PMID- 29895929
OWN - NLM
STAT- MEDLINE
DCOM- 20200122
LR  - 20200129
IS  - 1476-5365 (Electronic)
IS  - 0268-3369 (Linking)
VI  - 54
IP  - 1
DP  - 2019 Jan
TI  - Hepatic veno-occlusive disease following sirolimus-based immune suppression.
PG  - 85-89
LID - 10.1038/s41409-018-0233-2 [doi]
AB  - Sirolimus-based graft vs. host disease (GVHD) prophylaxis is associated with 
      higher incidence of veno-occlusive disease/sinusoidal obstruction syndrome 
      (VOD/SOS) after allogeneic hematopoietic cell transplantation (HCT). However, 
      whether the clinical manifestations and prognosis of VOD/SOS differs when 
      diagnosed in the setting of sirolimus-based GVHD prophylaxis is not well studied. 
      To address this question, we examined presenting features and treatment outcome 
      of VOD/SOS cases identified in a large retrospective cohort of consecutive HCT 
      procedures (n = 818 total, sirolimus (SIR)/tacrolimus (TAC) n = 308, and 
      methotrexate (MTX) or mycophenolate mofetil (MMF)/TAC n = 510). In multivariate 
      analysis, sirolimus-based GVHD prophylaxis (p = 0.006, HR 3.33, 1.94-5.7) 
      increased risk for VOD/SOS. A total of 58 patients were clinically diagnosed with 
      VOD/SOS (SIR/TAC 38/308, 12.3%, vs. MTX or MMF/TAC 20/510, 3.9%). VOD/SOS 
      diagnosed following SIR/TAC prophylaxis demonstrated later time of onset (median 
      39 vs. 26 days; p = 0.005), less severe hyperbilirubinemia (Bili > 2, 65% vs. 90% 
      p = 0.04), lesser degree of weight gain (weight gain > 5%, 52% vs 80%, p = 0.04), 
      and more frequent complete resolution of hepatic injury (79% vs. 55%, p = 0.05). 
      Presenting features and natural history of VOD/SOS in the context of SIR/TAC GVHD 
      prophylaxis differ and thus warrant particular clinical attention to later 
      hepatic injury in these patients.
FAU - Khimani, Farhad
AU  - Khimani F
AD  - BMTCI H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA. 
      Farhad.Khimani@moffitt.org.
FAU - McDonald, George B
AU  - McDonald GB
AD  - GI/Hepatology, Fred Hutchinson Cancer Research Center, Seattle, USA.
FAU - Shulman, Howard M
AU  - Shulman HM
AD  - Pathology, University of Washington, Seattle, USA.
FAU - Betts, Brian
AU  - Betts B
AUID- ORCID: 0000-0001-7643-2422
AD  - BMTCI H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
FAU - Locke, Frederick
AU  - Locke F
AD  - BMTCI H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
FAU - Fernandez, Hugo
AU  - Fernandez H
AD  - Moffitt Malignant Hematology and Cellular Therapy, Memorial Healthcare System, 
      Florida, USA.
FAU - Anasetti, Claudio
AU  - Anasetti C
AD  - BMTCI H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
FAU - Pidala, Joseph
AU  - Pidala J
AD  - BMTCI H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Observational Study
DEP - 20180612
PL  - England
TA  - Bone Marrow Transplant
JT  - Bone marrow transplantation
JID - 8702459
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Allografts
MH  - Female
MH  - *Graft vs Host Disease/blood/epidemiology/prevention & control
MH  - *Hematopoietic Stem Cell Transplantation
MH  - *Hepatic Veno-Occlusive Disease/blood/chemically induced/epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Sirolimus/administration & dosage/*adverse effects
EDAT- 2018/06/14 06:00
MHDA- 2020/01/23 06:00
CRDT- 2018/06/14 06:00
PHST- 2018/03/26 00:00 [received]
PHST- 2018/04/30 00:00 [accepted]
PHST- 2018/04/20 00:00 [revised]
PHST- 2018/06/14 06:00 [pubmed]
PHST- 2020/01/23 06:00 [medline]
PHST- 2018/06/14 06:00 [entrez]
AID - 10.1038/s41409-018-0233-2 [pii]
AID - 10.1038/s41409-018-0233-2 [doi]
PST - ppublish
SO  - Bone Marrow Transplant. 2019 Jan;54(1):85-89. doi: 10.1038/s41409-018-0233-2. 
      Epub 2018 Jun 12.