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KMID : 0338420220370010179
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The Korean Journal of Internal Medicine
2022 Volume.37 No. 1 p.179 ~ p.189
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Influence of creatinine levels on survival in patients with veno-occlusive disease treated with defibrotide
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Kong Seom-Gim
Lee Je-Hwan
Lim Young-Tak
Lee Ji-Hyun
Eom Hyeon-Seok
Lee Hye-Won
Kim Do-Young
Lim Sung-Nam
Yoon Sung-Soo
Kim Sung-Yong
Lee Ho-Sup
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Abstract
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Background/Aims: Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is one of the most fatal complications of hematopoietic cell transplantation (HCT), and defibrotide is the only curative drug. We conducted this study to confirm the survival rate of VOD/SOS patients diagnosed in Korea and assess the efficacy of defibrotide.
Methods: Patients diagnosed with VOD/SOS after allogenic HCT between 2003 and 2020 were enrolled. We investigated day +100 survival rates and associated risk factors in patients who satisfied the modified Seattle criteria within 50 days of HCT.
Results: A total of 110 patients satisfied the modified Seattle criteria, of which 65.5% satisfied the Baltimore criteria. Thirty-seven patients were treated with defibrotide. The day +100 survival rate of the 110 patients was 65.3%. The survival rates in patients who did not meet the Baltimore criteria and in those who did were 86.8% and 53.7%, respectively (p = 0.001). The day +100 survival rate of patients treated with defibrotide was 50.5%. Among the patients receiving defibrotide, those whose creatinine levels were more than 1.2 times the baseline had a significantly lower survival rate at 26.7% (p = 0.014). On multivariate regression analysis, the hazard ratio of satisfaction of the Baltimore criteria was 4.54 (95% confidence interval [CI], 1.69 to 12.21; p = 0.003). In patients treated with defibrotide, the hazard ratio was 8.70 (95% CI, 2.26 to 33.45; p = 0.002), when creatinine was more than 1.2 times the baseline on administration.
Conclusions: The day +100 survival rate was significantly lower when the Baltimore criteria were satisfied, and when there was an increase in creatinine at the time of defibrotide administration.
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KEYWORD
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Hepatic veno-occlusive disease, Hematopoietic stem cell transplantation, Risk factors, Survival rate, Creatinine
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