Low-dose unfractionated heparin prophylaxis is a safe strategy for the prevention of hepatic sinusoidal obstruction syndrome after myeloablative adult allogenic stem cell transplant Journal Article
| Authors: | Sola, M.; Bhatt, V.; Palazzo, M.; Cavalier, K. E.; Devlin, S. M.; Maloy, M.; Barker, J. N.; Castro-Malaspina, H.; Chung, D.; Dahi, P. B.; Jakubowski, A. A.; Landau, H.; Papadopoulos, E. B.; Perales, M. A.; Sauter, C.; Tamari, R.; Kernan, N. A.; Giralt, S.; Young, J. W.; Goldberg, J. D.; Ponce, D. M. |
| Article Title: | Low-dose unfractionated heparin prophylaxis is a safe strategy for the prevention of hepatic sinusoidal obstruction syndrome after myeloablative adult allogenic stem cell transplant |
| Abstract: | Hepatic sinusoidal obstruction syndrome (SOS) is a serious complication after allogeneic stem cell transplantation (allo-HCT). However, there is no uniform consensus on the optimal strategy for SOS prevention. Ursodeoxycholic acid is the most used regimen, even though its administration is challenging in recipients unable to tolerate oral medication. Defibrotide was recently studied in a phase 3 trial, but enrollment was stopped early due to futility. Low-dose unfractionated heparin (UFH) is an alternative strategy. However, its efficacy is reputed but unproven increased risk of bleeding has not been fully established. We evaluated 514 adult allo-HCT recipients who received SOS prophylaxis with low-dose UFH. Bleeding complications occurred in 12 patients 2.3% of patients of which only 2 (0.4%) had significant grade 3 bleeding. Only 14 patients were diagnosed with hepatic SOS. Univariate analysis showed that day 100 SOS was higher in recipients of unmodified grafts when compared to CD34+ selected ex vivo T-cell depleted grafts (p ≤ 0.001), and patients with hepatitis B and/or C exposure pre-HCT (p = 0.028). Overall, UFH was well tolerated and associated with a low incidence of subsequent hepatic SOS. Low-dose UFH prophylaxis can be considered in select patients who cannot tolerate oral ursodiol. © 2022, The Author(s), under exclusive licence to Springer Nature Limited. |
| Keywords: | adult; controlled study; aged; major clinical study; fludarabine; allogeneic stem cell transplantation; drug efficacy; drug safety; gastrointestinal hemorrhage; hepatitis b; hepatitis c; patient selection; cytarabine; cd34 antigen; low drug dose; etoposide; bleeding; incidence; cohort analysis; melphalan; hematopoietic stem cell transplantation; retrospective study; carmustine; thiotepa; patient care; anticoagulants; transplantation conditioning; heparin; t cell depletion; ex vivo study; epistaxis; graft recipient; clofarabine; anticoagulant agent; hemoptysis; lung hemorrhage; adverse event; liver venoocclusive disease; hepatic veno-occlusive disease; hemorrhage; polydeoxyribonucleotides; ursodeoxycholic acid; liver vein obstruction; contusion; humans; human; male; female; article; polydeoxyribonucleotide |
| Journal Title: | Bone Marrow Transplantation |
| Volume: | 57 |
| Issue: | 7 |
| ISSN: | 0268-3369 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2022-07-01 |
| Start Page: | 1095 |
| End Page: | 1100 |
| Language: | English |
| DOI: | 10.1038/s41409-022-01689-4 |
| PUBMED: | 35477992 |
| PROVIDER: | scopus |
| PMCID: | PMC9271583 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 August 2022 -- Source: Scopus |
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