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Gómez-Centurión I, Gallardo Morillo AI, Pérez Martínez A, Cabrero Calvo M, Chinea A, González L, Pedraza A, Jiménez Lorenzo MJ, Robles MC, Bailén R, Cascón MJP, Cabero A, Piñana Sánchez JL, Luna A, Perera Alvarez M, Rovira M, Torrent Catarineu A, Sánchez-Pina J, Kwon M. SINUSOIDAL OBSTRUCTION SYNDROME/VENO-OCCLUSIVE DISEASE AFTER UNMANIPULATED HAPLOIDENTICAL HSCT WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE: A STUDY ON BEHALF OF THE SPANISH HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CELLULAR THERAPY GROUP (GETH). Transplant Cell Ther 2024:S2666-6367(24)00440-8. [PMID: 38851323 DOI: 10.1016/j.jtct.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life threatening complication after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT). However, its characterization after haploidentical HSCT (haplo-HSCT) with post-transplant cyclophosphamide (PT-Cy) is scarce. OBJECTIVES To describe characteristics and outcomes of patients with SOS/VOD after haplo-HSCT with PT-Cy. STUDY DESIGN We conducted a retrospective study of 797 patients undergoing a haplo-HSCT with PT-Cy between 2007 and 2019 in 9 centers in Spain. SOS/VOD was defined according to modified Seattle, Baltimore or revised EBMT criteria. Severity was retrospectively graded according to revised EBMT severity criteria into 4 categories: mild, moderate, severe and very severe. RESULTS From 797 haplo-HSCT performed, 46 patients (5.77%) were diagnosed from SOS/VOD at a median of 19 days (range 4-84) after transplant. Based on revised EBMT severity criteria, there were 4 mild (8.7%), 10 moderate (21.7%), 12 severe (26.1%) and 20 very severe (43.5%) grade SOS/VOD cases. Overall, 30 patients (65%) achieved SOS/VOD complete response, 25 (83%) of whom were treated with defibrotide. Twenty patients (43%) died before day 100 after HSCT. Death was attributed to SOS/VOD in 11 patients, and 5 patients died of other causes without resolution of SOS/VOD. CONCLUSIONS Incidence of SOS/VOD after haplo-HSCT with PT-Cy was comparable to those reported after HLA-identical HSCT series. Most of the patients developed very severe SOS/VOD according to revised EBMT severity criteria. In spite of a promising SOS/VOD CR rate (65%), 100-day mortality remained high (43%), indicating that further improvement in the management of this potentially fatal complication is needed.
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Affiliation(s)
- I Gómez-Centurión
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | | | | | - M Cabrero Calvo
- Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - A Chinea
- Hospital Ramón y Cajal, Madrid, Spain; Hospital Regional Universitario de Málaga, Málaga, Spain
| | - L González
- Hospital Universitario de Gran Canaria Doctor Negrín, Gran Canaria, Spain; Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Pedraza
- Hospital Clinic, Barcelona, Spain; Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M J Jiménez Lorenzo
- Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Calbacho Robles
- Hospital 12 de Octubre, Madrid, Spain; Hospital Regional Universitario de Málaga, Málaga, Spain
| | - R Bailén
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - A Cabero
- Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | - A Luna
- Hospital Ramón y Cajal, Madrid, Spain
| | - M Perera Alvarez
- Hospital Universitario de Gran Canaria Doctor Negrín, Gran Canaria, Spain
| | - M Rovira
- Hospital Clinic, Barcelona, Spain
| | - A Torrent Catarineu
- Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - M Kwon
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Davidov Y, Shem-Tov N, Yerushalmi R, Hod T, Ben-Ari Z, Nagler A, Shimoni A, Danylesko I. Liver stiffness measurements predict Sinusoidal Obstructive Syndrome after hematopoietic stem cell transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02288-1. [PMID: 38658660 DOI: 10.1038/s41409-024-02288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/09/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
Sinusoidal Obstructive Syndrome (SOS) is a life-threatening complication after hematopoietic stem-cell transplantation (HSCT), characterized by post-sinusoidal portal hypertension. FibroScan is used to assess portal hypertension non-invasively. We assessed transient elastography (TE) applicability in diagnosing SOS. The study included 27 adult patients, 11 underwent TE for high SOS risk pre-HSCT, 17 underwent TE post-HSCT due to bilirubin ≥2 mg/dl with no definite diagnosis of SOS. The first group had median Liver Stiffness Measurement (LSM) of 7.4 kPa (range, 3.3-22.5). Based on LSM results, conditioning regimen was modified for six patients and two of them developed SOS. Only one patient who did not have protocol adjustment experienced SOS. No patient with LSM < 7 kPa developed SOS. The second group had median LSM of 7.7 kPa (4.4-31.5). Median LSM after HSCT was significantly higher in patients who subsequently developed established SOS (n = 10) compared to patients who did not (n = 8), with values of 10.7 kPa (5.6-31.5) and 5.9 kPa (4.4-13.8), respectively (p = 0.02). An LSM cut-off of 7.5 kPa had a sensitivity and specificity of 75 and 80% for diagnosing SOS. In conclusion, pre-HSCT LSM can help adjustment of conditioning regimen in patients with high-risk for SOS. Post-HSCT LSM can help in early diagnosis of SOS.
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Affiliation(s)
- Yana Davidov
- Liver Diseases Center, Sheba Medical Center, Tel-Hashomer, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Noga Shem-Tov
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ronit Yerushalmi
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tammy Hod
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Renal Transplant Center and Nephrology department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ziv Ben-Ari
- Liver Diseases Center, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Nagler
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avichai Shimoni
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ivetta Danylesko
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Israel
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Vujanić GM, Graf N, D'Hooghe E, Pritchard-Jones K, Bergeron C, Tinteren HV, Furtwängler R. Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30-year SIOP-RTSG experience. Pediatr Blood Cancer 2024; 71:e30852. [PMID: 38185745 DOI: 10.1002/pbc.30852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Completely necrotic Wilms tumor (CN-WT) following preoperative chemotherapy has been regarded as low-risk WT since the International Society of Paediatric Oncology (SIOP) 93-01 study, and patients have been treated with reduced postoperative therapy. The aim of the study was to evaluate whether the omission of adjuvant chemotherapy in patients with localized CN-WT stage I and radiotherapy in stage III was safe. PATIENTS AND METHODS The retrospective observational study of outcomes of patients diagnosed with localized CN-WT on central pathology review and treated according to the SIOP 93-01 and SIOP-WT-2001 protocols (1993-2022). RESULTS There were 125 patients with localized CN-WT: 90 with stage I, 10 with stage II, and 25 with stage III. Sixty-two of 125 (49.6%) patients had a discrepant diagnosis and/or staging between the institutional pathologist and central pathology review. In the group of 90 patients with stage I, postoperative chemotherapy was not given to 41 (46%) patients, whereas 49 patients received postoperative chemotherapy-in the latter group, two patients relapsed, and one of them died. One stage I and one stage II patient developed chemotherapy-induced toxicity and died. Nineteen of 25 patients with stage III received no flank radiotherapy. No stage III patient relapsed or died. The overall 5-year event-free survival (EFS) estimate for the entire cohort (stages I-III) was 96.8% [95% confidence interval, CI: 93.6%-99.6%] and the overall survival (OS) was 97.6% [95% CI: 95.0-100%]. The EFS and OS were 97% and 98%, respectively, for stage I, and 100% for stage III. CONCLUSION Omission of postoperative chemotherapy for patients with CN-WT stage I, and radiotherapy for stage III is safe. Rapid central pathology review is required to assign appropriate treatment and avoid treatment-related side effects.
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Affiliation(s)
- Gordan M Vujanić
- Department of Pathology, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Norbert Graf
- Department of Hematology and Oncology, Saarland University Hospital, Homburg, Germany
| | - Ellen D'Hooghe
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Christophe Bergeron
- Institut d'Hematologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Harm van Tinteren
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rhoikos Furtwängler
- Department of Hematology and Oncology, Saarland University Hospital, Homburg, Germany
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital University Hospital, Bern, Switzerland
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Shiratori S, Okada K, Sugita J, Nishida M, Iwai T, Ota S, Hashimoto D, Teshima T. HokUS-10 scoring system predicts the treatment outcome for sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation. Sci Rep 2023; 13:17374. [PMID: 37833418 PMCID: PMC10575893 DOI: 10.1038/s41598-023-43806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Hepatic sinusoidal obstruction syndrome (SOS) is a severe and life-threatening complication after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a multi-center retrospective study to evaluate the utility of our ultrasonographic scoring system for the diagnosis of SOS (HokUS-10) in predicting SOS-related mortality (SOS-RM). We analyzed a total of 42 patients who developed SOS after HSCT. The cumulative incidences of SOS-RM, non-relapse mortality (NRM), and overall survival at day 180 after the diagnosis of SOS were 26.4%, 28.8% and 54.5%, respectively. The area under the receiver operating characteristic curve analysis showed that the optimal cut-off value of HokUS-10 total score to predict SOS-RM was 8 points after the treatment of SOS. In the individual HokUS-10 score, ascites and portal vein flow-related scores (PV mean velocity and PV flow direction) after the treatment of SOS were shown as significant risk factors for SOS-RM. Our study suggested that US findings after the treatment can predict the treatment outcomes for SOS.
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Affiliation(s)
- Souichi Shiratori
- Department of Hematology, Hokkaido University Hospital, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kohei Okada
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Takahito Iwai
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Daigo Hashimoto
- Department of Hematology, Hokkaido University Hospital, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Hospital, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Schneider V, Cabanillas Stanchi KM, Althaus K, Schober S, Michaelis S, Seitz C, Lang P, Handgretinger R, Bakchoul T, Hammer S, Döring M. Hypofibrinolysis in pediatric patients with veno-occlusive disease in hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04798-9. [PMID: 37086290 PMCID: PMC10374734 DOI: 10.1007/s00432-023-04798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Veno-occlusive disease (VOD) is a serious complication of hematopoietic stem cell transplantation (HSCT) with a high incidence in pediatric patients. This study aimed to detect signs of hypofibrinolysis using thrombelastography. METHODS In this prospective single-center study, thrombelastographic measurements (EX and TPA tests) were taken during HSCT to detect signs of impaired coagulation, clot formation, or hypofibrinolysis. RESULTS Of 51 patients undergoing allogeneic and autologous HSCT, five (9.8%) developed VOD and received defibrotide treatment. Thrombelastography measurements were also obtained from 55 healthy children as a control group. The results show that clot lysis was prolonged in VOD patients compared to other HSCT patients and control group (lysis time, TPA test: day + 14 to + 21: VOD: 330 ± 67 s vs. HSCT: 246 ± 53 s; p = 0.0106; control: 234 ± 50 s; control vs. VOD: p = 0.0299). The maximum lysis was reduced in HSCT patients compared to controls (EX test: control: 8.3 ± 3.2%; HSCT: day 0 to + 6: 5.3 ± 2.6%, p < 0.0001; day + 7 to + 13: 3.9 ± 2.1%, p < 0.0001; day + 14 to d + 21: 4.1 ± 2.3%, p < 0.0001). CONCLUSION These results suggest that HSCT patients exhibit reduced fibrinolytic capacities and patients diagnosed with VOD show signs of hypofibrinolysis. This prospective study shows that fibrinolysis can be assessed in a rapid and accessible way via thrombelastography. Thrombelastography might be a parameter to support the diagnosis of a VOD and to serve as a follow-up parameter after the diagnosis of a VOD.
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Affiliation(s)
- Veronika Schneider
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin M Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Sarah Schober
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Sebastian Michaelis
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Christian Seitz
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Stefanie Hammer
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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Sarsour NY, Minervini M, Malik SM. Cemiplimab-Associated Sinusoidal Obstruction Syndrome. ACG Case Rep J 2023; 10:e01038. [PMID: 37091208 PMCID: PMC10118369 DOI: 10.14309/crj.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
A 58-year-old woman developed new-onset recurrent ascites after the recent initiation of cemiplimab for the treatment of advanced basal cell carcinoma. A comprehensive serological workup for viral, metabolic, and autoimmune causes was unrevealing. Transjugular liver biopsy demonstrated parenchymal changes consistent with a diagnosis of sinusoidal obstruction syndrome. While this is a condition commonly observed in patients after hematopoietic stem cell transplantation or use of chemotherapeutic agents, it should also be considered in patients who develop new-onset liver dysfunction after the initiation of checkpoint inhibitors.
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Affiliation(s)
- Nadeen Y. Sarsour
- University of Pittsburgh Department of Internal Medicine, Pittsburgh, PA
| | - Marta Minervini
- University of Pittsburgh Department of Pathology, Pittsburgh, PA
| | - Shahid M. Malik
- University of Pittsburgh Division of Gastroenterology, Hepatology, and Nutrition, Pittsburgh, PA
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Coutsouvelis J, Kirkpatrick CM, Dooley M, Spencer A, Kennedy G, Chau M, Huang G, Doocey R, Copeland TS, Do L, Bardy P, Kerridge I, Cole T, Fraser C, Perera T, Larsen SR, Mason K, O'Brien TA, Shaw PJ, Teague L, Butler A, Watson AM, Ramachandran S, Marsh J, Khan Z, Hamad N. Incidence of sinusoidal obstruction syndrome/veno-occlusive disease and treatment with defibrotide in allogeneic transplant: A multicentre Australasian registry study. Transplant Cell Ther 2023:S2666-6367(23)01173-9. [PMID: 36934993 DOI: 10.1016/j.jtct.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is an established complication in patients undergoing allogeneic haemopoietic stem cell transplantation. Defibrotide is an effective and safe pharmacological option for treating diagnosed SOS/VOD. OBJECTIVE By exploring data provided to the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) by centres from Australia and New Zealand, this study aimed to describe the incidence of SOS/VOD and patterns of defibrotide use from 2016 to 2020. STUDY DESIGN Patients who underwent allogeneic HSCT between 2016 and 2020 were identified from the ABMTRR. Data was extracted for a total of 3346 patients, 2692 from adult centres and 654 from paediatric centres, with a median follow up of 21.5 months and 33.3 months respectively. Descriptive statistics were used to describe the patient population, including the incidence of SOS/VOD and defibrotide use. Comparisons were made between patients not experiencing SOS/VOD, and those with the diagnosis, divided into defibrotide and no-defibrotide cohorts. Associations with overall survival and day 100 survival with variables such as gender, age, disease at transplant, source of stem cells, conditioning agents, SOS/VOD diagnosis and use of defibrotide were determined. RESULTS The reported incidence of SOS/VOD was 4.1% in adult centres and 11.5% in paediatric centres. Defibrotide was administered to 74.8% of adult patients with SOS/VOD and 97.3% of paediatric patients. Significant variability of use, dose and duration of defibrotide was seen across the adult centres. Day 100 survival rate and median overall survival (OS) for patients managed with defibrotide was 51.8% and 103 days respectively for adult patients, and 90.4% and not reached for paediatric patients. In adults, older age at transplant, an HLA matched donor who was a non-sibling relative, and a diagnosis of SOS/VOD treated with defibrotide, were all associated with reduced OS. In paediatrics, the patient and transplant characteristics that were associated with a reduced OS were a diagnosis of SOS/VOD and donor relation as 2 or more HLA mismatched relative. CONCLUSION A collaborative approach across Australasia to diagnose and manage SOS/VOD, in particular with respect to consistent defibrotide use, is recommended.
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Affiliation(s)
- John Coutsouvelis
- Pharmacy Department, Alfred Health, Commercial Road, Melbourne VIC 3004, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia.
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia
| | - Michael Dooley
- Pharmacy Department, Alfred Health, Commercial Road, Melbourne VIC 3004, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Andrew Spencer
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Health - Monash University, Commercial Road, Melbourne, VIC 3004, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston QLD 4029; University of Queensland Medical School, St Lucia QLD 4072, Australia
| | - Maggie Chau
- Pharmacy Department, Royal Melbourne Hospital, Grattan Street, Parkville VIC 3050, Australia
| | - Gillian Huang
- Blood Transplant and Cellular Therapies, Department of Clinical Haematology & BTCT, Westmead Hospital, Westmead NSW 2145, Australia
| | - Richard Doocey
- Auckland City and Starship Hospitals Stem Cell Transplant Programme, Park Road, Grafton Auckland 1023, New Zealand
| | - Tandy-Sue Copeland
- Pharmacy Department, Fiona Stanley Hospital, Level 7D, 11 Robyn Warren Drive, MURDOCH WA 6150, Australia
| | - Louis Do
- Haematology Department, St Vincent's Hospital & The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia
| | - Peter Bardy
- Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW 2065; Northern Blood Research Centre, Kolling Institute, St Leonards, NSW 2065; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006
| | - Theresa Cole
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC,3052; Murdoch Children's Research Institute, Melbourne, Parkville, VIC,3052; Dept of paediatrics, University of Melbourne, Melbourne VIC, Australia
| | - Chris Fraser
- Blood and Marrow Transplant Program, Queensland Children's Hospital, 501 Stanley Street, South Brisbane QLD 4101, Australia
| | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington Hospital, Riddiford St, Newtown, Wellington 6022, New Zealand
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Kate Mason
- Clinical Haematology, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick NSW 2031, Australia;; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Australia
| | - Peter J Shaw
- Blood Transplant and Cell Therapies Program, The Children's Hospital, Westmead NSW 2145, Australia; Clinical Professor, Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lochie Teague
- Starship Blood and Cancer Centre, Starship Hospital, 2 Park Rd, Grafton Auckland 1023, New Zealand
| | - Andrew Butler
- Haematology Department, Christchurch Hospital, 2 Riccarton Avenue, Christchurch 8140, New Zealand
| | - Anne-Marie Watson
- Haematology Department, Liverpool Hospital, Elizabeth Street, Liverpool NSW 2170, Australia
| | - Shanti Ramachandran
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Nedlands 6009, WA, Australia,; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia
| | - Jodie Marsh
- Townsville University Hospital, Angus Smith Drive, Douglas QLD 4814, Australia
| | - Zulekha Khan
- Australasian Bone Marrow Transplant Recipient Registry, Level 6, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia
| | - Nada Hamad
- Haematology Department, St Vincent's Hospital & The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia; Australasian Bone Marrow Transplant Recipient Registry, Level 6, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst NSW 2010, Australia; University of New South Wales, Sydney, Australia; University of Notre Dame Australia, Sydney Australia
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8
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Kidney Injury in Children after Hematopoietic Stem Cell Transplant. Curr Oncol 2023; 30:3329-3343. [PMID: 36975466 PMCID: PMC10047595 DOI: 10.3390/curroncol30030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Hematopoietic cell transplant (HCT), used for treatment of many malignant and non-malignant pediatric diseases, is associated with serious complications, limiting this therapy’s benefit. Acute kidney injury (AKI), seen often after HCT, can occur at different stages of the transplant process and contributes to morbidity and mortality after HCT. The etiology of AKI is often multifactorial, including kidney hypoperfusion, nephrotoxicity from immunosuppressive and antimicrobial agents, and other transplant-related complications such as transplant-associated thrombotic microangiopathy and sinusoidal obstructive syndrome. Early recognition of AKI is crucial to prevent further AKI and associated complications. Initial management includes identifying the etiology of AKI, preventing further kidney hypoperfusion, adjusting nephrotoxic medications, and preventing fluid overload. Some patients will require further support with kidney replacement therapy to manage fluid overload and AKI. Biomarkers of AKI, such as neutrophil gelatinase-associated lipocalin can aid in detecting AKI before a rise in serum creatinine, allowing earlier intervention. Long-term kidney dysfunction is also prominent in this population. Therefore, long-term follow-up and monitoring of renal function (glomerular filtration rate, microalbuminuria) is required along with management of hypertension, which can contribute to chronic kidney disease.
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Mohty M, Blaise D, Peffault de Latour R, Labopin M, Bourhis JH, Bruno B, Ceballos P, Detrait M, Gandemer V, Huynh A, Izadifar-Legrand F, Jubert C, Labussière-Wallet H, Lebon D, Maury S, Paillard C, Pochon C, Renard C, Rialland F, Schneider P, Sirvent A, Asubonteng K, Guindeuil G, Yakoub-Agha I, Dalle JH. Real-world use of defibrotide for veno-occlusive disease/sinusoidal obstruction syndrome: the DEFIFrance Registry Study. Bone Marrow Transplant 2022; 58:367-376. [PMID: 36564486 PMCID: PMC10073014 DOI: 10.1038/s41409-022-01900-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially life-threatening complication of haematopoietic cell transplantation (HCT) conditioning. The DEFIFrance post-marketing registry study evaluated effectiveness and safety in patients who received defibrotide. It collected retrospective/prospective patient data from 53 French HCT centres from July 2014 to March 2020. Primary endpoints were survival and complete response (CR; total serum bilirubin <2 mg/dL, multiorgan failure resolution) at Day 100 post-HCT among patients with severe/very severe VOD/SOS. A secondary endpoint was evaluation of treatment-emergent serious adverse events (TESAEs) of interest. Of 798 patients analysed, 251 and 81 received defibrotide treatment for severe/very severe VOD/SOS and mild/moderate VOD/SOS post-HCT, respectively; 381 received defibrotide for VOD/SOS prophylaxis. In patients with severe/very severe VOD/SOS post-HCT, Kaplan-Meier-estimated CR at Day 100 was 74% (95% confidence interval [CI]: 66%, 81%). At Day 100, 137/251 (55%) were alive and in CR. Kaplan-Meier-estimated Day 100 post-HCT survival was 61% (95% CI: 55%, 67%) in patients with severe/very severe VOD/SOS. TESAEs of interest occurred in 29% of these patients; VOD/SOS-related mortality at 12 months was 15%. DEFIFrance represents the largest collection of real-world data on post-registration defibrotide use, supporting the real-world utility of defibrotide for patients with severe/very severe VOD/SOS post-HCT.
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Affiliation(s)
- Mohamad Mohty
- Hôpital St Antoine, INSERM UMRs 938, Université Sorbonne, Paris, France.
| | - Didier Blaise
- Institut Paoli-Calmettes, Management Sport Cancer Laboratoire (MSC), Aix Marseille Université, Marseille, France
| | | | - Myriam Labopin
- Hôpital St Antoine, INSERM UMRs 938, Université Sorbonne, Paris, France
| | | | | | - Patrice Ceballos
- Département d'Hématologie, CHU de Montpellier, Montpellier, France
| | - Marie Detrait
- CHRU de Nancy, Service d'hématologie, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
| | | | - Anne Huynh
- Département d'Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Faezeh Izadifar-Legrand
- Institut Paoli-Calmettes, Management Sport Cancer Laboratoire (MSC), Aix Marseille Université, Marseille, France
| | - Charlotte Jubert
- Département d'Hémato-oncologie Pédiatrique, CHU Bordeaux, Bordeaux, France
| | | | | | - Sébastien Maury
- Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Catherine Paillard
- Département d'Hémato-oncologie Pédiatrique, CHU de Hautepierre, Strasbourg, France
| | - Cécile Pochon
- CHRU de Nancy, Service d'hématologie, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
| | - Cecile Renard
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Fanny Rialland
- CHU de Nantes, Hôpital Femme-Enfant-Adolescent, Nantes, France
| | - Pascale Schneider
- Département d'Hémato-oncologie Pédiatrique, CHU de Rouen, Rouen, France
| | - Anne Sirvent
- CHU de Montpellier, Hôpital A De Villeneuve, Montpellier, France
| | | | | | | | - Jean-Hugues Dalle
- Hôpital Robert-Debré, GHU APHP Nord et Université de Paris, Paris, France
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Shiratori S, Okada K, Matsuoka S, Ito S, Sugita J, Teshima T. Serum levels of albumin and creatinine predict the outcome of sinusoidal obstruction syndrome after allogeneic HSCT. Ann Hematol 2022; 101:2117-2118. [PMID: 35723710 DOI: 10.1007/s00277-022-04886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/04/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Souichi Shiratori
- Department of Hematology, Hokkaido University Hospital, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kohei Okada
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Satomi Matsuoka
- Division of Internal Medicine, Asahikawa City Hospital, Asahikawa, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Hospital, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Giglio F, Xue E, Greco R, Lazzari L, Clerici DT, Lorentino F, Mastaglio S, Marktel S, Lupo-Stanghellini MT, Marcatti M, Corti C, Bernardi M, Piemontese S, Ciceri F, Peccatori J. Defibrotide Prophylaxis of Sinusoidal Obstruction Syndrome in Adults Treated With Inotuzumab Ozogamicin Prior to Hematopoietic Stem Cell Transplantation. Front Oncol 2022; 12:933317. [PMID: 35785209 PMCID: PMC9240310 DOI: 10.3389/fonc.2022.933317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Sinusoidal Obstruction Syndrome (SOS) is a life threatening HSCT complication and it can rapidly evolve in Multiple Organ Dysfunction Syndrome, with a mortality exceeding 80%. Early treatment with defibrotide is the leading factor for efficacy. Its prophylactic use is recommended in the pediatric setting, but its value isn’t validated for adults, although factors for individual risk assessment are debated. We here present a real-world experience of Defibrotide prophylaxis in adults at very high risk of SOS. We treated with prophylactic Defibrotide and Ursodeoxycholic Acid seven patients receiving allogeneic HSCT for high risk B-ALL, previously treated with single agent Inotuzomab-Ozogamicin. They all had other high risk factors for SOS such as previous hepatotoxicity, previous allo-HSCT, double alkylating conditioning. All patients received Treosulfan-Fludarabine conditioning, Thiotepa was added in 4 patients and 4GyTBI in 2 patients. GvHD prophylaxis included post-transplant cyclophosphamide, rapamycin and mycophenolate. Donor source was PBSC. Five patients received family MMRD transplant, 1 patient a MRD transplant and 1 patient a MUD transplant. Non-severe gastrointestinal bleeding occurred in two patients requiring defibrotide temporarily discontinuation. SOS occurred in 3/7 cases within 21 days after HSCT and no late-onset SOS were diagnosed. SOS caused death in all cases. All three patients were characterized by a common pattern of very high risk factors by prior HSCT, they all received a myeloablative conditioning with Treosulfan-Thiotepa and a MMRD transplant. Defibrotide prophylaxis apparently failed to protect against the development of SOS in those patients treated with a double alkylator-based conditioning regimen, while a possible efficacy for the other high-risk patients is debatable.
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Affiliation(s)
- Fabio Giglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Fabio Giglio, ; Fabio Ciceri,
| | - Elisabetta Xue
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Greco
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Lazzari
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Teresa Clerici
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lorentino
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- PhD Program in Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sara Mastaglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Magda Marcatti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Piemontese
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
- *Correspondence: Fabio Giglio, ; Fabio Ciceri,
| | - Jacopo Peccatori
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Mohty M, Cluzeau T, Jubert C, Lawson S, Ryan RJ, Hanvesakul R, Perruccio K. Defibrotide-treated patients with anicteric or icteric veno-occlusive disease/sinusoidal obstruction syndrome after hematopoietic cell transplantation: an EBMT study. Bone Marrow Transplant 2022; 57:664-667. [PMID: 35115668 DOI: 10.1038/s41409-022-01588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Mohamad Mohty
- Department of Clinical Haematology and Cellular Therapy, Hôpital St Antoine, Sorbonne University, INSERM UMRs 938, Paris, France.
| | | | - Charlotte Jubert
- CHU Bordeaux Groupe Hospitalier Pellegrin-Enfants, Bordeaux, France
| | - Sarah Lawson
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Robert J Ryan
- Biostatistics, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Raj Hanvesakul
- Research and Development, Jazz Pharmaceuticals, Oxford, UK
| | - Katia Perruccio
- Mother and Child Health, Santa Maria della Misericordia Hospital, Perugia, Italy
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