Sinusoid obstruction syndrome

List the nonhematologic toxicity to high-dose chemotherapy used in myeloablative preparative regimens, specifically busulfan-induced seizures, hemorrhagic cystitis, gastrointestinal toxicities, and sinusoidal obstruction syndrome. 

Kumar, S., Deleve, L.D., Kamath, P.S., Tefferi, A. Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoetic stem cell transplantation (review). Mayo CHn. Proc. 2003 78 589-598... 

In 66 patients who received busulfan in combination with cyclophosphamide, etoposide, and/or cytarabine in preparation for bone marrow transplantation, there was a higher incidence of veno-occlusive disease of the liver (sinusoidal obstruction syndrome) in those who received busulfan + cyclophosphamide (four of 10) than in those who received busulfan + cyclophosphamide + cytarabine (one of 18) or busulfan + cyclophosphamide + etoposide (seven of 38) (24). The risk of veno-occlusive disease was higher in those whose busulfan AUC was over 1500 minute.pmol/l (relative risk = 11). Other pharmacokinetic parameters, age, sex, type of bone marrow transplantation, previous therapy, or pretransplant liver function tests were not predictive of veno-occlusive disease. 

A patient developed acute sinusoidal obstruction syndrome after taking tioguanine for 14 months for Crohn s disease (6). 

Kane S, Cohen SM, Hart J. Acute sinusoidal obstruction syndrome after 6-thioguanine therapy for Crohn s disease. Inflamm Bowel Dis 2004 I0(5) 652-4. 

Evidence of toxicity may not become apparent until some time after the alkaloid is ingested. The acute illness has been compared to the most common pro-thrombotic disorders that lead to Budd-Chiari syndrome, portal vein thrombosis, and sinusoidal obstruction syndrome, previously known as hepatic veno-occlusive disease of... 

Sinusoidal obstruction syndrome (veno-occlusive disease) has been reported in a patient receiving bevacizumab for metastatic colorectal cancer [195" ]. Venous thromboembolism in general has been reported to occur with a higher incidence during bevacizumab treatment [196 ]. 

Liver veno occlusive disease, recently defined as sinusoid obstruction syndrome (SOS), may develop in the first 40 days after transplantation as a consequence of a high-dose conditioning regimen. Prior liver disease predisposes to this complication which manifests as cholestasis and fluid retention secondary to portal hypertension and renal dysfunction. Current treatment of SOS consists of fluid restriction, diuretics, and defibrotide. Although transiently severe, the evolution is favorable in most cases. 

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