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Int J Hematol (2013) 97:284286 DOI 10.1007/s12185-012-1248-x
CASE REPORT
Tolvaptan as an alternative treatment for refractory uid retention associated with sinusoidal obstruction syndrome after allogeneic stem cell transplantation
Kimikazu Yakushijin Katsuya Yamamoto Keiji Kurata Yoshiharu Miyata Seiji Kakiuchi
Hideo Tomioka Yuriko Kawamori-Iwamoto Yumiko Inui Yukinari Sanada Atsuo Okamura
Tohru Murayama Hiroshi Matsuoka Hironobu Minami
Received: 29 September 2012 / Revised: 4 December 2012 / Accepted: 6 December 2012 / Published online: 8 January 2013 The Japanese Society of Hematology 2013
Abstract Tolvaptan is an oral vasopressin V2-receptor antagonist recognized as effective for uid retention associated with congestive heart failure and liver cirrhosis. However, there have been no reports concerning clinical experience with tolvaptan for sinusoidal obstruction syndrome (SOS). A 42-year-old male with primarily refractory T-lymphoblastic lymphoma underwent allogeneic peripheral blood stem cell transplantation from an HLA-matched sibling donor. The myeloablative conditioning regimen consisted of busulfan and cyclophosphamide. On day 20, the total bilirubin level was elevated to 2.0 mg/dL, and body weight increased from 76 to 85 kg, allowing a diagnosis of SOS to be made. Treatments with thrombomodulin, furosemide, carperitide, and low-dose dopamine were ineffective. By day 27, the patients body weight had increased to 90 kg, and he subsequently developed cardiopulmonary failure. Therefore, we administered low-dose tolvaptan for 2 days (3.75 mg on day 27 and 7.5 mg on day 28). Consequently, his ascites and edema were signicantly reduced, and body weight returned to 77 kg by day 34. However, he died of lymphoma progression on
day 55. Tolvaptan may be an alternative and promising treatment for refractory uid retention associated with SOS, although it is unclear whether tolvaptan administration leads to improvement in clinical outcome.
Keywords Tolvaptan Sinusoidal obstruction syndrome
Hematopoietic stem cell transplantation
Introduction
Sinusoidal obstruction syndrome (SOS) is a potentially lethal complication after hematopoietic stem cell transplantation (HSCT). The diagnosis of SOS is usually made based on the clinical criteria of jaundice, painful hepatomegaly, and uid retention with weight gain [1, 2]. The uid retention is occasionally refractory to diuretics, resulting in the severe form of SOS, for which hemodialysis is required to deal with renal failure in many SOS cases. However, it is not always easy or safe to use a venous access catheter for patients with SOS because...