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Advisor(s)
Abstract(s)
Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD)
is a major complication following hematopoietic stem cell transplantation, resulting from immune
and chemical toxicity in the sinusoidal endothelium and hepatocellular damage. In the most severe
cases, multiorgan dysfunction occurs, so it is essential to promptly identify patients at greater risk
of SOS/VOD and to adopt prophylactic strategies. Objectives: This study aims to systematize the
impact of different approaches as primary prophylaxes against SOS/VOD in patients undergoing
hematopoietic stem cell transplantation (HSCT). Methods: A systematic review and meta-analysis of
randomized clinical trials evaluating different strategies for primary prophylaxis of SOS/VOD was
carried out in pairwise fashion and with a consistent network structure. The odds ratio (OR) and corresponding
confidence intervals were calculated using the random-effects model. Heterogeneity was
assessed by the I2 method and the efficacy of each approach was estimated by SUCRA (surface under
the cumulative ranking curve). Results: Considering all patients undergoing HSCT, ursodeoxycholic
acid (UDCA) [OR = 0.38, 95%CI 0.14–1.06, SUCRA = 0.720] was associated with a lower incidence
of VOD while defibrotide reached a modest reduction in its incidence [OR = 0.64, 95%CI 0.23–1.67;
SUCRA = 0.486]. Considering the subgroup of patients undergoing hematopoietic progenitors
allotransplantation, defibrotide scored higher [OR = 0.51, 95%CI 0.09–2.85, SUCRA = 0.650] by comparison
with UDCA [OR = 0.53, 95%CI 0.14–1.96, SUCRA = 0.639]. Conclusions: This is the first
meta-analysis comparing primary prophylaxes against SOS/VOD. UDCA yielded more promising
results when considering all patients undergoing hematopoietic stem cell transplantation, yet, in
a subgroup analysis of the ones exposed to allogeneic grafts, it becomes not significantly overrun
by defibrotide.
Description
Keywords
Hematopoietic stem cell transplantation Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) Prophylaxis Ursodeoxycholic acid Defibrotide Heparin Fresh frozen plasma
Pedagogical Context
Citation
Sousa-Pimenta, Mário; Martins, Ângelo; Estevinho, Letícia M.; Vaz, Carlos Pinho; Leite, Luís; Mariz, José (2024). Hepatic Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease (SOS/VOD) Primary Prophylaxis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Network Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine. ISSN 2077-0383. 13:22, p. 1-14
Publisher
MDPI