title: Hepatic sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation in adult patients with idiopathic aplastic anemia.
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/m(2) 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.
authors.affiliation: Divison of Hematology and Hematological Malignancies, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
authors.forename: Chul Won
authors.initials: CW
authors.lastname: Jung
authors.forename: Young Don
authors.initials: YD
authors.lastname: Joo
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Byung Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Jung Hye
authors.initials: JH
authors.lastname: Choi
authors.forename: Jae-Yong
authors.initials: JY
authors.lastname: Kwak
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Sung Hwa
authors.initials: SH
authors.lastname: Bae
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Won
authors.forename: Sukjoong
authors.initials: S
authors.lastname: Oh
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Jae-Hoo
authors.initials: JH
authors.lastname: Park
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: Allogeneic hematopoietic stem cell transplantation; Aplastic anemia; Sinusoidal obstruction syndrome; Veno-occlusive disease