DOI: 10.12890/2024_004885

Hepatic sinusoidal obstruction syndrome (SOS) associated with checkpoint inhibitor therapy

Authors

  • Marianna Litterio Department of Life, Health & Environmental Sciences, University of L’Aquila, L’Aquila, Italy
  • Nicole Marchetti Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Francesco Carubbi Department of Life, Health & Environmental Sciences, University of L’Aquila, L’Aquila, Italy
  • Marianna Tudini Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Luciano Mutti Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; Center of Biotechnology, College of Science and Technology, Temple University, SHRO, Philadelphia, USA; Italian Group for Mesothelioma, Italy
  • Claudio Ferri Department of Life, Health & Environmental Sciences, University of L’Aquila, L’Aquila, Italy

marianna.litterio@graduate.univaq.it

Keywords

Sinusoidal obstruction syndrome, SOS, pembrolizumab, immune checkpoint inhibitors

Abstract

Sinusoidal obstruction syndrome (SOS) is a distinctive and potentially fatal form of hepatic injury that mainly occurs after hematopoietic-stem cell transplantation but also due to many other conditions including drug or toxin exposure. Recently, immune checkpoint inhibitors (ICIs) have revolutionised the treatment of many solid organ malignancies. Furthermore, as their use has become more widespread, rare toxicities have emerged. The difficulty lies in diagnosing these unusual toxicities with an incidence of as low as less than 1% hence defined as SOS. The development of the disease can be rapid and unpredictable. The severe forms of SOS may result in multi-organ dysfunction with a high mortality rate (>80%).
We present the case of a patient with metastatic lung adenocarcinoma treated with the ICI pembrolizumab who developed SOS with marked portal hypertension as a rare severe, toxic side effect of immunotherapy. This report highlights the importance of considering SOS in patients who develop liver dysfunction and/or portal hypertension during or after immunotherapy for neoplastic disease. Early identification and severity assessment is crucial in facilitating prompt diagnosis and timely treatment, improving the prognosis of our patients.

View the entire article

Downloads

References

  1. Mavrikou I, Chatzidimitriou D, Skoura L, Nikolousis E, Sakellari I, Gavriilaki E. Molecular Advances in Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease. Int J Mol Sci 2023;24:5620.
  2. Corbacioglu S, Jabbour EJ, Mohty M. Risk Factors for Development of and Progression of Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome. Biol Blood Marrow Transplant 2019;25:1271-1280.
  3. Javaid A, Bennett C, Rao A, Spain L. Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management. Pharmaceut Med 2024;38:25-38.
  4. Sakumura M, Tajiri K, Miwa S, Nagata K, Kawai K, Miyazono T, et al. Hepatic Sinusoidal Obstruction Syndrome Induced by Non-transplant Chemotherapy for Non-Hodgkin Lymphoma. Intern Med 2017;56:395-400.
  5. Bonifazi F, Barbato F, Ravaioli F, Sessa M, Defrancesco I, Arpinati M, et al. Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation. Front Immunol 2020;11:489.
  6. Fan CQ, Crawford JM. Sinusoidal obstruction syndrome (hepatic veno-occlusive disease). J Clin Exp Hepatol 2014;4:332-46.
  7. Aziz MT, Kakadiya PP, Kush SM, Weigel K, Lowe DK. Defibrotide: An Oligonucleotide for Sinusoidal Obstruction Syndrome. Ann Pharmacother 2018;52:166-174.

Published

2024-12-13

Issue

Vol. 12 No. 1 (2025)

Categories

How to Cite

1.
Litterio M, Marchetti N, Carubbi F, Tudini M, Mutti L, Ferri C. Hepatic sinusoidal obstruction syndrome (SOS) associated with checkpoint inhibitor therapy. EJCRIM [Internet]. 2024 Dec. 13 [cited 2026 Nov. 3];12(1). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4885