Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study |
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Authors: | Antonio Colecchia Federico Ravaioli Mariarosaria Sessa Vanessa Luigina Alemanni Elton Dajti Giovanni Marasco Amanda Vestito Rocco Maurizio Zagari Francesco Barbato Mario Arpinati Michele Cavo Davide Festi Francesca Bonifazi |
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Institution: | 1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy;2. Gastroenterology Unit, Borgo Trento University Hospital, Verona, Italy;3. Institute of Hematology L. and A Seràgnoli, Sant''Orsola Malpighi University Hospital, Bologna, Italy |
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Abstract: | Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a life-threatening complication affecting patients undergoing hematopoietic stem cell transplantation (HSCT). The survival rate is higher when specific therapy is initiated early; thus, improving early, noninvasive diagnosis of VOD/SOS is an important need. In an adult population undergoing HSCT, we aimed to assess the role of liver stiffness measurement (LSM), evaluated by transient elastography (TE), for diagnosing VOD/SOS. Between April 2016 and March 2018, 78 consecutive adult patients with indications for allogeneic HSCT were prospectively included. LSM was performed before HSCT and at days +9/10, +15/17, and +22/24 post-HSCT. New European Society for Blood and Marrow Transplantation criteria were used to establish VOD/SOS diagnosis. Four patients developed VOD/SOS (5.1%) during the study period, with a median time of +17 days post-HSCT. A sudden increase in LSM compared with previously assessed values and pre-HSCT values, was seen in all patients who developed VOD/SOS. LSM increases occurred from 2 to 12 days before clinical SOS/VOD appearance. The VOD/SOS diagnostic performance of increased LSM over pre-HSCT assessment showed an area under the receiver operating characteristic curve of 0.997 (sensitivity 75%; specificity 98.7%). LSM gradually decreased following successful VOD/SOS-specific treatment. Interestingly, LSM values did not increase significantly in patients experiencing hepatobiliary complications (according to the Common Terminology Criteria) other than VOD/SOS. LSM by TE can be considered a promising method to perform an early, preclinical diagnosis and follow-up of VOD/SOS. |
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Keywords: | Correspondence and reprint requests: Antonio Colecchia MD Department of Medical and Surgical Sciences University of Bologna Bologna 40138 Italy Gastroenterology Unit Borgo Trento University Hospital Verona 37100 Italy Hepatic veno-occlusive disease Elastography Sinusoidal obstruction syndrome Ultrasound FibroScan Ultrasonography |
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