SOS! Immunotherapy-Associated Sinusoidal Obstructive Syndrome

Ho, Thanh P.; Venkatesh, Sudhakar K.; Alkhatib, Hani; Yan, Yiyi

doi:10.1200/jop.19.00276

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Sinusoidal obstruction syndrome (SOS) is an obliterative venulitis characterised by fibrotic damage of small hepatic vessels [ 78 ]. It is typically associated with allogenic haematopoietic stem cell transplants, but cases have been reported in patients with colorectal cancer with liver metastases post-cytoreductive surgery as well as with the drug gemtuzumab ozogamicin [ 79 ]. Five cases of SOS have been reported in patients with metastatic melanoma who received ICIs without additional recognised risk factors for this condition [ 78 – 80 ].…”

Section: Other Rare Toxicitiesmentioning

confidence: 99%

“…Clinical features include painful hepatomegaly, fluid overload and deranged liver function tests with raised bilirubin. Imaging may demonstrate a pattern of heterogenous enhancement in the portal phase and MRI can be helpful in assessment [ 79 ]. Invasively measured portal pressures may be elevated [ 78 , 79 ].…”

Section: Other Rare Toxicitiesmentioning

confidence: 99%

“…Imaging may demonstrate a pattern of heterogenous enhancement in the portal phase and MRI can be helpful in assessment [ 79 ]. Invasively measured portal pressures may be elevated [ 78 , 79 ]. Histological examination reveals non-fibrous portal areas with sinusoidal dilation and perisinusoidal fibrosis with lobular veins occluded with fibrous tissue [ 78 ].…”

Section: Other Rare Toxicitiesmentioning

confidence: 99%

“…Cases have been managed with a combination of ICI cessation, corticosteroids and mycophenolate mofetil. In addition, supportive medications, mainly for the symptoms of fluid overload, have been used [ 78 , 79 ]. The role of defibrotide in ICI-induced SOS is unclear [ 79 ].…”

Section: Other Rare Toxicitiesmentioning

confidence: 99%

“…In addition, supportive medications, mainly for the symptoms of fluid overload, have been used [ 78 , 79 ]. The role of defibrotide in ICI-induced SOS is unclear [ 79 ]. These strategies resulted in clinical and biochemical improvements.…”

Section: Other Rare Toxicitiesmentioning

confidence: 99%

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Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management

Javaid,

Bennett,

Rao

et al. 2024

Pharm Med

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Immune checkpoint inhibitors (ICIs) have revolutionised the treatment landscape across many solid organ malignancies and form part of routine clinical practice in many tumours. As indications for monotherapy, doublet therapy and combination approaches with chemotherapy and targeted agents expand, clinicians must be aware of the wide range of possible immune-related adverse events (irAEs). Common toxicities, including rash, colitis, hepatitis and pneumonitis are well described in the literature, and have established diagnostic and management algorithms. Rarer toxicities, often with an incidence of less than 1%, are less defined. These syndromes can be poorly recognised, may take on a fulminant course and do not have established or evidence-based diagnostic and management strategies. As such, patients may experience increased morbidity, mortality and poorer outcomes, related both to these irAEs as well as how the treatment of these may affect the management of their underlying malignancy. In this review, we aim to explore the incidence, potential biomarkers, pathogenesis, diagnostic work-up and clinical sequelae of a selection of uncommon irAEs, with a focus on myocarditis, neurological and haematologic syndromes. Further prospective research is required to accurately define the incidence and pathogenesis of these conditions, with the aim of increasing clinician awareness of rare irAEs and to assist with a more personalised and mechanism-based approach to these syndromes.

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Section: Other Rare Toxicitiesmentioning

confidence: 99%

Section: Other Rare Toxicitiesmentioning

confidence: 99%

Section: Other Rare Toxicitiesmentioning

confidence: 99%

Section: Other Rare Toxicitiesmentioning

confidence: 99%

Section: Other Rare Toxicitiesmentioning

confidence: 99%

See 3 more Smart Citations

Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management

Javaid,

Bennett,

Rao

et al. 2024

Pharm Med

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Pembrolizumab

2020

Reactions Weekly

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Hepatic sinusoidal obstruction syndrome after immune-checkpoint-inhibitor therapy: when the liver sends SOS

Kasper,

Fischer,

Schumacher

2024

BMJ Case Rep

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A woman in her 50s presented to the hospital with new-onset jaundice and ascites. Her medical history included a melanoma of the right shoulder, diagnosed 8 months before, for which she had received four cycles of ipilimumab and nivolumab. Due to the oncological history and previous immunotherapy, an immune-checkpoint-inhibitor (ICI)-induced hepatitis was suspected, and a high-dose corticosteroid treatment was initiated. However, as there was no improvement in the liver function tests, a percutaneous liver biopsy was performed for further diagnostic clarification. Histological analysis ultimately identified a hepatic sinusoidal obstruction syndrome (SOS) as the underlying cause of liver dysfunction and portal hypertension. ICI-related hepatic SOS represents an extremely rare adverse event related to immunotherapy that should be considered in all patients with treatment-refractory ICI-related hepatotoxicity and clinical signs of portal hypertension.

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SOS! Immunotherapy-Associated Sinusoidal Obstructive Syndrome

Cited by 3 publications

References 5 publications

Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management

Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management

Pembrolizumab

Hepatic sinusoidal obstruction syndrome after immune-checkpoint-inhibitor therapy: when the liver sends SOS

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