Sinusoidal Obstruction Syndrome Following Myeloablative Therapy and Tranexamic Acid Treatment for Hemorrhage in Two Patients with Neuroblastoma

Felix Zirngibl; Carina Flemmig; Peter Lang; Annette Künkele; Angelika Eggert; Johannes H Schulte; Hedwig E Deubzer

doi:10.3390/children7110198

Sinusoidal Obstruction Syndrome Following Myeloablative Therapy and Tranexamic Acid Treatment for Hemorrhage in Two Patients with Neuroblastoma

Children (Basel). 2020 Oct 28;7(11):198. doi: 10.3390/children7110198.

Authors

Felix Zirngibl^{1

2}, Carina Flemmig^{1

3}, Peter Lang⁴, Annette Künkele^{1

2

5}, Angelika Eggert^{1

2

5

6}, Johannes H Schulte^{1

2

5

6}, Hedwig E Deubzer^{1

2

5

6

7}

Affiliations

¹ Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
² Berliner Institut für Gesundheitsforschung (BIH), 10178 Berlin, Germany.
³ Parexel International GmbH, 14050 Berlin, Germany.
⁴ Department of Pediatrics, Children's University Hospital, University of Tübingen, 72076 Tübingen, Germany.
⁵ German Cancer Consortium (DKTK), Partner Site Berlin, 10117 Berlin, Germany.
⁶ German Cancer Research Center Heidelberg (DKFZ), 69120 Heidelberg, Germany.
⁷ Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin and the Max-Delbrueck-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany.

Abstract

Adverse thromboembolic events following administration of the anti-fibrinolytic agent tranexamic acid (TA), used to prevent/treat excessive blood loss, are rare. We present the clinical course of two young patients (22 and 56 months) receiving busulfan/melphalan (Bu/Mel) high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HSCT) to treat high-risk neuroblastoma, who developed hepatic sinusoidal obstruction syndrome (SOS) within 48 h after systemic TA treatment for a hemodynamically relevant hemorrhage. Defibrotide treatment resolved hepatic SOS, but the short time between TA administration and SOS onset suggests a causal association.

Keywords: embryonal tumor; fibrinolysis inhibitor; pediatric hematopoietic stem cell transplantation; thrombotic event; transplant-related complication.

Publication types

Case Reports