Four-drug Combination Therapy for Venous Occlusive Disease Prophylaxis after Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Hepatic sinusoidal occlusion syndrome (SOS) or venous occlusive disease (VOD) is a frequent complication of allogeneic Hematopoietic stem cell transplantation (allo-HSCT). The mortality rate of patients with severe VOD is extremely high. It is of utmost importance to explore practical ways to reduce the incidence of VOD. The present study aimed to evaluate the efficacy and safety of a prophylaxis strategy involving the combined use of prostaglandin E1 (PGE1), dalteparin, low molecular weight glucan dextran (LMWD), and ursodeoxycholic acid (UDCA). We conducted a single-center retrospective clinical observation of 225 patients who received allo-HSCT for hematological disorders between 2008 and 2022, all of whom received these four medicines for VOD. These 225 patients were within the age range of 6-58 years, and their donors were classified as related donors (75.5%) and unrelated donors (24.5%). All patients underwent a myeloablative conditioning regimen prior to transplantation. Each patient possessed at least one risk factor for VOD, and 167 (74.2%) cases were deemed to be at high risk. Ultimately, only two patients developed VOD, with an incidence of only 0.89%, of whom one was late-onset VOD. The bleeding rate was 32.9%, with predominantly grade 1-2 (93.2%). The incidence of bleeding aligns with findings reported in other literature. Remarkably, the mortality rate associated with bleeding during transplantation was a mere 1.8%, significantly lower than the average. The results of the study demonstrated the effectiveness and safety of the four PGE1-based medications in the prevention of VOD after allo-HSCT.