Sinusoidal obstruction syndrome (SOS) is one of the severe complications of
hematopoietic stem cell transplantation (HSCT). Systemic management including respiratory and circulatory support is necessary. In addition, abdominal paracentesis is often needed for
pain relief and to reduce the pressure of tense
ascites. Concentrated
ascites reinfusion
therapy (CART) involves the filtration, concentration, and reinfusion of drained
ascites, which contributes to reuse of autologous
proteins. CART has been reported as supportive
therapy for patients with
liver cirrhosis and
cancer. We retrospectively reviewed the efficacy and safety of CART in three patients (two with
acute myelogenous leukemia and one with
chronic myeloid leukemia) who developed SOS after allo-HSCT. They all had symptomatic, tense, and
diuretic-refractory
ascites with right costal
pain and marked
weight gain. Two patients showed immediate improvement after CART. However, one patient experienced four CARTs with slow recovery. All patients are now alive and are being monitored as outpatients over 2 years with remission. No severe adverse event was observed related to CART, and 25.2-98.0 (median 30.2) grams of
albumin was collected and reinfused. CART after paracentesis reduces
protein loss in
ascites by reinfusion of autologous
protein instead of exogenous
albumin preparations. Although transient
fever is reported as a frequent adverse event, no events like severe
bleeding or
infection were observed. While its safety has not been fully established in patients with
hematological disease after HSCT, CART may be a considerable supportive
therapy for SOS with tense
ascites.