Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
Department of Leukemia, MD Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2019 Jul;25(7):1271-1280. doi: 10.1016/j.bbmt.2019.02.018. Epub 2019 Feb 22.
Veno-occlusive disease, also known as sinusoidal obstruction syndrome (VOD/SOS), is a potentially life-threatening complication of allogeneic or autologous hematopoietic stem cell transplantation (HSCT) most commonly associated with high-intensity chemotherapies. The development of VOD/SOS may be rapid and unpredictable, and the importance of identifying risk factors to facilitate prompt diagnosis and timely treatment has become increasingly recognized. The reporting of new retrospective study data for adults and children and the emergence of novel anticancer therapies that may increase the risk of VOD/SOD also necessitate updates on risk factors, as provided in this review. The latest studies reporting VOD/SOS risk factors support previously published data, although the importance of patient-related factors, such as acute kidney injury, increased international normalized ratio, female sex (in children), and platelet refractoriness, is given greater emphasis in the recent data. Non-transplantation-related chemotherapies associated with increased risk for VOD/SOS include oxaliplatin and 5-fluorouracil chemotherapies. The novel antibody drug conjugates gemtuzumab ozogamicin and inotuzumab ozogamicin are now reported in product labeling to pose risks for VOD/SOS based on clinical trial data; an expert consensus panel has issued recommendations for risk reduction measures with inotuzumab ozogamicin treatment, including VOD/SOS prophylaxis and limitation to ≤2 inotuzumab ozogamicin treatment cycles. A wide range of biomarkers, including genetic, hematologic, hepatic, and inflammatory factors, as well as novel diagnostic techniques such as thromboelastography and measures of liver stiffness, may further enhance future risk calculation for VOD/SOS, although none has been widely adopted. Continual monitoring for and recognition of VOD/SOS risk factors are essential for optimal management of this complication.
静脉闭塞病，又称窦状隙阻塞综合征（VOD/SOS），是一种异基因或自体造血干细胞移植（HSCT）的潜在致命并发症，最常与高强度化疗相关。VOD/SOS 的发展可能迅速且不可预测，因此越来越认识到识别风险因素以促进快速诊断和及时治疗的重要性。新的回顾性研究数据在成人和儿童中的报告以及可能增加 VOD/SOD 风险的新型抗癌疗法的出现，也需要对风险因素进行更新，本综述提供了相关内容。最新报告的 VOD/SOS 风险因素的研究支持先前发表的数据，尽管患者相关因素（如急性肾损伤、国际标准化比值升高、女性（儿童）和血小板反应性降低）的重要性在最近的数据中得到了更多的强调。与 VOD/SOS 风险增加相关的非移植相关化疗包括奥沙利铂和氟尿嘧啶化疗。新型抗体药物偶联物 gemtuzumab ozogamicin 和 inotuzumab ozogamicin 现根据临床试验数据被报告在产品标签中存在 VOD/SOS 风险；一个专家共识小组发布了有关 inotuzumab ozogamicin 治疗的风险降低措施的建议，包括 VOD/SOS 预防和限制 inotuzumab ozogamicin 治疗周期数≤2。一系列生物标志物，包括遗传、血液、肝脏和炎症因素，以及新型诊断技术，如血栓弹力图和肝脏硬度测量，可能进一步增强未来 VOD/SOS 的风险计算，尽管尚未广泛采用。持续监测和识别 VOD/SOS 风险因素对于这种并发症的最佳管理至关重要。
