Successful Treatment of Very Severe Sinusoidal Obstruction Syndrome After Gemtuzumab Ozogamicin With Transjugular Intrahepatic Portosystemic Shunt, Defibrotide, and High-Dose Corticosteroids: A Case Report.
Autor: | Thielemans N; Department of Clinical Hematology, Universitair Ziekenhuis Brussel, Brussels, BEL., De Beule N; Department of Clinical Hematology, Universitair Ziekenhuis Brussel, Brussels, BEL., Van den Bergh F; Department of Interventional Radiology, Universitair Ziekenhuis Brussel, Brussels, BEL., Lefesvre P; Department of Anatomopathology, Universitair Ziekenhuis Brussel, Brussels, BEL., De Becker A; Department of Clinical Hematology, Universitair Ziekenhuis Brussel, Brussels, BEL. |
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Jazyk: | angličtina |
Zdroj: | Cureus [Cureus] 2024 Aug 24; Vol. 16 (8), pp. e67682. Date of Electronic Publication: 2024 Aug 24 (Print Publication: 2024). |
DOI: | 10.7759/cureus.67682 |
Abstrakt: | Sinusoidal obstruction syndrome (SOS) is a rare but potentially life-threatening complication, usually described in the setting of hematopoietic stem cell transplantation (HSCT). The very severe forms have a high mortality rate (>80%) and need fast recognition and urgent treatment. In this case report, we describe a unique and successful treatment strategy. We present a 27-year-old patient with newly diagnosed CD33+ acute myeloid leukemia (AML). She was treated with induction chemotherapy (7+3 regimen) and gemtuzumab ozogamicin (GO). In the absence of other major risk factors, she developed a very severe SOS with multiple organ failure. She was successfully treated with the urgent insertion of a transjugular intrahepatic portosystemic shunt (TIPS), defibrotide, and high-dose corticosteroids. This case of successful treatment for very severe SOS supports a combination strategy involving the immediate mechanical reduction of portal hypertension through TIPS and drug-mediated inhibition of microvascular thrombosis. Furthermore, this case shows the need for an improved prevention strategy, including the identification of additional risk factors and biomarkers. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Thielemans et al.) |
Databáze: | MEDLINE |
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