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Clinicopathologic features of late-onset veno-occlusive disease/sinusoidal obstruction syndrome after high dose intravenous busulfan and hematopoietic cell transplant.
Leuk Lymphoma. 2012 Aug; 53(8):1552-7.LL

Abstract

Most cases of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) occur <21 days after allogeneic hematopoietic stem cell transplant (HCT). Rarely, however, VOD/SOS can occur later, and can be confused with other causes. We report the clinicopathologic features of eight patients with advanced hematologic malignancies developing VOD/SOS >30 days after dose-escalated busulfan/fludarabine/alemtuzumab and HCT. Median time to diagnosis was 52 days (range: 33-77). For seven patients, VOD/SOS was confirmed by liver biopsies showing classical features including reticulin deposition within sinusoids, central vein occlusions, hepatocyte atrophy/necrosis, sinusoidal/perivenular hemorrhage and sparing of portal tracts. VOD/SOS risk was directly related to higher busulfan plasma exposures. Two patients died from VOD/SOS, and in another two patients VOD/SOS was contributory to death. Late-onset VOD/SOS may be underrecognized and should be considered in the differential diagnosis of patients undergoing HCT, particularly after high dose busulfan. Liver biopsy should be entertained even late in the course if appropriate signs/symptoms exist.

Authors+Show Affiliations

Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22280517

Citation

Pai, Rish K., et al. "Clinicopathologic Features of Late-onset Veno-occlusive Disease/sinusoidal Obstruction Syndrome After High Dose Intravenous Busulfan and Hematopoietic Cell Transplant." Leukemia & Lymphoma, vol. 53, no. 8, 2012, pp. 1552-7.
Pai RK, van Besien K, Hart J, et al. Clinicopathologic features of late-onset veno-occlusive disease/sinusoidal obstruction syndrome after high dose intravenous busulfan and hematopoietic cell transplant. Leuk Lymphoma. 2012;53(8):1552-7.
Pai, R. K., van Besien, K., Hart, J., Artz, A. S., & O'Donnell, P. H. (2012). Clinicopathologic features of late-onset veno-occlusive disease/sinusoidal obstruction syndrome after high dose intravenous busulfan and hematopoietic cell transplant. Leukemia & Lymphoma, 53(8), 1552-7. https://doi.org/10.3109/10428194.2012.661052
Pai RK, et al. Clinicopathologic Features of Late-onset Veno-occlusive Disease/sinusoidal Obstruction Syndrome After High Dose Intravenous Busulfan and Hematopoietic Cell Transplant. Leuk Lymphoma. 2012;53(8):1552-7. PubMed PMID: 22280517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicopathologic features of late-onset veno-occlusive disease/sinusoidal obstruction syndrome after high dose intravenous busulfan and hematopoietic cell transplant. AU - Pai,Rish K, AU - van Besien,Koen, AU - Hart,John, AU - Artz,Andrew S, AU - O'Donnell,Peter H, Y1 - 2012/03/13/ PY - 2012/1/28/entrez PY - 2012/1/28/pubmed PY - 2012/12/12/medline SP - 1552 EP - 7 JF - Leukemia & lymphoma JO - Leuk. Lymphoma VL - 53 IS - 8 N2 - Most cases of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) occur <21 days after allogeneic hematopoietic stem cell transplant (HCT). Rarely, however, VOD/SOS can occur later, and can be confused with other causes. We report the clinicopathologic features of eight patients with advanced hematologic malignancies developing VOD/SOS >30 days after dose-escalated busulfan/fludarabine/alemtuzumab and HCT. Median time to diagnosis was 52 days (range: 33-77). For seven patients, VOD/SOS was confirmed by liver biopsies showing classical features including reticulin deposition within sinusoids, central vein occlusions, hepatocyte atrophy/necrosis, sinusoidal/perivenular hemorrhage and sparing of portal tracts. VOD/SOS risk was directly related to higher busulfan plasma exposures. Two patients died from VOD/SOS, and in another two patients VOD/SOS was contributory to death. Late-onset VOD/SOS may be underrecognized and should be considered in the differential diagnosis of patients undergoing HCT, particularly after high dose busulfan. Liver biopsy should be entertained even late in the course if appropriate signs/symptoms exist. SN - 1029-2403 UR - https://www.unboundmedicine.com/medline/citation/22280517/Clinicopathologic_features_of_late_onset_veno_occlusive_disease/sinusoidal_obstruction_syndrome_after_high_dose_intravenous_busulfan_and_hematopoietic_cell_transplant_ L2 - http://www.tandfonline.com/doi/full/10.3109/10428194.2012.661052 DB - PRIME DP - Unbound Medicine ER -