Sinusoidal Obstruction Syndrome Clinical Trial
Official title:
A Retrospective Study About Detection of Sinusoidal Obstruction Syndrome With Ultrasound After Allogeneic Hematopoietic Stem Cell Transplantation
We would like conduct a retrospective study in our center to evaluate the early detection of sinusoidal obstruction syndrome with hepatic ultrasound after allogeneic hematopoietic stem cell transplantation.
The diagnosis of sinusoidal obstruction syndrome also know as veno-occlusive disease is often
difficult. This is a potentially life-threatening complication that can develop after
allogeneic hematopoietic stem cell transplantation. Clinically, sinusoidal obstruction
syndrome is charaterized by hepatomegaly, right upper quadrant pain, jaundice and ascites.
The diagnosis is based on biological parameters (bilirubin increase ≥ 2mg/dL or 34.2µmol/L)
and clinical evaluation (sodium fluid retention with weight gain > 5%, ascites, painful
hepatomegaly) (reference : M. Mohty and al. Revised criteria for sinusoidal obstruction
syndrome, Bone Marrow Transplantation (2016) 906-912).
Early therapeutic intervention is pivotal for survival in sinusoidal obstruction syndrome,
thus a rapid and reliable diagnosis has to be made. To rule out major differential diagnosis,
a reliable imaging method is needed. In practice, doppler ultrasonography, is helpful to
detect hepatomegaly and ascites but also is an help to explore well defined criteria of
sinusoidal obstruction syndrome already published. For sonography criteria: hepatomegaly (3
measures) with an increase of 2cm versus baseline, gallbladder wall thickening, ascites or 3
criteria of a native VOD; splenomegaly, increase of the portal vein diameter, decrease of the
hepatic vein diameter, visualisation of the para umbilical vein and for the doppler :
increase of the hepatic artery RI (>0.75), monophasic flow in the hepatic veins (venous
retraction is very typical but very late), flow demodulation on portal vein, decrease in
portal flow, portal flow congestion, reversed flow, flow recorded in the para-umbilical vein
; all five last signs are late (reference : Lassau N. et al Prognostic value of doppler
ultrasonography in hepatic veno occlusive disease. Transplantation 2002 jul 15 ;74(1) :60-6).
These criteria can confirm the diagnosis : 6 signs of wich the first 3 can affirm the
diagnosis with certainty in combination with clinical and biological parameters. There is
currently a few data in the literature about early detection of this complication with
systematic ultrasound. In this study, we want to evaluate in a retrospective study the
interest of this technique in the early and systematic detection of sinusoidal obstruction
syndrome.
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