Low-dose unfractionated heparin prophylaxis is a safe strategy for the prevention of hepatic sinusoidal obstruction syndrome after myeloablative adult allogenic stem cell transplant.

Adult Anticoagulants / administration & dosage Hematopoietic Stem Cell Transplantation / adverse effects Hemorrhage / etiology Heparin / administration & dosage Hepatic Veno-Occlusive Disease / diagnosis Humans Polydeoxyribonucleotides / therapeutic use Transplantation Conditioning / adverse effects Ursodeoxycholic Acid / therapeutic use

Journal

Bone marrow transplantation

ISSN: 1476-5365

Titre abrégé: Bone Marrow Transplant

Pays: England

ID NLM: 8702459

Informations de publication

Date de publication:
07 2022

Historique:

received: 30 06 2021

accepted: 13 04 2022

revised: 11 04 2022

pubmed: 29 4 2022

medline: 12 7 2022

entrez: 28 4 2022

Statut: ppublish

Résumé

Hepatic sinusoidal obstruction syndrome (SOS) is a serious complication after allogeneic stem cell transplantation (allo-HCT). However, there is no uniform consensus on the optimal strategy for SOS prevention. Ursodeoxycholic acid is the most used regimen, even though its administration is challenging in recipients unable to tolerate oral medication. Defibrotide was recently studied in a phase 3 trial, but enrollment was stopped early due to futility. Low-dose unfractionated heparin (UFH) is an alternative strategy. However, its efficacy is reputed but unproven increased risk of bleeding has not been fully established. We evaluated 514 adult allo-HCT recipients who received SOS prophylaxis with low-dose UFH. Bleeding complications occurred in 12 patients 2.3% of patients of which only 2 (0.4%) had significant grade 3 bleeding. Only 14 patients were diagnosed with hepatic SOS. Univariate analysis showed that day 100 SOS was higher in recipients of unmodified grafts when compared to CD34+ selected ex vivo T-cell depleted grafts (p ≤ 0.001), and patients with hepatitis B and/or C exposure pre-HCT (p = 0.028). Overall, UFH was well tolerated and associated with a low incidence of subsequent hepatic SOS. Low-dose UFH prophylaxis can be considered in select patients who cannot tolerate oral ursodiol.

Identifiants

DOI: 10.1038/s41409-022-01689-4 PMID: 35477992 PMC: PMC9271583

pubmed: 35477992

doi: 10.1038/s41409-022-01689-4

pii: 10.1038/s41409-022-01689-4

pmc: PMC9271583

mid: NIHMS1798371

doi:

Substances chimiques

Anticoagulants 0

Polydeoxyribonucleotides 0

Ursodeoxycholic Acid 724L30Y2QR

Heparin 9005-49-6

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1095-1100

Subventions

Organisme : NCI NIH HHS

ID : P01 CA023766

Pays : United States

Organisme : NCI NIH HHS

ID : P30 CA008748

Pays : United States

Informations de copyright

Références

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