Underdiagnosed veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) as a major cause of multi-organ failure in acute leukemia transplant patients: an analysis from the EBMT Acute Leukemia Working Party

Bazarbachi, Abdul Hamid ; Al Hamed, Rama ; Labopin, Myriam ; Halaburda, Kazimierz ; Labussiere, Helene ; Bernasconi, Paolo ; Schroyens, Wilfried ; Gandemer, Virginie ; Schaap, Nicolaas P. M. ; Loschi, Michael ; Jindra, Pavel ; Snowden, John ; Wu, Depei ; Guffroy, Blandine ; Rovira, Montserrat ; Chantepie, Sylvain P. ; Poiré, Xavier ; Lopez-Corral, Lucia ; Nikolousis, Manos ; Pelosini, Matteo ; Ciceri, Fabio ; Baron, Frederic ; Bazarbachi, Ali ; Corbacioglu, Selim ; Savani, Bipin N. ; Peric, Zinaida ; Nagler, Arnon ; Carreras, Enric ; Mohty, Mohamad

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Details

Item type:	Article
Journal or Publication Title:	Bone Marrow Transplantation
Publisher:	Springer
Place of Publication:	LONDON
Volume:	56
Number of Issue or Book Chapter:	4
Page Range:	pp. 917-927
Date:	2021
Institutions:	Medicine > Abteilung für Pädiatrische Hämatologie, Onkologie und Stammzelltransplantation
Identification Number:	Value Type 10.1038/s41409-020-01135-3 DOI
Keywords:	VERSUS-HOST-DISEASE; OCCLUSIVE DISEASE; MARROW-TRANSPLANTATION; CELL TRANSPLANTATION; EUROPEAN-SOCIETY; DIAGNOSIS; BLOOD; LIVER;
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	50611

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is a complex, potentially fatal therapy featuring a myriad of complications. Triggering event(s) of such complications vary significantly, but often a so-called "multi-organ failure" (MOF) is reported as the leading cause of death. The identification of the exact trigger of MOF is critical towards early and disease-specific intervention to ...

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is a complex, potentially fatal therapy featuring a myriad of complications. Triggering event(s) of such complications vary significantly, but often a so-called "multi-organ failure" (MOF) is reported as the leading cause of death. The identification of the exact trigger of MOF is critical towards early and disease-specific intervention to improve outcome. We examined data from 202 alloHCT patients reported to have died of MOF from the EBMT registry aiming to determine their exact cause of death focusing on veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) due to its life-threatening, often difficult to capture yet preventable nature. We identified a total of 70 patients (35%) for whom VOD/SOS could be considered as trigger for MOF and leading cause of death, among which 48 (69%) were previously undiagnosed. Multivariate analysis highlighted history of hepatic comorbidity or gentuzumab use and disease status beyond CR1 as the only significant factors predictive of VOD/SOS incidence (OR = 6.6; p = 0.001 and OR = 3.3; p = 0.004 respectively). VOD/SOS-related MOF was widely under-reported, accounting for 27% of deaths attributed to MOF of unknown origin without a previous VOD/SOS diagnosis. Our results suggest most missed cases developed late VOD/SOS beyond 21 days post-alloHCT, highlighting the importance of the newly revised EBMT criteria.

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Metadata last modified: 11 Oct 2021 13:10

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