological mechanisms. Optimal treatment for HSCT-related PVOD remains to be determined.
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Affiliation(s)
- Noémie Tissot
- Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, Besançon, France
| | - David Montani
- Université; Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service de Pneumologie, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France; INSERM UMR-S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, France; Université Grenoble Alpes, Grenoble, France
| | - Thibaud Soumagne
- Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, Besançon, France.
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26
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Liu L, Zhang W, Zhuge YZ. [Review on diagnostic criteria of hepatic sinusoidal obstruction syndrome]. Zhonghua Gan Zang Bing Za Zhi 2020; 28:1064-1068. [PMID: 34865358 DOI: 10.3760/cma.j.cn501113-20190415-00124] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hepatic sinusoidal obstruction syndrome (HSOS) is a kind of hepatic vascular disease which is characterized by damage to hepatic sinusoidal endothelial cells, centrilobular hepatic vein and/or interlobular vein, resulting in stenosis or lumen occlusion, hepatic injury and acute sinusoidal portal hypertension. Generally, most patients with HSOS have mild manifestations, but in severely ill patients, the disease can lead to multiple organ dysfunction/failure, and the mortality rate can be as high as 70%-80%. Therefore, it is important to identify and treat HSOS as soon as possible. This paper introduces the current clinical diagnostic criteria of HSOS, including the Modified Seattle and Baltimore Criteria along with "Nanjing Criteria", and reviews their characteristics, scope of application and limitations.
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Affiliation(s)
- L Liu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China; Department of Gastroenterology, Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China
| | - W Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Y Z Zhuge
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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27
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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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28
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Trenker C, Burchert A, Schumacher C, Schäfer JA, Dohse M, Timmesfeld N, Neubauer A, Sohlbach K, Michel C, Görg C. Pathologic Hepatic Contrast-Enhanced Ultrasound Pattern in Patients Undergoing Allogeneic Stem Cell Transplantation. Ultrasound Med Biol 2020; 46:1865-1871. [PMID: 32499194 DOI: 10.1016/j.ultrasmedbio.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/10/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
Veno-occlusive disease (VOD) is a severe complication of allogeneic stem cell transplantation (allo-SCT). Its diagnosis is difficult, and ultrasound (US) has not been proven to be of additional diagnostic value. In the work described here, we prospectively analyzed the hepatic contrast-enhanced ultrasound (CEUS) pattern before and after allo-SCT and correlated these results with the pre-allo-SCT VOD risk factors, clinical VOD findings and conventional US findings. Thirty consecutive patients who underwent allo-SCT and had at least one VOD risk factor were studied. B-Mode US and CEUS were longitudinally performed at defined time points before and after allo-SCT. The 1-min hepatic enhancement (OMHE) in CEUS was standardized to splenic enhancement and quantified using optical density (OD) measurement software. A hypo-OMHE was arbitrarily defined as pathologic (pOMHE) if the OD of the liver was less than 90% compared with the mean splenic OD. Twenty-one patients (70%) had a pOMHE, the occurrence of which peaked at day 10 after allo-SCT. The number of pre-treatment VOD risk factors significantly differed between the pathologic and non-pathologic OD groups. Together, patients undergoing allo-SCT frequently exhibit a pathologic hepatic CEUS pattern, which can be quantified by OD measurement and is suggestive of pre-clinical VOD or other hepatic pathologies.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany.
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Caren Schumacher
- Interdisciplinary Ultrasound Center, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Jonas A Schäfer
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Marius Dohse
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Bochum, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Kristina Sohlbach
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Christian Michel
- Department of Hematology, Oncology and Immunology, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Ultrasound Center, University Hospital Marburg and Philipps University Marburg, Marburg, Germany
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Botti S, Agreiter I, Orlando L, Gargiulo G, Bonifazi F, Banfi MM, Cappucciati L, Caffarri C, De Cecco V, Deiana GM, Gavezzotti M, Magarò A, Netti MG, Pignatelli AC, Rostagno E, Samarani E, Cardoso JS, Soave S, Valente CM, Vedovetto A, Zecca M, Luminari S, Merli F, Guberti M. Nursing role in the assessment and care of hepatic sinusoidal obstruction syndrome patients: a consensus paper by the "Gruppo Italiano Trapianto di Midollo Osseo". Support Care Cancer 2020; 28:5125-5137. [PMID: 32056012 DOI: 10.1007/s00520-020-05353-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Sinusoidal obstruction syndrome (SOS) is one of the most serious complications post haematopoietic stem cell transplantation (HSCT). The diagnosis of SOS is clinical, but nurses should be involved in the pre-transplant risk assessment period and play a crucial role in the early detection of signs and symptoms during and after hospitalization. The aim of this work is to achieve a consensus on nurses' behaviour in caring for SOS. METHODS On behalf of the Italian Group for Bone and Marrow Transplantation (GITMO), a promoter committee was established to put in place a consensus conference approach. A multidisciplinary group of GITMO together with four nurses, three haematology physicians and one patient representative acted as jury, who reviewed the reports and wrote recommendations and suggestions. Recommendations gaining 100% of consensus were considered 'Golden Points of Care'; if a consensus was achieved by ≥ 75% of the jury's members, those recommendations were defined as 'Good Practices'. RESULTS Eighteen papers written by nurses as first authors have been identified. Golden Points of Care and Good Practices were worked out for the following topics: nurses' role in general, nurses' role in pre-transplant assessment, pre-transplant risk assessment and risk stratification, baseline monitoring, suspected mild or moderate SOS, suspected severe or very severe SOS and late-onset cases. CONCLUSION SOS is relatively rare; therefore, a holistic approach to the patients' needs considering nursing role as essential may result in better care outcomes.
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Affiliation(s)
- Stefano Botti
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Iris Agreiter
- Bone Marrow Transplant Unit Denis Burkitt, St. James's Hospital, Dublin, Ireland
| | - Laura Orlando
- Bone Marrow Transplant Unit, Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland
| | - Gianpaolo Gargiulo
- Haematology Unit, Federico II University Hospital of Naples, Naples, Italy
| | - Francesca Bonifazi
- Institute of Haematology "Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Marina Marialuisa Banfi
- Bone Marrow Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Lorella Cappucciati
- Department of Haematology, Guglielmo da Saliceto Hospital Piacenza, Piacenza, Italy
| | - Cristiana Caffarri
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina De Cecco
- Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Marta Gavezzotti
- Haematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Magarò
- Division of Haemato-oncology, European Institute of Oncology Milan, Milan, Italy
| | - Maria Giovanna Netti
- Department of Pediatric Oncology, Neuro-Oncology Unit, Meyer Children's University Hospital Florence, Florence, Italy
| | | | - Elena Rostagno
- Paediatric Haemato-oncology and BMT Department, Azienda Ospedaliero, Universitaria S. Orsola Malpighi, Bologna, Italy
| | | | | | - Sonia Soave
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata "University Hospital" Rome, Rome, Italy
| | | | - Alessio Vedovetto
- Health Profession Direction, Nursing Course University of Padova, Padua, Italy
| | - Marco Zecca
- Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Luminari
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Health Professions Direction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Mahadeo KM, Bajwa R, Abdel-Azim H, Lehmann LE, Duncan C, Zantek N, Vittorio J, Angelo J, McArthur J, Schadler K, Chan S, Tewari P, Khazal S, Auletta JJ, Choi SW, Shoberu B, Kalwak K, Harden A, Kebriaei P, Abe JI, Li S, Moffet JR, Abraham S, Tambaro FP, Kleinschmidt K, Richardson PG, Corbacioglu S. Diagnosis, grading, and treatment recommendations for children, adolescents, and young adults with sinusoidal obstructive syndrome: an international expert position statement. Lancet Haematol 2020; 7:e61-e72. [PMID: 31818728 DOI: 10.1016/s2352-3026(19)30201-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
Sinusoidal obstructive syndrome, also known as hepatic veno-occlusive disease, is a potentially life-threatening complication that occurs in children undergoing haemopoietic stem-cell transplantation (HSCT). Differences in the incidence of genetic predisposition and clinical presentation of sinusoidal obstructive syndrome between children and adults have rendered the historical Baltimore and Seattle diagnostic criteria insufficient for children. In 2017, the European Society for Blood and Marrow Transplantation (EBMT) proposed the first paediatric diagnostic and severity grading guidelines for sinusoidal obstructive syndrome, intended for implementation across European centres. However, universally accepted paediatric criteria are needed to ensure prompt diagnosis, definitive treatment, and improved outcomes for children, adolescents, and young adults with sinusoidal obstructive syndrome, and to facilitate international clinical research collaboration. We convened an international panel of multidisciplinary experts including physicians with expertise in HSCT, paediatric intensive care, nephrology, hepatology, radiology, pathology, and transfusion medicine; HSCT advanced-practice providers and medical trainees; pharmacists; and translational and basic science researchers from the Pediatric Acute Lung Injury and Sepsis Investigators Network, the EBMT, the Pediatric Blood and Marrow Transplant Consortia, and several other institutions with extensive experience in sinusoidal obstructive syndrome. Panellists convened at The University of Texas, MD Anderson Cancer Center (Houston, TX, USA) in February, 2019, to evaluate the available evidence. In this expert position statement paper, we provide consensus recommendations for the international implementation of guidelines for the diagnosis, severity grading, and treatment of sinusoidal obstructive syndrome among children, adolescents, and young adults. We endorse universal adoption of paediatric diagnostic guidelines for sinusoidal obstruction syndrome as proposed by the EBMT, and provide implementation guidance for standardisation across centres; we have further proposed adjunctive use of age-appropriate organ-specific toxicity criteria for severity grading and provided prophylaxis and treatment considerations among children and adolescent and young adult patients. Key recommendations include: (1) liver biopsy, portal venous wedge pressure, and reversal of portal venous flow on Doppler ultrasonography should not be used for the routine diagnosis of sinusoidal obstructive syndrome in children, adolescents, and young adults; (2) platelet refractoriness can be defined as a corrected count increment of less than 5000-7500 following at least two sequential ABO-compatible fresh platelet transfusions; (3) hepatomegaly is best defined as an absolute increase of at least 1 cm in liver length at the midclavicular line; and if a baseline measurement is not available, hepatomegaly can be defined as greater than 2 SDs above normal for age; and (4) the presence and volume of ascites can be categorised as mild (minimal fluid by liver, spleen, or pelvis), moderate (<1 cm fluid), or severe (fluid in all three regions with >1 cm fluid in at least two regions).
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Affiliation(s)
- Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leslie E Lehmann
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Christine Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Nicole Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School. University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer Vittorio
- Department of Pediatrics, Division of Pediatric Transplant Hepatology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Angelo
- Department of Pediatrics, Renal Division, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer McArthur
- Department of Pediatrics, Division of Critical Care, St Jude's Children's Research Hospital, Memphis, TN, USA
| | - Keri Schadler
- Department of Pediatrics, Division of Pediatric Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherwin Chan
- Department of Radiology, Division of Pediatric Radiology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Priti Tewari
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sajad Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffery J Auletta
- Department of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Sung Won Choi
- Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplant, University of Michigan, Ann Arbor, MI, USA
| | - Basirat Shoberu
- Department of Pharmacy, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Krzysztof Kalwak
- Department of Paediatrics, Division of Immunology and Transplantology, Medical University Wroclaw, Wroclaw, Poland
| | - Avis Harden
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun-Ichi Abe
- Department of Cardiology, Division of Internal Medicine/Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shulin Li
- Department of Pediatrics, Division of Pediatric Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jerelyn Roberson Moffet
- Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Susan Abraham
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Paolo Tambaro
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA; UOC SIT-TMO AORN Santobono-Pausilipon-Napoli, Italy
| | - Katharina Kleinschmidt
- Department of Pediatrics, Division of Pediatric Oncology, Stem Cell Transplant, University Hospital of Regensburg, Regensburg, Germany
| | - Paul G Richardson
- Department of Medical Oncology, Division of Hematologic Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Selim Corbacioglu
- Department of Pediatrics, Division of Pediatric Oncology, Stem Cell Transplant, University Hospital of Regensburg, Regensburg, Germany
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Yang XQ, Ye J, Li X, Li Q, Song YH. Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis, treatment, and outcomes. World J Gastroenterol 2019; 25:3753-3763. [PMID: 31391770 PMCID: PMC6676551 DOI: 10.3748/wjg.v25.i28.3753] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/05/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by the intake of pyrrolizidine alkaloids (PAs). To date, PAs-induced HSOS has not been extensively studied. In view of the difference in etiology of HSOS between the West and China, clinical profiles, imaging findings, treatment, and outcomes of HSOS associated with hematopoietic stem cell transplantation or oxaliplatin might be hardly extrapolated to PAs-induced HSOS. Reactive metabolites derived from PAs form pyrrole-protein adducts that result in toxic destruction of hepatic sinusoidal endothelial cells. PAs-induced HSOS typically manifests as painful hepatomegaly, ascites, and jaundice. Laboratory tests revealed abnormal liver function tests were observed in most of the patients with PAs-induced HSOS. In addition, contrast computed tomography and magnetic resonance imaging scan show that patients with PAs-induced HSOS have distinct imaging features, which reveal that radiological imaging provides an effective noninvasive method for the diagnosis of PAs-induced HSOS. Liver biopsy and histological examination showed that PAs-induced HSOS displayed distinct features in acute and chronic stages. Therapeutic strategies for PAs-induced HSOS include rigorous fluid management, anticoagulant therapy, glucocorticoids, transjugular intrahepatic portosystemic shunt, liver transplantation, etc. The aim of this review is to describe the pathogenesis, clinical profiles, diagnostic criteria, treatment, and outcomes of PAs-induced HSOS.
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Affiliation(s)
- Xiao-Qian Yang
- Division of Gastroenterology, Union Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jin Ye
- Division of Gastroenterology, Union Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical college, Huazhong University of Science and technology, Wuhan 430022, Hubei Province, China
| | - Qian Li
- Department of Radiology, Union Hospital, Tongji Medical college, Huazhong University of Science and technology, Wuhan 430022, Hubei Province, China
| | - Yu-Hu Song
- Division of Gastroenterology, Union Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Ewing LE, McGill MR, Yee EU, Quick CM, Skinner CM, Kennon-McGill S, Clemens M, Vazquez JH, McCullough SS, Williams DK, Kutanzi KR, Walker LA, ElSohly MA, James LP, Gurley BJ, Koturbash I. Paradoxical Patterns of Sinusoidal Obstruction Syndrome-Like Liver Injury in Aged Female CD-1 Mice Triggered by Cannabidiol-Rich Cannabis Extract and Acetaminophen Co-Administration. Molecules 2019; 24:molecules24122256. [PMID: 31212965 PMCID: PMC6630875 DOI: 10.3390/molecules24122256] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 12/18/2022] Open
Abstract
The goal of this study was to investigate the potential for a cannabidiol-rich cannabis extract (CRCE) to interact with the most common over-the-counter drug and the major known cause of drug-induced liver injury–acetaminophen (APAP)–in aged female CD-1 mice. Gavaging mice with 116 mg/kg of cannabidiol (CBD) [mouse equivalent dose (MED) of 10 mg/kg of CBD] in CRCE delivered with sesame oil for three consecutive days followed by intraperitoneally (i.p.) acetaminophen (APAP) administration (400 mg/kg) on day 4 resulted in overt toxicity with 37.5% mortality. No mortality was observed in mice treated with 290 mg/kg of CBD+APAP (MED of 25 mg/kg of CBD) or APAP alone. Following CRCE/APAP co-administration, microscopic examination revealed a sinusoidal obstruction syndrome-like liver injury–the severity of which correlated with the degree of alterations in physiological and clinical biochemistry end points. Mechanistically, glutathione depletion and oxidative stress were observed between the APAP-only and co-administration groups, but co-administration resulted in much greater activation of c-Jun N-terminal kinase (JNK). Strikingly, these effects were not observed in mice gavaged with 290 mg/kg CBD in CRCE followed by APAP administration. These findings highlight the potential for CBD/drug interactions, and reveal an interesting paradoxical effect of CBD/APAP-induced hepatotoxicity.
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Affiliation(s)
- Laura E Ewing
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Mitchell R McGill
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Center for Dietary Supplements Research, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Eric U Yee
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Charles M Skinner
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Center for Dietary Supplements Research, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Stefanie Kennon-McGill
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Melissa Clemens
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Joel H Vazquez
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Sandra S McCullough
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - D Keith Williams
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Kristy R Kutanzi
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Larry A Walker
- National Center for Natural Products Research, University of Mississippi, University, MS 38677, USA.
- ElSohly Laboratories, Inc. (ELI), Oxford, MS 38677, USA.
| | - Mahmoud A ElSohly
- National Center for Natural Products Research, University of Mississippi, University, MS 38677, USA.
- ElSohly Laboratories, Inc. (ELI), Oxford, MS 38677, USA.
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, University, MS 38677, USA.
| | - Laura P James
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Bill J Gurley
- Center for Dietary Supplements Research, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Igor Koturbash
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- Center for Dietary Supplements Research, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Faraci M, Bertaina A, Luksch R, Calore E, Lanino E, Saglio F, Prete A, Menconi M, De Simone G, Tintori V, Cesaro S, Santarone S, Orofino MG, Locatelli F, Zecca M. Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease after Autologous or Allogeneic Hematopoietic Stem Cell Transplantation in Children: a retrospective study of the Italian Hematology-Oncology Association-Hematopoietic Stem Cell Transplantation Group. Biol Blood Marrow Transplant 2018; 25:313-320. [PMID: 30266674 DOI: 10.1016/j.bbmt.2018.09.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/19/2018] [Indexed: 11/17/2022]
Abstract
Sinusoidal obstruction syndrome (SOS), also known as veno-occlusive disease (VOD), is a potentially life-threatening complication that may develop after hematopoietic stem cell transplantation (HSCT). The aims of this retrospective multicenter study were to evaluate the incidence of SOS/VOD in a large cohort of children transplanted in centers across Italy by applying the new European Society for Blood and Marrow Transplantation (EBMT) criteria and to analyze the risk factors underlying this complication. We retrospectively reviewed data of pediatric HSCTs performed in 13 AIEOP (Associazione Italiana di Ematologia e Oncologia Pediatrica)-affiliated centers between January 2000 and April 2016. The new pediatric EBMT criteria were retrospectively applied for diagnoses of SOS/VOD and severity grading. Among 5072 transplants considered at risk for SOS/VOD during the study period, 103 children (2%) developed SOS/VOD, and the grade was severe or very severe in all patients. The median time of SOS/VOD occurrence was 17 days after HSCT (range, 1 to 104). Sixty-nine patients (67%) were treated with defibrotide for a median time of 16 days (range, 4 to 104). In multivariable analysis age < 2 years, use of busulfan during the conditioning regimen, female gender, and hemophagocytic lymphohistiocytosis were risk factors statistically associated with the development of SOS/VOD. The overall mortality directly related to SOS/VOD was 15.5%. Overall survival at 1 year was worse in patients with SOS/VOD (P = .0033), and this difference disappeared 5 years after HSCT. Nonrelapse mortality was significantly higher 1 and 5 years after transplantation in patients who developed SOS/VOD (P < .001). Based on the application of new EBMT criteria, the overall incidence of SOS/VOD recorded in this large Italian pediatric retrospective study was 2%. Nonrelapse mortality was significantly higher in patients who developed SOS/VOD. Identifying the risk factors associated with SOS/VOD can lead to more effective early treatment strategies of this potentially fatal HSCT complication in childhood.
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS-Istituto G. Gaslini, Genova, Italy.
| | - Alice Bertaina
- Department of Pediatric Hematology and Oncology, IRCCS, Ospedale Bambino Gesù, Rome, Italy
| | - Roberto Luksch
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Calore
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, Azienda Ospedaliera-University of Padova, Padova, Italy
| | - Edoardo Lanino
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS-Istituto G. Gaslini, Genova, Italy
| | - Francesco Saglio
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Arcangelo Prete
- Oncology, Hematology and Hematopoietic Stem Cell Transplant Program, U.O. Pediatrics- S. Orsola-Malpighi University of Bologna, Bologna, Italy
| | - Mariacristina Menconi
- Haematopoietic Stem Cell Transplantation Unit, Pediatric Clinic of University of Pisa, Pisa, Italy
| | - Giusy De Simone
- Department of Hemato-Oncology, Santobono-Pausilipon Hospital, BMT Unit, Napoli, Italy
| | - Veronica Tintori
- Transplantation Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stella Santarone
- Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy
| | - Maria Grazia Orofino
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico, Cagliari, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS, Ospedale Bambino Gesù, Rome, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Corbacioglu S, Carreras E, Ansari M, Balduzzi A, Cesaro S, Dalle JH, Dignan F, Gibson B, Guengoer T, Gruhn B, Lankester A, Locatelli F, Pagliuca A, Peters C, Richardson PG, Schulz AS, Sedlacek P, Stein J, Sykora KW, Toporski J, Trigoso E, Vetteranta K, Wachowiak J, Wallhult E, Wynn R, Yaniv I, Yesilipek A, Mohty M, Bader P. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation. Bone Marrow Transplant 2018; 53:138-145. [PMID: 28759025 PMCID: PMC5803572 DOI: 10.1038/bmt.2017.161] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/22/2017] [Accepted: 05/29/2017] [Indexed: 12/21/2022]
Abstract
The advances in hematopoietic cell transplantation (HCT) over the last decade have led to a transplant-related mortality below 15%. Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication of HCT that belongs to a group of diseases increasingly identified as transplant-related, systemic endothelial diseases. In most cases, SOS/VOD resolves within weeks; however, severe SOS/VOD results in multi-organ dysfunction/failure with a mortality rate >80%. A timely diagnosis of SOS/VOD is of critical importance, given the availability of therapeutic options with favorable tolerability. Current diagnostic criteria are used for adults and children. However, over the last decade it has become clear that SOS/VOD is significantly different between the age groups in terms of incidence, genetic predisposition, clinical presentation, prevention, treatment and outcome. Improved understanding of SOS/VOD and the availability of effective treatment questions the use of the Baltimore and Seattle criteria for diagnosing SOS/VOD in children. The aim of this position paper is to propose new diagnostic and severity criteria for SOS/VOD in children on behalf of the European Society for Blood and Marrow Transplantation.
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Affiliation(s)
- S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - E Carreras
- Hematology Department, Josep Carreras Foundation & Leukemia Research Institute, Hospital Clínic, Barcelona, Spain
| | - M Ansari
- Hemato-Oncology Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - A Balduzzi
- Pediatric Clinic, University of Milano-Bicocca, San Gerardo Hospital, Milan, Italy
| | - S Cesaro
- Department of Pediatric Oncohematology, Giambattista Rossi University Hospital, Verona, Italy
| | - J-H Dalle
- Department of Hematology and Immunology, Hospital Robert Debre, Paris 7-Paris Diderot University, Paris, France
| | - F Dignan
- Department of Clinical Haematology, Manchester Royal Infirmary, Manchester, UK
| | - B Gibson
- Royal Hospital for Sick Children, Glasgow, UK
| | - T Guengoer
- Division of Blood and Marrow Transplantation, University Children’s Hospital, Zurich, Switzerland
| | - B Gruhn
- Department of Pediatrics, University Hospital of Jena, Jena, Germany
| | - A Lankester
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Locatelli
- Department of Pediatric Hematology and Oncology, University of Pavia, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - A Pagliuca
- Department of Haematology, King’s College Hospital, London, UK
| | - C Peters
- Department of Pediatrics, St Anna Kinderspital, Vienna, Austria
| | - P G Richardson
- Division of Hematologic Malignancy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - A S Schulz
- Department of Pediatrics, University Children’s Hospital, Ulm, Germany
| | - P Sedlacek
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - J Stein
- Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - K-W Sykora
- Pediatric Hematology-Oncology, Children’s Hospital, Medical School, Hannover, Germany
| | | | - E Trigoso
- University Hospital and Polytechnic La Fe, Valencia, Spain
| | - K Vetteranta
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - J Wachowiak
- Department of Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation, University of Medical Sciences, Poznan, Poland
| | - E Wallhult
- Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Wynn
- Royal Manchester Children’s Hospital, Manchester, UK
| | - I Yaniv
- Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - A Yesilipek
- Pediatric Stem Cell Transplantation Unit, Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - M Mohty
- Hôpital Saint-Antoine, APHP, Université Pierre & Marie Curie, INSERM UMRS 938, Paris, France
| | - P Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
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35
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In brief: Defibrotide (Defitelio) for hepatic veno-occlusive disease. Med Lett Drugs Ther 2016; 58:120. [PMID: 27603963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Richardson PG, Riches ML, Kernan NA, Brochstein JA, Mineishi S, Termuhlen AM, Arai S, Grupp SA, Guinan EC, Martin PL, Steinbach G, Krishnan A, Nemecek ER, Giralt S, Rodriguez T, Duerst R, Doyle J, Antin JH, Smith A, Lehmann L, Champlin R, Gillio A, Bajwa R, D'Agostino RB, Massaro J, Warren D, Miloslavsky M, Hume RL, Iacobelli M, Nejadnik B, Hannah AL, Soiffer RJ. Phase 3 trial of defibrotide for the treatment of severe veno-occlusive disease and multi-organ failure. Blood 2016; 127:1656-65. [PMID: 26825712 PMCID: PMC4817309 DOI: 10.1182/blood-2015-10-676924] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022] Open
Abstract
Hepatic veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), is a potentially life-threatening complication of hematopoietic stem cell transplantation (HSCT). Untreated hepatic VOD/SOS with multi-organ failure (MOF) is associated with >80% mortality. Defibrotide has shown promising efficacy treating hepatic VOD/SOS with MOF in phase 2 studies. This phase 3 study investigated safety and efficacy of defibrotide in patients with established hepatic VOD/SOS and advanced MOF. Patients (n = 102) given defibrotide 25 mg/kg per day were compared with 32 historical controls identified out of 6867 medical charts of HSCT patients by blinded independent reviewers. Baseline characteristics between groups were well balanced. The primary endpoint was survival at day +100 post-HSCT; observed rates equaled 38.2% in the defibrotide group and 25% in the controls (23% estimated difference; 95.1% confidence interval [CI], 5.2-40.8;P= .0109, using a propensity-adjusted analysis). Observed day +100 complete response (CR) rates equaled 25.5% for defibrotide and 12.5% for controls (19% difference using similar methodology; 95.1% CI, 3.5-34.6;P= .0160). Defibrotide was generally well tolerated with manageable toxicity. Related adverse events (AEs) included hemorrhage or hypotension; incidence of common hemorrhagic AEs (including pulmonary alveolar [11.8% and 15.6%] and gastrointestinal bleeding [7.8% and 9.4%]) was similar between the defibrotide and control groups, respectively. Defibrotide was associated with significant improvement in day +100 survival and CR rate. The historical-control methodology offers a novel, meaningful approach for phase 3 evaluation of orphan diseases associated with high mortality. This trial was registered at www.clinicaltrials.gov as #.
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Affiliation(s)
- Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Marcie L Riches
- Division of Hematology/Oncology, University of North Carolina Hospitals, Bone Marrow and Stem Cell Transplant Clinic, University of North Carolina Cancer Hospital, Chapel Hill, NC
| | - Nancy A Kernan
- Pediatric Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joel A Brochstein
- Department of Pediatrics, Stem Cell Transplant Program, Cohen Children's Medical Center, New Hyde Park, NY
| | - Shin Mineishi
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Amanda M Termuhlen
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA
| | - Sally Arai
- Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | - Stephan A Grupp
- Pediatric Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Eva C Guinan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Hematology/Oncology, Children's Hospital, Boston, MA
| | - Paul L Martin
- Division of Pediatric Blood and Marrow Transplant, Duke University Medical Center, Durham, NC
| | - Gideon Steinbach
- Gastroenterology Division, University of Washington School of Medicine and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Amrita Krishnan
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Eneida R Nemecek
- Pediatric Bone Marrow Transplant Program, Oregon Health and Science University, Portland, OR
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Tulio Rodriguez
- Hematology/Oncology, Loyola University Medical Center, Chicago, IL
| | - Reggie Duerst
- Stem Cell Transplant Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - John Doyle
- Pediatric Hematology/Oncology, CancerCare Manitoba and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph H Antin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Angela Smith
- Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | - Leslie Lehmann
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Hematology/Oncology, Children's Hospital, Boston, MA
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Alfred Gillio
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ
| | - Rajinder Bajwa
- Department of Hematology/Oncology/BMT, The Ohio State University/Nationwide Children's Hospital, Columbus, OH
| | | | - Joseph Massaro
- Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Diane Warren
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Robin L Hume
- Regulatory Affairs, Jazz Pharmaceuticals, Palo Alto, CA
| | | | - Bijan Nejadnik
- Research and Clinical Development, Galena Biopharma, San Ramon, CA; and
| | | | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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37
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Dalle JH, Giralt SA. Hepatic Veno-Occlusive Disease after Hematopoietic Stem Cell Transplantation: Risk Factors and Stratification, Prophylaxis, and Treatment. Biol Blood Marrow Transplant 2015; 22:400-9. [PMID: 26431626 DOI: 10.1016/j.bbmt.2015.09.024] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [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: 07/15/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022]
Abstract
Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), can develop in a subset of patients, primarily after myeloablative hematopoietic stem cell transplantation, but it also may occur after reduced-intensity conditioning. Severe VOD/SOS, typically characterized by multiorgan failure, has been associated with a mortality rate greater than 80%. Therefore, an accurate and prompt diagnosis of VOD/SOS is essential for early initiation of appropriate therapy to improve clinical outcomes. Moreover, some studies have support the use of prophylaxis for patients who are at high risk of developing VOD/SOS. This review summarizes risk factors associated with development of VOD/SOS, including pretransplantation patient characteristics and factors related to stem cell transplantation, that can facilitate patient stratification according to risk. The incidence of VOD/SOS, clinical features, and diagnostic criteria are reviewed. Data on emerging treatment strategies for patients with VOD/SOS are discussed in the context of recent treatment guidelines. Additionally, options for prophylaxis in individuals who are at increased risk are presented. Although historically only those patients with moderate to severe VOD/SOS have been treated, early therapy and prophylaxis may be appropriate for many patients and may have the potential to improve patients' outcomes and survival, including for those with nonsevere disease.
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Affiliation(s)
- Jean-Hugues Dalle
- Department of Paediatric Haematology, Paris Diderot University, Sorbonne Paris Cité, Hôpital Robert Debré, APHP, Paris, France
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
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Akil A, Zhang Q, Mumaw CL, Raiker N, Yu J, Velez de Mendizabal N, Haneline LS, Robertson KA, Skiles J, Diaz-Ricart M, Carreras E, Renbarger J, Hanash S, Bies RR, Paczesny S. Biomarkers for Diagnosis and Prognosis of Sinusoidal Obstruction Syndrome after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1739-45. [PMID: 26172478 PMCID: PMC4568166 DOI: 10.1016/j.bbmt.2015.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/06/2015] [Indexed: 12/11/2022]
Abstract
Reliable, noninvasive methods for diagnosing and prognosing sinusoidal obstruction syndrome (SOS) early after hematopoietic cell transplantation (HCT) are needed. We used a quantitative mass spectrometry-based proteomics approach to identify candidate biomarkers of SOS by comparing plasma pooled from 20 patients with and 20 patients without SOS. Of 494 proteins quantified, we selected 6 proteins (L-Ficolin, vascular cell adhesion molecule-1 [VCAM1], tissue inhibitor of metalloproteinase-1, von Willebrand factor, intercellular adhesion molecule-1, and CD97) based on a differential heavy/light isotope ratio of at least 2 fold, information from the literature, and immunoassay availability. Next, we evaluated the diagnostic potential of these 6 proteins and 5 selected from the literature (suppression of tumorigenicity-2 [ST2], angiopoietin-2 (ANG2), hyaluronic acid [HA], thrombomodulin, and plasminogen activator inhibitor-1) in samples from 80 patients. The results demonstrate that together ST2, ANG2, L-Ficolin, HA, and VCAM1 compose a biomarker panel for diagnosis of SOS. L-Ficolin, HA, and VCAM1 also stratified patients at risk for SOS as early as the day of HCT. Prognostic Bayesian modeling for SOS onset based on L-Ficolin, HA, and VCAM1 levels on the day of HCT and clinical characteristics showed >80% correct prognosis of SOS onset. These biomarkers may provide opportunities for preemptive intervention to minimize SOS incidence and/or severity.
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Affiliation(s)
- Ayman Akil
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Qing Zhang
- Department of Genomics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christen L Mumaw
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nisha Raiker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jeffrey Yu
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Laura S Haneline
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kent A Robertson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jodi Skiles
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Enric Carreras
- Hospital Clinic, IDIBAPS, Barcelona, Spain; José Carreras Foundation & Leukemia Research Institute, Barcelona, Spain
| | - Jamie Renbarger
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samir Hanash
- Red and Charline McCombs Institute for the Early Detection and Treatment of Cancer, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert R Bies
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sophie Paczesny
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana.
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39
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Shen T, Feng XW, Geng L, Zheng SS. Reversible sinusoidal obstruction syndrome associated with tacrolimus following liver transplantation. World J Gastroenterol 2015; 21:6422-6426. [PMID: 26034381 PMCID: PMC4445123 DOI: 10.3748/wjg.v21.i20.6422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/26/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Sinusoidal obstruction syndrome (SOS), previously known as hepatic veno-occlusive disease, is a rare disorder in solid organ transplant patients, and is an uncommon complication after liver transplantation. Severe SOS with hepatic failure causes considerable mortality. Tacrolimus has been reported to be an offending agent, which potentially plays a role in the pathophysiological process of SOS. SOS due to tacrolimus has been reported in lung and pancreatic transplantations, but has never been described in a liver transplant recipient. Herein, we present a case of SOS after liver transplantation, which was possibly related to tacrolimus. A 27-year-old man developed typical symptoms of SOS with painful hepatomegaly, ascites and jaundice after liver transplantation, which regressed following withdrawal of tacrolimus. By excluding other possible predisposing factors, we concluded that tacrolimus was the most likely cause of SOS.
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Abstract
Hepatic sinusoidal obstruction syndrome (HSOS), characterized by hepatomegaly, ascites and hyperbilirubinemia, is caused by toxic injury to hepatic sinusoidal endothelial cells. One major etiology of HSOS in China is the intake of products containing pyrrolizidine alkaloids (PA) such as Tusanqi. The manifestations of patients with HSOS are usually non-specific, presenting with abnormal liver function and portal hypertension. Diagnosis of the disease depends mostly on liver histopathology when clinical and imaging data are not sufficient. A history of Tusanqi intake is mostly important for the diagnosis. Due to a lack of effective, evidence-based treatments for HSOS, avoiding the mistaken use of PA-containing products including Tusanqi is important for the prevention of HSOS.
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Affiliation(s)
- Ji Yao Wang
- Department of Gastroenterology, Zhongshan Hospital and Center of Evidence-Based Medicine, Fudan University, Shanghai, China
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41
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Yabuta M, Shibata T, Shibata T, Shinozuka K, Isoda H, Okamoto S, Uemoto S, Togashi K. Long-term outcome of percutaneous interventions for hepatic venous outflow obstruction after pediatric living donor liver transplantation: experience from a single institute. J Vasc Interv Radiol 2013; 24:1673-81. [PMID: 24008112 DOI: 10.1016/j.jvir.2013.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 04/22/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate retrospectively the long-term outcome of percutaneous interventions for hepatic venous outflow obstruction (HVOO) occurring after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS Between October 1997 and December 2012, 48 patients (24 boys, 24 girls; median age, 6 y) who had undergone LDLT were confirmed to have HVOO using percutaneous hepatic venography and manometry. All patients underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, patency rates, stent placement, and major complications were evaluated. RESULTS Technical success was achieved in 92 of 93 sessions (99.0%) and in 47 of 48 patients (97.9%), and clinical success was achieved in 41 of 48 patients (85.4%). During the follow-up period (range, 1-182 mo; median, 51.5 mo), 28 patients were treated with a single session of balloon angioplasty, and 20 patients who developed recurrent stenosis were treated with repeated percutaneous interventions. The rates of primary and primary-assisted patency at 1, 3, 5, and 10 years after balloon angioplasty were 64%, 57%, 57%, and 52% (primary patency) and 98%, 95%, 95%, and 95% (primary-assisted patency). Of six patients with stent placement, four had no recurrent HVOO after the stent placement, but two developed recurrent stenosis. The stent migrated to the right atrium in one patient. CONCLUSIONS Percutaneous interventions were effective treatments for HVOO after LDLT.
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Affiliation(s)
- Minoru Yabuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine,54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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42
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Yamamoto S, Yagawa A, Toyama D, Akiyama K, Hayashi M, Mabuchi M, Shimizu T, Ikeda H, Isoyama K. Successful treatment of hepatic sinusoidal obstructive syndrome after hematopoietic stem cell transplantation in a child using recombinant thrombomodulin. Acta Haematol 2013; 129:62-4. [PMID: 23147560 DOI: 10.1159/000343194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/05/2012] [Indexed: 01/18/2023]
Affiliation(s)
- Shohei Yamamoto
- Division of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Japan.
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43
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Aydoğdu M, Ozyilmaz E, Köktürk N, Yeğin ZA, Özkurt ZN, Aki ZS, Sucak G. Is there any relationship between pulmonary function tests and post-transplant complications of allogeneic hematopoetic stem cell transplantation? Minerva Med 2012; 103:189-198. [PMID: 22653099] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Pulmonary function tests (PFT) have an important role in the assessment of pulmonary and nonpulmonary complications of hematopoetic stem cell transplantation (HSCT). In this study the relationship between PFTs and DLCOadj values and the complications of HSCT was investigated. The possible role of iron overload in the deterioration of the PFTs after HSCT was also searched. METHODS One hundred and fifty one patients who had undergone allogeneic HSCT between years 2003 through 2008, and had the records of PFTs prior to and at 1, 3, 6, 9 and 12 months after transplantation were included in the study. Prospectively collected data of these patients were analysed retrospectively. RESULTS Although no significant difference was identified in other PFT parameters, a significant decrease in DLCOadj was determined after 1st and 3rd months of HSCT. A significant correlation was found between pretransplant DLCOadj value <%70 and sinusoidal obstruction syndrome (SOS) (P=0.001, r=0.323), but in multivariate analysis pretransplant DLCOadj was not an independent predictor of SOS; only total body irradiation (TBI) (OR: 3.673, %95 CI: 0.880-15.804), the day of platelet engraftment (OR=1.093, %95 CI: 1.029-1.161) and serum ferritin (OR=1.001, %95 CI: 1.000-1.001) were significant. Advancing age and serum ferritin levels >600 ng/mL were the independent risk factors for pretransplant DLCOadj <%70 (OR: 0.970, %95 CI: 0.941-0.999 and OR: 2.355, %95 CI: 1.058-5.241 respectively). CONCLUSION Although a significant correlation exists between pretransplant DLCOadj values and post-transplant SOS development, pretransplant DLCOadj was not an independent predictor of SOS. Increased serum ferritin levels were common both for pretransplant DLCO decrease and post-transplant SOS development. Iron induced endothelial damage may be the common pathophysiologic mechanism causing lung and liver vulnerability, and DLCOadj may be a non-invasive method of demonstrating this vulnerability.
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Affiliation(s)
- M Aydoğdu
- Department of Pulmonary Diseases, Gazi University Medical Faculty, Ankara, Turkey.
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44
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Yao JY, Zhi M, Cao WT, Huang Y, Li CJ. Successful treatment with danhong injection for hepatic veno-occlusive disease. Hepatogastroenterology 2011; 58:992-995. [PMID: 21830430] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hepatic veno-occlusive disease (HVOD) is a clinical syndrome characterized as hepatomegaly, ascites, jaundice and elevation of hepatic enzymes as an outcome from fibrous obliteration of small centrilobular hepatic venules. It is recognized as a rare but life-threatening complication of organ transplantation, tumor eradication chemotherapy and is associated with haematopoietic stem cell transplantation (SCT). Recent researches report that ingestion of plants which contain pyrrolizidine alkaloids (PAs) is associated with the onset of HVOD with unclear pathogenesis. Nowadays, there is no effective therapeutic strategy for HVOD besides supportive care using diuretics or albumin. In our case, a 42-year-old woman administered a concoction of Chinese traditional medicine supposed to contain PAs, was found to develop HVOD confirmed by liver biopsy. A therapeutic strategy was developed using Danhong injection, accompanied with supportive care, and obtained a favorable response manifesting as regression of symptoms and decline of hepatic enzymes. Danhong injection, a Chinese medical product exerting a milder anticoagulation and antithrombotic effect, is beneficial to HVOD probably by promoting microcirculation, ameliorating liver function and inhibiting hepatic fibrosis.
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Affiliation(s)
- Jia-Yin Yao
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, China
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45
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46
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Chen Z, Huo JR. Hepatic veno-occlusive disease associated with toxicity of pyrrolizidine alkaloids in herbal preparations. Neth J Med 2010; 68:252-260. [PMID: 20558855] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hepatic veno-occlusive disease (VOD) is frequently linked to stem cell transplantation (SCT), mainly related to the conditioning regime, and contributes to considerable morbidity and mortality. However, pyrrolizidine alkaloid (PA)-induced VOD has long been overlooked. The pathogenesis of VOD remains poorly understood; studies suggest that endothelial cell injury, cytokines and haemostatic derangement are all involved in the pathogenesis of VOD. Until recently, treatment options have been limited and no uniformly effective therapy has been established. Thus, treatment is largely supportive and symptomatic. Ongoing work, including development of new animal models and clinical studies, is needed to help us fully understand the pathogenesis of VOD and enable us to devise effective solutions. Furthermore, it is strongly advised that supervisory measures be taken to standardise the use of herbal medication.
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Affiliation(s)
- Zhe Chen
- Department of Digestive Disease, The Second Xiang-Ya Hospital of Central South University, Changsha, Hunan Province, China
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47
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Liang P, Peng S, Bai ST. [Hepatic veno occlusive disease in a child]. Zhongguo Dang Dai Er Ke Za Zhi 2010; 12:308-309. [PMID: 20416231] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Peng Liang
- Department of Internal Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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48
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Ito S, Taguchi J, Kato J, Nakaya A, Tachibana T, Takemura S, Sano A, Ohata M, Ishigatsubo Y, Fujita H. [Usefulness of serum plasminogen activator inhibitor-1 for diagnosis and monitoring of late-onset sinusoidal obstruction syndrome after allogeneic stem cell transplantation]. Rinsho Ketsueki 2010; 51:69-73. [PMID: 20134143] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sinusoidal obstruction syndrome (SOS) was originally defined as a clinical syndrome occurring by three weeks after transplantation; however, it occurs even after three or more weeks, and such cases are called late-onset SOS. We report here a case of late-onset SOS. The patient was a 17-year-old male with acute myeloid leukemia in second complete remission. He received a preparative regimen including busulfan followed by allo-peripheral blood stem cell transplantation from an HLA-matched sibling donor. On day 28 after transplantation, he developed hepatomegaly with pain. On day 33 PAI-1 level was increased. Two days later ascites developed, leading to a diagnosis of late-onset SOS. The symptoms improved with conservative therapy and the level of PAI-1 was normalized. When hepatic impairment appears three or more weeks after transplantation, late-onset SOS should be considered. PAI-1 is a useful marker for the diagnosis and follow up of late-onset SOS.
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Affiliation(s)
- Satomi Ito
- Department of Hematology, Shizuoka Red Cross Hospital
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49
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Faqih N, Hazin R, Barbar M, Ismael T, Al-Gharabli F, Sultan I. Severe veno-occlusive disease in an overweight infant with a renal tumor. Pediatr Blood Cancer 2009; 52:900. [PMID: 19213075 DOI: 10.1002/pbc.21944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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50
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Abstract
We describe a 10-day-old male presenting with drop foot and immobility in his right leg; no abnormality in physical examination had been found upon delivery or discharge. Magnetic resonance imaging showed a pelvic mass with an extension to the great sciatic foramen. Fine-needle aspiration biopsy revealed congenital infantile fibrosarcoma. He was started on vincristine, actinomycin-D, cyclophosphamide chemotherapy. However, he died soon after the second cycle due to veno-occlusive disease of the liver. Differential diagnosis of drop foot and immobility in lower extremity must include infiltrating neoplasms in pelvis.
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Affiliation(s)
- Bora Gülhan
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
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