Defibrotide Prophylaxis of Sinusoidal Obstruction Syndrome in Adults Treated With Inotuzumab Ozogamicin Prior to Hematopoietic Stem Cell Transplantation

• DOI: 10.3389/fonc.2022.933317
• Publication Date: 2022-06-15T05:36:35Z
• Authors: Fabio Giglio; Elisabetta Xue; Raffaella Greco; Lorenzo Lazzari; Daniela Teresa Cl...; Francesca Lorentino; Sara Mastaglio; Sarah Marktel; Maria Teresa Lupo...; Magda Marcatti; Consuelo Corti; Massimo Bernardi; Simona Piemontese; Fabio Ciceri; Jacopo Peccatori
• Keywords: Defibrotide; Treosulfan; ThioTEPA; Hepatic veno-occlusive disease

Sinusoidal Obstruction Syndrome (SOS) is a life threatening HSCT complication and it can rapidly evolve in Multiple Organ Dysfunction Syndrome, with mortality exceeding 80%. Early treatment defibrotide the leading factor for efficacy. Its prophylactic use recommended pediatric setting, but its value isn't validated adults, although factors individual risk assessment are debated. We here present real-world experience of Defibrotide prophylaxis adults at very high SOS. treated Ursodeoxycholic Acid seven patients receiving allogeneic B-ALL, previously single agent Inotuzomab-Ozogamicin. They all had other SOS such as previous hepatotoxicity, allo-HSCT, double alkylating conditioning. All received Treosulfan-Fludarabine conditioning, Thiotepa was added 4 4GyTBI 2 patients. GvHD included post-transplant cyclophosphamide, rapamycin mycophenolate. Donor source PBSC. Five family MMRD transplant, 1 patient MRD transplant MUD transplant. Non-severe gastrointestinal bleeding occurred two requiring temporarily discontinuation. 3/7 cases within 21 days after no late-onset were diagnosed. caused death cases. three characterized by common pattern prior HSCT, they myeloablative conditioning Treosulfan-Thiotepa apparently failed to protect against development those alkylator-based regimen, while possible efficacy high-risk debatable.