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Low-dose unfractionated heparin prophylaxis is a safe strategy for the prevention of hepatic sinusoidal obstruction syndrome after myeloablative adult allogenic stem cell transplant.
Sola, Maria; Bhatt, Valkal; Palazzo, Meighan; Cavalier, Kathleen E; Devlin, Sean M; Maloy, Molly; Barker, Juliet N; Castro-Malaspina, Hugo; Chung, David; Dahi, Parastoo B; Jakubowski, Ann A; Landau, Heather; Papadopoulos, Esperanza B; Perales, Miguel-Angel; Sauter, Craig; Tamari, Roni; Kernan, Nancy A; Giralt, Sergio; Young, James W; Goldberg, Jenna D; Ponce, Doris M.
Affiliation
  • Sola M; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Bhatt V; Hematology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain.
  • Palazzo M; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Cavalier KE; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Devlin SM; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Maloy M; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Barker JN; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Castro-Malaspina H; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Chung D; Weill Cornell Medical College, New York, NY, USA.
  • Dahi PB; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Jakubowski AA; Weill Cornell Medical College, New York, NY, USA.
  • Landau H; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Papadopoulos EB; Weill Cornell Medical College, New York, NY, USA.
  • Perales MA; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Sauter C; Weill Cornell Medical College, New York, NY, USA.
  • Tamari R; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Kernan NA; Weill Cornell Medical College, New York, NY, USA.
  • Giralt S; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Young JW; Weill Cornell Medical College, New York, NY, USA.
  • Goldberg JD; Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Ponce DM; Weill Cornell Medical College, New York, NY, USA.
Bone Marrow Transplant ; 57(7): 1095-1100, 2022 07.
Article in En | MEDLINE | ID: mdl-35477992
ABSTRACT
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.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hepatic Veno-Occlusive Disease / Heparin / Hematopoietic Stem Cell Transplantation / Anticoagulants Type of study: Diagnostic_studies / Etiology_studies Limits: Adult / Humans Language: En Journal: Bone Marrow Transplant Journal subject: TRANSPLANTE Year: 2022 Document type: Article Affiliation country: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hepatic Veno-Occlusive Disease / Heparin / Hematopoietic Stem Cell Transplantation / Anticoagulants Type of study: Diagnostic_studies / Etiology_studies Limits: Adult / Humans Language: En Journal: Bone Marrow Transplant Journal subject: TRANSPLANTE Year: 2022 Document type: Article Affiliation country: United States