Hepatic sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation in adult patients with idiopathic aplastic anemia

Title
Hepatic sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation in adult patients with idiopathic aplastic anemia
Author(s)
김민경윤성수[윤성수]김혁[김혁]이규형[이규형]손상균[손상균]주영돈[주영돈]정철원[정철원]김성현[김성현]김병수[김병수]최정혜[최정혜]곽재용[곽재용]배성화[배성화]신호진[신호진]원종호[원종호]오석중[오석중]이원식[이원식]박재후[박재후]
Keywords
BONE-MARROW-TRANSPLANTATION; TOTAL-BODY IRRADIATION; VENOOCCLUSIVE DISEASE; PLASMINOGEN-ACTIVATOR; CONDITIONING REGIMEN; LIVER TOXICITY; ORAL BUSULFAN; CYCLOPHOSPHAMIDE; PHARMACOKINETICS; CHILDREN
Issue Date
201310
Publisher
PERGAMON-ELSEVIER SCIENCE LTD
Citation
LEUKEMIA RESEARCH, v.37, no.10, pp.1241 - 1247
Abstract
We retrospectively investigated the incidence, risk factors, and outcomes of SOS (sinusoidal obstruction syndrome; previously veno-occlusive disease [VOD]) after allogeneic hematopoietic stem cell transplantation (alloHSCT) in aplastic anemia. Two hundred and sixty patients were included in the analysis. SOS developed in 7.3% (n = 19/260) of patients. Classical Cy (200 mg/m(2))-ATG was the most common conditioning regimen (84.2%) in the SOS group. The SOS mortality rate was 4/19 (21.1%). Univariate analyses revealed that Cy 200 mg/m2 conditioning (p = 0.035), classical Cy-ATG conditioning (p = 0.007), and horse ATG conditioning (p < 0.001) were significant risk factors for developing SOS. Multivariate analysis revealed that only horse ATG conditioning was a poor prognostic factor (HR = 3.484; 95% CI 1.226-9.904; p = 0.002). Rabbit ATG (HR 12.719; 95% CI 2.332-69.373; p = 0.003) and weight gain > 10% (HR 35.655; 95% CI 2.208-575.805; p = 0.012) were risk factors in the overall SOS group. Both rabbit ATG conditioning and weight gain of more than 10% were associated with poor overall survival with a median of 1.2 months (5Y survival rate, any risk factor vs. none: 74.6% vs. 0.0%; p < 0.001; Fig. 2) in the SOS group. In conclusion, SOS is a relatively rare (7.3%) but highly fatal (21.1%) acute complication of alloHSCT in AA, and the horse ATG conditioning regimen was a significant risk factor for developing SOS. (C) 2013 Elsevier Ltd. All rights reserved.
URI
http://hdl.handle.net/YU.REPOSITORY/28785http://dx.doi.org/10.1016/j.leukres.2013.06.024
ISSN
0145-2126
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의과대학 > 내과학교실 > Articles
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