LAUSR

Sinusoidal obstruction syndrome (SOS) in the pediatric population is not limited to a well-defined group of patients who undergo autologous stem cell transplantation. We describe the clinical characteristics of five patients with history of medulloblastoma who developed SOS during treatment as per Head Start (HS) regimens. A chart review of 31 patients from 2006 to 2017 revealed that five patients (16.1%) developed SOS during the course of their therapy (2 patients were enrolled on HS IV). The median age at diagnosis was 2.5 years (range 2-5 years). All three patients diagnosed in the era of HSII/III developed SOS in transplant setting. The other 2 patients on HS IV developed SOS during the induction chemotherapy cycles. In the follow-up period, one patient developed metastatic disease 2 years after completion of therapy. Another patient died from pulmonary fibrosis 4 years post-transplant. Two patients developed fibronodular hyperplasia of the liver on further imaging. The dose of carboplatin for the 3 patients treated as per HSII/III was dosed by the AUC using the Calvert method. The remaining 2 patients had received the induction chemotherapy cycles (second and third) based on the square meter dose on the HS IV guidelines; one of them continued on the same regimen after the dose was adjusted to weight based in the subsequent cycles. Dose calculation based on the weight and age of young patients, particularity those who are under five should be taken into consideration in future studies. Long term consequences of severe SOS should be monitored.