Premium
Gemtuzumab ozogamicin‐induced sinusoidal obstructive syndrome treated with defibrotide: a case report
Author(s) -
Lannoy D.,
Decaudin B.,
Grozieux de Laguérenne A.,
Barrier F.,
Pig J. M.,
Wetterwald M.,
Odou P.
Publication year - 2006
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2006.00742.x
Subject(s) - medicine , defibrotide , hepatic veno occlusive disease , gastroenterology , gemtuzumab ozogamicin , transplantation , alkaline phosphatase , calicheamicin , bilirubin , alanine transaminase , cholestasis , hematopoietic stem cell transplantation , surgery , stem cell , cd33 , myeloid leukemia , cd34 , biochemistry , chemistry , biology , genetics , enzyme
Summary New treatments for relapse of acute myeloid leukaemia (AML), include gemtuzumab ozogamicin (GO), an anti‐CD33 monoclonal antibody. We describe a second case of GO‐induced sinusoidal obstructive syndrome (SOS) effectively treated with defibrotide (DF). No stem‐cell transplantation was involved. On day 23 after the first GO dose, a patient presented with ascites, weight gain, liver enlargement and pain in the right upper quadrant. Sudden hepatic cytolysis (transaminases at six times the normal range: grade 3) and cholestasis [alkaline phosphatase ALP and gamma‐glutamyltransferase (GGT) respectively at four and eight times the normal range: grade 2] were observed but there was no evidence of increase serum bilirubin. Treatment with DF (Prociclide ® , Crinos; 10 mg/kg/day, or 200 mg, q.i.d.) improved the hepatic abnormality within a few days (serum transaminases decreased from 312 to 103 IU/L for aspartate aminotransferase (AST) and from 141 to 80 IU/L for alanine aminotransferase (ALT) within 3 days ALP increased from 253 to 383 IU/L and gamma‐GT from 238 to 417 IU/L 4 days after administration of DF. The clinical and biological features of our case suggest a direct involvement of GO in causing SOS, even when used as monotherapy, without allogenic stem‐cell transplantation. Low dose DF (10 mg/kg/day) given early during the development of SOS associated with GO was effective. Unfortunately, in our case the patient eventually died of multi‐organ failure probably because of failure of GO.