Classical and Late‐Onset <scp>SOS</scp>/<scp>VOD</scp> After Allogeneic <scp>HSCT</scp>: A Japanese Transplant Registry Analysis

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a lethal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). According to the 2016 European Society for Blood and Marrow Transplantation criteria, SOS/VOD is classified into classical SOS/VOD and late-onset SOS/VOD, but their similarities and differences remain unclear. Here we retrospectively investigated the incidence, risk factors, and impact on transplant outcomes of classical and late-onset SOS/VOD in 16 518 allo-HSCT recipients using the Japanese nationwide registry data. The cumulative incidences of classical and late-onset SOS/VOD were 2.5% and 2.2%, with a median onset of 13 and 42 days after transplantation, respectively. Both patients with classical (hazard ratio [HR], 3.45; 95% CI, 3.07-3.87) and late-onset (HR, 3.98; 95% CI, 3.51-4.51) SOS/VOD had a significantly worse overall survival compared with those without. The risk factors for classical and late-onset SOS/VOD are different. Hepatic comorbidities, high-risk diseases, use of melphalan (MEL), and myeloablative conditioning are associated with both types of SOS/VOD. Whereas poor performance status, a prior history of transplantation, and positive hepatitis C virus are associated with only classical SOS/VOD, allo-HSCT from cord blood or related human leukocyte antigen-haploidentical donors, use of total body irradiation and busulfan (BU), and tacrolimus-based graft-versus-host disease prophylaxis are associated with only late-onset SOS/VOD. In particular, the incidence of late-onset SOS/VOD is much higher in patients receiving both BU- and MEL-containing conditioning regimens. These findings suggest that different monitoring and treatment approaches are necessary for allo-HSCT recipients at high risk for classical and late-onset SOS/VOD.

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Publication Details

Journal
American Journal of Hematology
Published
2025-05-19
DOI
https://doi.org/10.1002/ajh.27715
Citations
2
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
Field-Weighted Citation Impact
3.54

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article

Classical and Late‐Onset SOS/VOD After Allogeneic HSCT: A Japanese Transplant Registry Analysis

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Naonori Harada et al.
2 citations
American Journal of Hematology
Hematopoietic Stem Cell Transplantation
3.54
article

Classical and Late‐Onset SOS/VOD After Allogeneic HSCT: A Japanese Transplant Registry Analysis

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Naonori Harada, Masatoshi Sakurai, Kyoko Masuda, Kimikazu Yakushijin, Tetsuya Nishida, Hideki Nakasone, Shuichi Ota, Makoto Onizuka, Yuho Najima, Noriko Doki, Keisuke Kataoka, Satoshi Yoshihara, Shoko Ukita, Jun Ishikawa, Hiroyuki Ohigashi, Takahiro Fukuda, Masashi Sawa, Yoshiko Atsuta
article en
2 citations

Abstract

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a lethal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). According to the 2016 European Society for Blood and Marrow Transplantation criteria, SOS/VOD is classified into classical SOS/VOD and late-onset SOS/VOD, but their similarities and differences remain unclear. Here we retrospectively investigated the incidence, risk factors, and impact on transplant outcomes of classical and late-onset SOS/VOD in 16 518 allo-HSCT recipients using the Japanese nationwide registry data. The cumulative incidences of classical and late-onset SOS/VOD were 2.5% and 2.2%, with a median onset of 13 and 42 days after transplantation, respectively. Both patients with classical (hazard ratio [HR], 3.45; 95% CI, 3.07-3.87) and late-onset (HR, 3.98; 95% CI, 3.51-4.51) SOS/VOD had a significantly worse overall survival compared with those without. The risk factors for classical and late-onset SOS/VOD are different. Hepatic comorbidities, high-risk diseases, use of melphalan (MEL), and myeloablative conditioning are associated with both types of SOS/VOD. Whereas poor performance status, a prior history of transplantation, and positive hepatitis C virus are associated with only classical SOS/VOD, allo-HSCT from cord blood or related human leukocyte antigen-haploidentical donors, use of total body irradiation and busulfan (BU), and tacrolimus-based graft-versus-host disease prophylaxis are associated with only late-onset SOS/VOD. In particular, the incidence of late-onset SOS/VOD is much higher in patients receiving both BU- and MEL-containing conditioning regimens. These findings suggest that different monitoring and treatment approaches are necessary for allo-HSCT recipients at high risk for classical and late-onset SOS/VOD.

American Journal of HematologyVol. 100(8)
Tokai University (JP), Jichi Medical University (JP), Aichi Medical University (JP), Keio University (JP), Kanagawa Prefectural Hospital Organization (JP), Tokyo Metropolitan Komagome Hospital (JP), Keio University Hospital (JP), Sapporo Hokuyu Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), Hokkaido University Hospital (JP), Anjo Kosei Hospital (JP), Osaka International Cancer Institute (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Fuchu Hospital (JP), Jichi Medical University Saitama Medical Center (JP), Toranomon Hospital (JP), Kanagawa Cancer Center, Osaka Metropolitan University (JP), Kobe University (JP), Tokyo Metropolitan University (JP)
Amgen, Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Alexion Pharmaceuticals, Jazz Pharmaceuticals, Japan Blood Products Organization, Incyte, Nippon Shinyaku, Kyorin Pharmaceutical, JCR Pharmaceuticals, Eisai, Meiji Seika Pharma, Astellas Pharma, Shionogi, Otsuka Pharmaceutical, Teijin Pharma, Ono Pharmaceutical, SymBio Pharmaceuticals Limited, Novartis Pharma, Chugai Pharmaceutical, Daiichi Sankyo Europe
Good health and well-being
Openalex Percentile: Top 8%
Hematopoietic Stem Cell Transplantation
3.54
DOIOpen Access PDFOpenAlex
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