Early clinical predictors of hepatic veno-occlusive disease/sinusoidal obstruction syndrome after myeloablative stem cell transplantation Journal Article


Authors: Roeker, L. E.; Kim, H. T.; Glotzbecker, B.; Nageshwar, P.; Nikiforow, S.; Koreth, J.; Armand, P.; Cutler, C.; Alyea, E. P.; Antin, J. H.; Richardson, P. G.; Soiffer, R. J.; Ho, V. T.
Article Title: Early clinical predictors of hepatic veno-occlusive disease/sinusoidal obstruction syndrome after myeloablative stem cell transplantation
Abstract: Hepatic veno-occlusive disease (VOD), or sinusoidal obstruction syndrome (SOS), is a serious complication of hematopoietic stem cell transplantation (HSCT) with mortality in its severe form exceeding 80%. Although the incidence of VOD/SOS has fallen with contemporary transplantation practices, the increasing use of inotuzumab, the return of gemtuzumab, and the popularity of pharmacokinetic-guided high-dose busulfan may impact incidence. Early intervention with defibrotide improves survival, but prompt diagnosis can be difficult. We aimed to identify clinical parameters that could aid in early detection of VOD/SOS in a large, retrospective, cohort study. Of the 1823 adult patients who underwent myeloablative HSCT between 1996 and 2015 in our center, 205 (11%) developed VOD/SOS, with a median onset of day +14. We compared parameters in the 7 days preceding VOD/SOS onset for cases to 447 randomly selected control subjects in an analogous time frame to determine those with predictive value. Between 7 days before and the day of diagnosis, VOD/SOS patients had higher serum creatinine levels and were more likely to develop acute kidney injury (61% versus 33%, P <.0001), more commonly experienced refractoriness to platelet transfusion (48% versus 24%, P <.0001), and had higher trough serum tacrolimus levels (7 days before VOD/SOS onset: median 8.8 versus 7.3, P =.0002; day of onset: median 9.3 versus 7.2, P <.0001) compared with control subjects. Acute renal dysfunction, platelet refractoriness, and elevated or abnormal tacrolimus levels are dynamic clinical markers that should alert clinicians to the development of VOD/SOS before the presence of classical diagnostic criteria. Using these clinical features to recognize VOD/SOS earlier in its clinical course could promote earlier treatment and lead to improved outcomes of this potentially serious complication. © 2018
Keywords: tacrolimus; veno-occlusive disease; defibrotide; sinusoidal obstruction syndrome; sos; vod
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 1
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-01-01
Start Page: 137
End Page: 144
Language: English
DOI: 10.1016/j.bbmt.2018.07.039
PROVIDER: scopus
PUBMED: 30081073
DOI/URL:
Notes: Biol. Blood Marrow Transplant. -- Export Date: 2 January 2019 -- Article -- CODEN: BBMTF -- Source: Scopus
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  1. Lindsey Elizabeth Roeker
    106 Roeker