Richi Kashyap, Faiz Anwer, Muhammad Areeb Iqbal, Farhan Khalid, Anam Khan, Muhammad Ashar Ali, Muhammad Yasir Anwar, Anamika Chaudhary, Ali Jaan
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Recombinant thrombomodulin (rTM), an endothelial anticoagulant co-factor, as prophylactic therapy might be able to prevent veno-occlusive complications after stem cell transplantation.</p><p><strong>Methods: </strong>A literature search was performed on PubMed, Embase, and Web of Science. We used the following Mesh terms and Emtree terms, \"Hepatic Veno-Occlusive Diseases\" OR \"Sinusoidal Obstruction\" OR \"Stem Cell Transplantations \" AND \"Thrombomodulin\" from the inception of data up to April 1, 2021. The PICO (Patient/Population, Intervention, Comparison and Outcomes) framework was used for the literature search.</p><p><strong>Results: </strong>For the VOD incidence after HSCTstem cell transplantation, the result was in favor of rTM with a risk ratio (RR) of 0.53 (I<sup>2</sup> = 0%, 95% confidence interval [CI] = 0.32-0.89). The incidence of transplant-associated thrombotic microangiopathy (TA-TMA) after HSCT was reduced in rTM group. The RR for incidence of TA-TMA was 0.48 (I<sup>2</sup> = 62%, 95% CI = 0.20-1.17) favoring rTM. The RR for incidence of graft-versus-host disease (GvHD) was also lower in rTM group, 0.48 (I<sup>2</sup> = 64%, 95% CI = 0.32-0.72).</p><p><strong>Conclusion: </strong>In our meta-analysis, we evaluate the efficacy and safety of rTM in the prevention of SOS after HSCT. 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Various factors put patients undergoing allogeneic HSCT at an increased risk for VOD. Thrombomodulin (TM) is an important factor which has a wide range of effects, including anticoagulant, anti-inflammatory, angiogenic, and protective effect, on endothelial cells. It plays a role in preventing excessive coagulation and thrombosis by binding with thrombin and inhibiting the coagulation cascade. There are a limited number of options for the prevention of this fatal complication. Recombinant thrombomodulin (rTM), an endothelial anticoagulant co-factor, as prophylactic therapy might be able to prevent veno-occlusive complications after stem cell transplantation.</p><p><strong>Methods: </strong>A literature search was performed on PubMed, Embase, and Web of Science. 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The RR for incidence of graft-versus-host disease (GvHD) was also lower in rTM group, 0.48 (I<sup>2</sup> = 64%, 95% CI = 0.32-0.72).</p><p><strong>Conclusion: </strong>In our meta-analysis, we evaluate the efficacy and safety of rTM in the prevention of SOS after HSCT. 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引用次数: 0
摘要
背景:肝静脉闭塞性疾病(VOD)，也被称为窦状静脉阻塞综合征(SOS)，是造血干细胞移植(HSCT)后的致命并发症。各种因素使接受同种异体造血干细胞移植的患者发生VOD的风险增加。凝血调节素(Thrombomodulin, TM)是一种重要的因子，对内皮细胞具有抗凝、抗炎、血管生成和保护作用。它通过与凝血酶结合，抑制凝血级联，起到防止过度凝血和血栓形成的作用。预防这一致命并发症的选择有限。重组血栓调节蛋白(rTM)，一种内皮抗凝辅助因子，作为预防性治疗可能能够预防干细胞移植后的静脉闭塞并发症。方法:在PubMed、Embase和Web of Science上进行文献检索。从数据开始到2021年4月1日，我们使用了以下Mesh术语和Emtree术语，“肝静脉闭塞性疾病”或“窦状动脉阻塞”或“干细胞移植”和“血栓调节素”。使用PICO(患者/人群，干预，比较和结果)框架进行文献检索。结果:对于造血干细胞移植后的VOD发生率，rTM的风险比(RR)为0.53 (I2 = 0%， 95%可信区间[CI] = 0.32-0.89)。rTM组移植相关血栓性微血管病变(TA-TMA)发生率降低。TA-TMA发病率的RR为0.48 (I2 = 62%， 95% CI = 0.20-1.17)，有利于rTM。rTM组移植物抗宿主病(GvHD)发生率的RR也较低，为0.48 (I2 = 64%， 95% CI = 0.32-0.72)。结论:在我们的荟萃分析中，我们评估了rTM预防HSCT后SOS的有效性和安全性。根据我们的研究结果，rTM的使用显著减少了HSCT后的SOS发作、TA-TMA和GvHD。
Efficacy and Safety of Recombinant Thrombomodulin for the Prophylaxis of Veno-Occlusive Complication in Allogeneiccit Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.
Background: Hepatic veno-occlusive disease (VOD), also termed as sinusoidal obstruction syndrome (SOS), is a lethal complication after hematopoietic stem cell transplantation (HSCT). Various factors put patients undergoing allogeneic HSCT at an increased risk for VOD. Thrombomodulin (TM) is an important factor which has a wide range of effects, including anticoagulant, anti-inflammatory, angiogenic, and protective effect, on endothelial cells. It plays a role in preventing excessive coagulation and thrombosis by binding with thrombin and inhibiting the coagulation cascade. There are a limited number of options for the prevention of this fatal complication. Recombinant thrombomodulin (rTM), an endothelial anticoagulant co-factor, as prophylactic therapy might be able to prevent veno-occlusive complications after stem cell transplantation.
Methods: A literature search was performed on PubMed, Embase, and Web of Science. We used the following Mesh terms and Emtree terms, "Hepatic Veno-Occlusive Diseases" OR "Sinusoidal Obstruction" OR "Stem Cell Transplantations " AND "Thrombomodulin" from the inception of data up to April 1, 2021. The PICO (Patient/Population, Intervention, Comparison and Outcomes) framework was used for the literature search.
Results: For the VOD incidence after HSCTstem cell transplantation, the result was in favor of rTM with a risk ratio (RR) of 0.53 (I2 = 0%, 95% confidence interval [CI] = 0.32-0.89). The incidence of transplant-associated thrombotic microangiopathy (TA-TMA) after HSCT was reduced in rTM group. The RR for incidence of TA-TMA was 0.48 (I2 = 62%, 95% CI = 0.20-1.17) favoring rTM. The RR for incidence of graft-versus-host disease (GvHD) was also lower in rTM group, 0.48 (I2 = 64%, 95% CI = 0.32-0.72).
Conclusion: In our meta-analysis, we evaluate the efficacy and safety of rTM in the prevention of SOS after HSCT. According to our results, rTM use led to a significant reduction in SOS episodes, TA-TMA, and GvHD after HSCT.
期刊介绍：
Hematology Oncology and Stem Cell Therapy is an international, peer-reviewed, open access journal that provides a vehicle for publications of high-quality clinical as well as basic science research reports in hematology and oncology. The contents of the journal also emphasize the growing importance of hematopoietic stem cell therapy for treatment of various benign and malignant hematologic disorders and certain solid tumors.The journal prioritizes publication of original research articles but also would give consideration for brief reports, review articles, special communications, and unique case reports. It also offers a special section for clinically relevant images that provide an important educational value.
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