LAUSR

Autologous stem cell transplantation (ASCT) is a cornerstone of lymphoma therapeutics, especially in the relapse setting. BEAM (carmustine, etoposide, cytarabine, and melphalan) is the most widely used conditioning regimen with a low rate of transplant mortality. Bendamustine has occasionally been used in France as a substitute for carmustine during a period of shortage (“BendaEAM”). Sinusoidal obstruction syndrome (SOS) is a potentially life-threatening complication, rarely observed after ASCT. In an EBMT study of 1010 patients, SOS occurred in less than 1% after BEAM in patients who had a normal level of AST before ASCT and a Karnofsky scale of less than 90% [1]. Six SOS were observed in the Henri Mondor University Hospital during the last 10 years (incidence 4.1% among 145 ASCTs for lymphoma). In Curie Institute in Paris, an incidence of 3/46 (6.5%) was reported for six years. After these cases and several reports in other centers, a national retrospective study was initiated. After a national alert spread through our cooperative group (LYSA) and the French Health Agency (ANSM), data from ASCT patients were collected focusing on history of lymphoma, SOS risk factors [2] (i.e., active viral hepatitis, cirrhosis, tumoral infiltration, liver function, chemotherapy, concomitant drugs...), conditioning, diagnostic criteria for SOS (based on the EBMT classification [3] or liver biopsy), treatment of SOS, and outcomes. Under French law, retrospective studies using data from medical charts required only authorization of the National Commission for Data Protection and Liberties (CNIL) (authorization number 2212876). Differential diagnoses (infections, treatment toxicity) were eliminated. Some cases have already been reported [4, 5]. Six cases came from clinical studies: three from BIBLOS (NCT02055924), two