Korean J Intern Med.
2022 Jan;37(1):179-189. 10.3904/kjim.2021.178.
Influence of creatinine levels on survival in patients with veno-occlusive disease treated with defibrotide
- Affiliations
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- 1Department of Pediatrics, Kosin University College of Medicine, Busan, Korea
- 2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 3Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
- 4Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
- 5Department of Internal Medicine, National Cancer Center, Goyang, Korea
- 6Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- 7Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
- 8Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 9Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
- 10Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- KMID: 2524253
- DOI: http://doi.org/10.3904/kjim.2021.178
Abstract
- 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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