Allogeneic hematopoietic SCT for adults AML using i.v. BU in the conditioning regimen: outcomes and risk factors for the occurrence of hepatic sinusoidal obstructive syndrome

Abstract

I.v. BU is frequently used in the conditioning regimen prior to allogeneic hematopoietic SCT (allo-HSCT); however, overall outcomes, incidence of hepatic sinusoidal obstructive syndrome (SOS) and its risk factors are not well known. With this aim, we performed a study on 257 AML adult recipients. Seattle Criteria were used for diagnosis and classification of SOS. The median age was 44 years. Donors were HLA-identical siblings in 60%, HLA-matched unrelated in 29% and HLA mismatched in 11%. Conditioning regimen was myeloablative in 84% (i.v. BU with CY was the most frequently used regimen) and it was reduced intensity in 16% (i.v. BU associated with fludarabine). Acute and chronic GVHD was observed in 28% and 44%, respectively. Two-year incidence of non-relapse mortality was 16±2% and 2-year leukemia-free survival for patients in CR1, CR2 and non remission at HSCT were 55±4%, 58±7%, and 20 ± 5%, respectively. At 6 months, incidence of SOS was 7.8 ± 2%; and it was severe in eight patients (3%). Factors associated with the occurrence of SOS were: HLA-mismatched donor HSCT (P ¼ 0.002) and patients transplanted in non-remission (P ¼ 0.002).In conclusion, outcomes of HSCT using i.v. BU are encouraging in this setting, SOS incidence is low and it is influenced by the type of donor and disease status at the time of transplant.

Toxicity and efficacy of busulfan and fludarabine myeloablative conditioning for HLA-identical sibling allogeneic hematopoietic cell transplantation in AML and MDS

“…compared with oral Bu, with RIC compared with MAC, and with BuFlu compared with BuCy conditioning. 43,44 The 1.5% early NRM found in our study confirms the low toxicity profile of this regimen. With BuFlu, early mortality can be reduced in patients with advanced age or disease status and even in heavily pretreated patients.…”

Efficiency of allogeneic hematopoietic SCT from HLA fully-matched non-sibling relatives: A new prospect of exploiting extended family search

“…40,[42][43][44][45][46] The overall rates of aGvHD and cGvHD in both malignant and non-malignant subsets were comparable with other studies applying sibling donors. [47][48][49][50] As one might predict, PBSC was accompanied with higher risk of cGvHD and aGvHD. Full and mixed chimerism was noted in 76% and 15% of recipients, respectively, while in 8% of patients, rejection occurred.…”

“…[51][52][53][54] Regarding the recent studies, outcomes of matched-other related HSCT in our study are comparable with matched-sibling donors. 47,55,56 It is noteworthy that our patients were mostly pediatric cases. The age factor may justify the overall favorable outcome of the transplant.…”

Prophylactic Danshen Injection Combined with Prostaglandin E1 and Low-dose Heparin may prevent Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation: A Single-center Study in China

“…VOD is more common after allogeneic HSCT (allo-HSCT) accompanied by amyeloablative conditioning regimen, or with unrelated/HLA-mismatched donors, compared with allo-HSCT with reduced intensity conditioning regimen and autologous HSCT (auto-HSCT) [2]. Busulfan, especially oral busulfan, combination with cyclophosphamideis associated with an increased risk of VOD [3]. Older age, impaired Karnofsky status (< 90) and advanced-stage disease have been reported asrisk factors for VOD.…”

“…The incidence of VOD is reported to range from 5% to 60% in adults and from 18% to 28% in children [1]. The risk factors for VOD include older age, advanced disease, conditioning regimen especially oral Busulfan regimen, HLA mismatched, unrelated donors, non-T-cell depleted graft and positive serology results for Cytomegalovirus (CMV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV) [2,3]. The mortality rate of VOD is nearly 50% [4].…”