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Reduced Risk of Sinusoidal Obstruction Syndrome of the Liver after Busulfan-Cyclophosphamide Conditioning Prior to Allogeneic Hematopoietic Stem Cell Transplantation
Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden;Port Said Univ, Dept Biochem, Fac Med, Port Said, Egypt.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala Univ Hosp, KFUE, Uppsala, Sweden.
Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden;Karolinska Univ Hosp, Cell Therapies & Allogene Stem Cell Transplantat, Stockholm, Sweden.
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(English)In: Clinical and Translational Science, ISSN 1752-8054, E-ISSN 1752-8062Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this study is to evaluate the incidence of sinusoidal obstruction syndrome (SOS) of the liver and the clinical outcome after hematopoietic stem cell transplantation (HSCT) based on several modifications in our protocols. We retrospectively investigated 372 patients undergoing myeloablative conditioning with oral busulfan (Bu) and cyclophosphamide before allogeneic HSCT during 1990-2015. Patients' supportive care was changed in order to reduce the regimen-related toxicities. Norethisterone use was terminated in 1998, therapeutic drug monitoring of Bu was initiated in 2000, and the use of liver supportive drugs, such as ursodeoxycholic acid and N-acetyl-L-cysteine, were started in 2002 and 2009, respectively. In total, 26 patients (7.0%) developed SOS at a median of 19 days after transplantation. Of these 26 patients, 20 died at a median of 119 days after HSCT and 102 days after the diagnosis of SOS. The incidence of SOS decreased over time in accordance with the improvements in supportive care. The highest incidence of SOS was during 1995-1999 (16.2%) compared with 2.3% during 2010-2015. Overall survival for patients with SOS was 62%, 46%, and 27% at 100 days, 1 year, and 5 years after HSCT, respectively, compared with 92%, 77%, and 66% for those who did not develop SOS (P < 0.001). In conclusion, the incidence of SOS and related deaths were significantly decreased over the last years. Our institution pursues massive preventative and personalized measures for SOS. This strategy may also be applicable in other conditioning protocols in order to reduce the incidence of SOS and, hence, improve the clinical outcome.

Place, publisher, year, edition, pages
WILEY.
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Hematology
Identifiers
URN: urn:nbn:se:uu:diva-397777DOI: 10.1111/cts.12709ISI: 000494577400001PubMedID: 31675173OAI: oai:DiVA.org:uu-397777DiVA, id: diva2:1374288
Funder
Swedish Cancer SocietySwedish Research Council, 2016-00516Swedish Research Council, 2017-00355Swedish Childhood Cancer Foundation, PR2013-0022Swedish Childhood Cancer Foundation, KF2013-0011Marianne and Marcus Wallenberg FoundationStockholm County Council
Note

De två första författarna delar förstaförfattarskapet.

Available from: 2019-11-29 Created: 2019-11-29 Last updated: 2019-11-29

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