Impact of Oral Eicosapentaenoic Acid on Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome Onset Prevention: Single-Center Retrospective Analysis
Miyazaki Y, Narumi H, Azuma T, Tanimoto K, Masuda Y, Kato J, Konishi T, Nabe S, Maruta M, Ochi T, Yamanouchi J, Takenaka K (2025) · Transplantation and Cellular Therapy · n=138
Study Profile
- Design
- single-center retrospective analysis of 138 allogeneic HSCT in 123 patients (Ehime University Hospital, Japan, April 2008-June 2024)
- Sample size (n)
- 138
- Intervention
- Oral eicosapentaenoic acid (EPA) 1800 mg/d divided into 2-3 doses + ursodeoxycholic acid post allo-HSCT (n=91)
- Comparator
- Ursodeoxycholic acid alone post allo-HSCT (n=47)
- Primary endpoint
- Incidence of VOD/SOS after allogeneic HSCT
- Primary result
- VOD/SOS occurred in 0 of 91 EPA recipients (0%) vs 3 of 47 non-EPA recipients (6.5%, p=0.014); no difference in 100-day post-transplant mortality between groups
- Follow-up duration
- Up to 100 days post-HSCT
- PMID
- 41057124
Key Findings
- 16-year single-center experience (138 transplants in 123 patients)
- 0% VOD/SOS in EPA group vs 6.5% in non-EPA group (p=0.014)
- EPA 1800 mg/d dose used in standard practice
- No difference in early post-transplant mortality
- Hypothesis-generating; warrants prospective trial
Limitations
- Retrospective design with confounding by indication possible
- Single-center experience limits generalizability
- Small absolute event numbers (3 VOD/SOS cases)
- Era effects across 16 years
- Not applicable to whole-leech hirudotherapy
Clinical Implications
Miyazaki 2025 introduces oral EPA as a potentially low-cost, low-toxicity VOD/SOS prevention strategy worth further investigation. For ASH, this work illustrates how a nutritional supplement might serve as an alternative to pharmaceutical defibrotide, distinct from the K040187 device-leech US clinical practice but illustrative of broader principles of mechanistic prevention.
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