Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease and Multiorgan Failure after Stem Cell Transplantation: A Multicenter, Randomized, Dose-Finding Trial

Paul G. Richardson, Robert J. Soiffer, Joseph H. Antin, Hajime Uno, Zhezhen Jin, Joanne Kurtzberg, Paul L. Martin, Gideon Steinbach, Karen F. Murray, Georgia B. Vogelsang, Allen R. Chen, Amrita Krishnan, Nancy A. Kernan, David E. Avigan, Thomas R. Spitzer, Howard M. Shulman, Donald N. Di Salvo, Carolyn Revta, Diane Warren, Parisa MomtazGary Bradwin, L. J. Wei, Massimo Iacobelli, George B. McDonald, Eva C. Guinan

Research output: Contribution to journalArticle

Abstract

Therapeutic options for severe hepatic veno-occlusive disease (VOD) are limited and outcomes are dismal, but early phase I/II studies have suggested promising activity and acceptable toxicity using the novel polydisperse oligonucleotide defibrotide. This randomized phase II dose-finding trial determined the efficacy of defibrotide in patients with severe VOD following hematopoietic stem cell transplantation (HSCT) and identified an appropriate dose for future trials. Adult and pediatric patients received either lower-dose (arm A: 25 mg/kg/day; n = 75) or higher-dose (arm B: 40 mg/kg/day; n = 74) i.v. defibrotide administered in divided doses every 6 hours for ≥14 days or until complete response, VOD progression, or any unacceptable toxicity occurred. Overall complete response and day +100 post-HSCT survival rates were 46% and 42%, respectively, with no significant difference between treatment arms. The incidence of treatment-related adverse events was low (8% overall; 7% in arm A, 10% in arm B); there was no significant difference in the overall rate of adverse events between treatment arms. Early stabilization or decreased bilirubin was associated with better response and day +100 survival, and decreased plasminogen activator inhibitor type 1 (PAI-1) during treatment was associated with better outcome; changes were similar in both treatment arms. Defibrotide 25 or 40 mg/kg/day also appears effective in treating severe VOD following HSCT. In the absence of any differences in activity, toxicity or changes in PAI-1 level, defibrotide 25 mg/kg/day was selected for ongoing phase III trials in VOD.

Original languageEnglish (US)
Pages (from-to)1005-1017
Number of pages13
JournalBiology of Blood and Marrow Transplantation
Volume16
Issue number7
DOIs
StatePublished - Jul 1 2010

Keywords

  • Defibrotide
  • Dose-Finding Study
  • Multi-organ failure
  • Severe Veno-Occlusive Disease

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Richardson, P. G., Soiffer, R. J., Antin, J. H., Uno, H., Jin, Z., Kurtzberg, J., Martin, P. L., Steinbach, G., Murray, K. F., Vogelsang, G. B., Chen, A. R., Krishnan, A., Kernan, N. A., Avigan, D. E., Spitzer, T. R., Shulman, H. M., Di Salvo, D. N., Revta, C., Warren, D., ... Guinan, E. C. (2010). Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease and Multiorgan Failure after Stem Cell Transplantation: A Multicenter, Randomized, Dose-Finding Trial. Biology of Blood and Marrow Transplantation, 16(7), 1005-1017. https://doi.org/10.1016/j.bbmt.2010.02.009