Sousa-Pimenta Mário, Martins Ângelo, Estevinho Letícia M, Pinho Vaz Carlos, Leite Luís, Mariz José
Department of Hematology and Bone Marrow Transplantation, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal.
i3S-Instituto de Investigação e Inovação em Saúde da Universidade do Porto, 4200-135 Porto, Portugal.
J Clin Med. 2024 Nov 17;13(22):6917. doi: 10.3390/jcm13226917.
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. : This study aims to systematize the impact of different approaches as primary prophylaxes against SOS/VOD in patients undergoing hematopoietic stem cell transplantation (HSCT). : 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 I method and the efficacy of each approach was estimated by SUCRA (surface under the cumulative ranking curve). : 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]. : 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.
肝窦阻塞综合征/静脉闭塞性疾病（SOS/VOD）是造血干细胞移植后的一种主要并发症，由肝窦内皮的免疫和化学毒性以及肝细胞损伤引起。在最严重的情况下，会发生多器官功能障碍，因此及时识别SOS/VOD风险较高的患者并采取预防策略至关重要。本研究旨在系统评估不同方法作为造血干细胞移植（HSCT）患者SOS/VOD一级预防措施的效果。对评估SOS/VOD一级预防不同策略的随机临床试验进行了系统评价和荟萃分析，采用两两比较的方式，并构建了一致的网络结构。使用随机效应模型计算比值比（OR）和相应的置信区间。通过I²方法评估异质性，并通过累积排名曲线下面积（SUCRA）估计每种方法的疗效。在所有接受HSCT的患者中，熊去氧胆酸（UDCA）[OR = 0.38，95%CI 0.14 - 1.06，SUCRA = 0.720]与VOD发生率较低相关，而去纤苷可使其发生率适度降低[OR = 0.64，95%CI 0.23 - 1.67；SUCRA = 0.486]。在接受造血祖细胞同种异体移植的患者亚组中，与UDCA[OR = 0.53，95%CI（0.14 - 1.96），SUCRA = 0.639]相比，去纤苷得分更高[OR = 0.51，95%CI（0.0九 - 2.85），SUCRA = 0.650]。这是第一项比较SOS/VOD一级预防措施的荟萃分析。在考虑所有接受造血干细胞移植的患者时，UDCA产生了更有前景的结果，然而，在接受同种异体移植患者的亚组分析中，去纤苷并未显著超过它。
