Liver Injury after Autologous Hematopoietic Stem Cell Transplant: DILI and SOS
Introduction: Autologous Hematopoietic Stem Cell Transplant (AHCT) is an integral part of the treatment for many hematological and immunological diseases. However, the AHCT is associated with several complications, including liver diseases, such as sinusoidal obstruction syndrome (SOS), viral hepati...
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Veröffentlicht in: | Blood 2018-11, Vol.132 (Supplement 1), p.2161-2161 |
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Sprache: | eng |
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Zusammenfassung: | Introduction: Autologous Hematopoietic Stem Cell Transplant (AHCT) is an integral part of the treatment for many hematological and immunological diseases. However, the AHCT is associated with several complications, including liver diseases, such as sinusoidal obstruction syndrome (SOS), viral hepatitis, and sepsis-associated cholestasis. Drug-induced liver injury (DILI) is one of the most common and serious adverse drug side effects. This issue is particularly important in the context of high dose chemotherapy but it is still understudied. This study aims to determine the incidence of SOS and DILI among patients who underwent the autologous stem cell transplant.
Methods: A retrospective cohort study was conducted among all patients who had undergone an autologous stem cell transplant at the hospital of Universidade Federal da Bahia (UFBA), Brazil, from July 2010 to July 2017. Daily weight and clinical and laboratory data ̶ aminotransferases, alkaline phosphatase (ALP), gamaGT (GGT), and total bilirubin (TB) levels ̶ were collected from beginning of the conditioning regimen to D+21 post-transplant. SOS diagnosis was based on modified Seattle Criteria (2 of 3 of the following items during the first 21 days post-transplant: TB ≥ 2mg/dl, hepatomegaly or upper right quadrant abdominal pain, and weight gain above 2% of pre-transplant weight). SOS severity was based on EBMT criteria. The International Serious Adverse Events Consortium 2011 criteria was used for DILI diagnosis, considering any of the following: (1) hepatocellular DILI: ALT ≥ 5 x upper limit normal (ULN); (2) cholestatic DILI: ALP ≥ 2 x ULN, especially in patients with elevated GGT, and without bone-disease-related ALP elevation; (3) mixed DILI: ALT ≥ 3 x ULN and total bilirubin (TB) ≥ 2 x ULN. All patients with SOS were excluded for the DILI diagnosis. All statistics were calculated using SPSS v 20.0 (SPSS Inc). Descriptive analysis and chi-square were applied, and the alpha error was 5%. The study protocol was approved by the institutional review board.
Results: One hundred and seventy-five patients were included in the study. The mean age was 44.2 ± 15.4 years old, and 56.6% of patients (n= 99) were male. The main transplant indications were the following: multiple myeloma (55.4%, n= 97), lymphoma (36.0%, n= 63), acute myeloid leukemia (3.4%, n= 6), and germ cell tumor (3.4%, n= 6). Most patients presented aminotransferases (73.1%, n= 128) or ALP (44.0%, n= 77) elevations, but DILI incidence was |
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ISSN: | 0006-4971 1528-0020 |
DOI: | 10.1182/blood-2018-99-120015 |