ArticleAnnals of hematology2026
Chronic portal hypertension following inotuzumab ozogamicin in a low-risk patient: a case of overriding baseline risk and long-term management.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Inotuzumab ozogamicin (InO) is effective for relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) but is associated with hepatotoxicity, particularly sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), which leads to portal hypertension (PH). We report a case of a 50-year-old woman who, after receiving InO, developed SOS/VOD and subsequent chronic PH, manifesting as recurrent variceal bleeding approximately 18 months post-treatment. A literature review highlights diagnostic advances using non-invasive tools like transient elastography, the central role of calicheamicin-induced endothelial injury and complement activation in pathogenesis, and risk mitigation through ursodiol prophylaxis and avoidance of dual-alkylator conditioning regimens. The case further illustrates that PH can present with atypical hemodynamics, such as preserved portal flow and absence of cirrhosis, and may emerge as a chronic sequela long after acute SOS/VOD resolution. Quantitative risk assessment using a validated model (CIBMTR) revealed a very low pre-treatment SOS/VOD risk (2.64%), highlighting that InO-induced injury can override a favorable baseline risk profile. This underscores the importance of long-term monitoring for PH, even after resolution of acute SOS/VOD and achievement of leukemia remission, to optimize outcomes in InO-treated patients.
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