Sinusoidal obstructive syndrome associated with inotuzumab
| Diagnosis (new EBMT criteria18 ) . | Prevention . | Treatment . |
|---|---|---|
| Within 21 d from HCT | Avoid double alkylator for conditioning regimen with HCT | Permanent discontinuation of inotuzumab if occurs while on therapy |
| Bilirubin ≥2 mg/dL along with 2 of the following: (1) painful hepatomegaly, (2) weight gain >5%, and (3) ascites | Avoid treatment with >2 cycles of inotuzumab if planning HCT after induction | Supportive therapy for fluid balance and pain control |
| Late onset >21 d after HCT | Avoid concomitant hepatotoxic medication use (eg, azoles) | Paracentesis if respiratory compromise due to ascites |
| Symptoms as the criteria above | Encourage use of prophylactic agents, such as ursodiol during HCT | Limit fluid removal with paracentesis to <1 L to avoid disruption of renal perfusion |
| Histological diagnosis of SOS | Defibrotide for severe SOS | |
| Two of the above criteria along with hemodynamic and/or ultrasound evidence of SOS |
| Diagnosis (new EBMT criteria18 ) . | Prevention . | Treatment . |
|---|---|---|
| Within 21 d from HCT | Avoid double alkylator for conditioning regimen with HCT | Permanent discontinuation of inotuzumab if occurs while on therapy |
| Bilirubin ≥2 mg/dL along with 2 of the following: (1) painful hepatomegaly, (2) weight gain >5%, and (3) ascites | Avoid treatment with >2 cycles of inotuzumab if planning HCT after induction | Supportive therapy for fluid balance and pain control |
| Late onset >21 d after HCT | Avoid concomitant hepatotoxic medication use (eg, azoles) | Paracentesis if respiratory compromise due to ascites |
| Symptoms as the criteria above | Encourage use of prophylactic agents, such as ursodiol during HCT | Limit fluid removal with paracentesis to <1 L to avoid disruption of renal perfusion |
| Histological diagnosis of SOS | Defibrotide for severe SOS | |
| Two of the above criteria along with hemodynamic and/or ultrasound evidence of SOS |
EBMT, European Society for Blood and Marrow Transplantation; HCT, allogeneic stem cell transplantation.