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. 2024 Mar 12;8(5):1128-1136.
doi: 10.1182/bloodadvances.2023011233.

Incidence and risk factors of early onset VOD/SOS differ in younger vs older adults after stem cell transplantation

Curtis Marcoux  1   2 , Rima M Saliba  1 , Whitney Wallis  1 , Sajad Khazal  3   4 , Dristhi Ragoonanan  3 , Gabriela Rondon  1 , Priti Tewari  3 , Uday Popat  1 , Betul Oran  1 , Amanda Olson  1 , Qaiser Bashir  1 , Muzaffar Qazilbash  1 , Amin Alousi  1 , Chitra Hosing  1 , Yago Nieto  1 , Gheath Alatrash  1 , David Marin  1 , Katayoun Rezvani  1 , Issa Khouri  1 , Samer Srour  1 , Richard Champlin  1 , Elizabeth Shpall  1 , Partow Kebriaei  1
Affiliations

Incidence and risk factors of early onset VOD/SOS differ in younger vs older adults after stem cell transplantation

Curtis Marcoux et al. Blood Adv. .

Abstract

Veno-occlusive disease (VOD) is a rare but potentially life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Although increasing awareness and modern transplant techniques have mitigated risk, the interaction of historic risk factors in the current era with posttransplant cyclophosphamide (PTCy) is unknown. We performed a retrospective single-center analysis of adult patients aged ≥18 years undergoing allo-SCT (N = 1561) using predominately PTCy as graft-versus-host disease (GVHD) prophylaxis (72%). We found a higher rate of VOD at 16.8% (20 of 119) in those aged ≤25 years compared with 3.8% (55 of 1442) in those aged >25 years, with unique predictors of VOD within each cohort. Multivariate classification and regression tree (CART) analysis confirmed age as the primary independent determinant of the rate of VOD. Among patients aged 18 to 25 years, disease risk index (DRI; 31% with high/very high DRI vs 12% low/intermediate DRI; P = .03) and prior lines of chemotherapy (24% with >1 vs 6% with ≤1; P = .03) were the strongest predictors of VOD. Incidence of VOD in patients aged >25 years of age consistently ranged between 3% and 5% across most risk factors evaluated, with only hepatic factors (baseline elevation of bilirubin, aspartate transferase, alanine aminotransferase) or gemtuzumab exposure associated with increased rates of VOD. There was no significant difference in rates of VOD in those receiving PTCy compared with those receiving alternate GVHD prophylaxis. Our data highlight the differences in incidence and predictors of VOD between younger (≤25) and older (>25) adults undergoing allo-SCT.

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Conflict of interest statement

Conflict-of-interest disclosure: P.K. reports consultancy for Pfizer and Jazz Pharmaceuticals. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Multivariate classification and regression tree (CART) analysis for VOD risk.
See this image and copyright information in PMC

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