Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Transplant Cell Ther. 2022 Nov;28(11):779.e1-779.e9. doi: 10.1016/j.jtct.2022.08.013. Epub 2022 Aug 19.
Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is one of the most serious complications to occur early after allogeneic hematopoietic cell transplantation (HCT). However, detailed data on VOD/SOS after cord blood transplantation (CBT) are not available. The objective of this retrospective study was to evaluate the incidence, risk factors, and clinical impact of VOD/SOS after single-unit unrelated CBT for adult patients at our institution. We retrospectively evaluated the incidence, risk factors, and outcomes of VOD/SOS after 390 single-unit unrelated CBTs performed in 332 adults under a prophylactic strategy of ursodeoxycholic acid (UDCA) and i.v. heparin at our institution between 1998 and 2021. VOD/SOS was observed in 24 of the 390 CBTs. The cumulative incidence of VOD/SOS was 5.9% at 30 days and 6.2% at 100 days after CBT. Multivariate analysis showed that cryopreserved CD34 cell dose ≥1.0 × 10/kg was significantly associated with a decreased risk of VOD/SOS after CBT (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.12 to 0.91; P = .032). In multivariate analysis, the development of VOD/SOS was significantly associated with higher overall mortality (HR, 6.19; 95% CI, 3.61 to 10.65; P < .001), treatment failure (HR, 4.79; 95% CI, 2.95 to 7.76; P < .001), and nonrelapse mortality (HR, 12.60; 95% CI, 6.90 to 23.00; P < .001). Our study shows that the incidence of hepatic VOD/SOS was relatively low after unrelated single-unit CBT under a prophylactic strategy of UDCA and i.v. heparin. A higher cryopreserved cord blood CD34 cell dose was associated with a reduction in VOD/SOS, suggesting that selection of a higher cord blood unit CD34 cell dose could be efficient in preventing hepatic VOD/SOS in adults undergoing single-unit CBT.
肝静脉闭塞病（VOD），也称为窦状隙阻塞综合征（SOS），是异基因造血细胞移植（HCT）后早期最严重的并发症之一。然而，关于脐带血移植（CBT）后 VOD/SOS 的详细数据尚不可用。本回顾性研究的目的是评估我们机构中成人单份无关供体 CBT 后 VOD/SOS 的发生率、危险因素和临床影响。我们回顾性评估了 1998 年至 2021 年期间，我们机构在预防用熊去氧胆酸（UDCA）和静脉肝素的方案下，对 332 例成人进行的 390 例单份无关供体 CBT 后 VOD/SOS 的发生率、危险因素和结局。在 390 例 CBT 中有 24 例发生了 VOD/SOS。CBT 后 30 天和 100 天的 VOD/SOS 累积发生率分别为 5.9%和 6.2%。多变量分析显示，冷冻保存的 CD34 细胞剂量≥1.0×10/kg 与 CBT 后 VOD/SOS 风险降低显著相关（风险比 [HR]，0.33；95%置信区间 [CI]，0.12 至 0.91；P=0.032）。多变量分析显示，VOD/SOS 的发生与更高的总死亡率（HR，6.19；95%CI，3.61 至 10.65；P<0.001）、治疗失败（HR，4.79；95%CI，2.95 至 7.76；P<0.001）和非复发死亡率（HR，12.60；95%CI，6.90 至 23.00；P<0.001）显著相关。我们的研究表明，在预防用 UDCA 和静脉肝素的方案下，成人接受单份无关供体 CBT 后，肝 VOD/SOS 的发生率相对较低。冷冻保存的脐带血 CD34 细胞剂量较高与 VOD/SOS 减少相关，提示在接受单份 CBT 的成人中，选择较高的脐带血单位 CD34 细胞剂量可能有效预防肝 VOD/SOS。
