Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease in Hematopoetic Stem Cell Transplant Patients
Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease in Hematopoetic Stem Cell Transplant Patients
The purpose of this study is to (1) demonstrate the efficacy and safety (toxicity) of 25
 mg/kg/day of Defibrotide in patients with severe veno-occlusive disease (sVOD) and (2)
 evaluate serum and endothelial markers of veno-occlusive disease (VOD) through the analysis
 of blood samples.
This is a historically-controlled, multicenter, open label Phase 3 study to determine the
 safety and efficacy of 25 mg/kg/day of Defibrotide (DF) for the treatment of severe VOD in
 hematopoietic stem cell transplantation (HSCT) patients.

 In this study, the term "severe VOD" is defined as those patients who meet the Baltimore
 diagnostic criteria for VOD (total bilirubin >/= 2.0 mg/dL plus two of the following:
 ascites, >/=5% weight gain and hepatomegaly), who also have multi-organ failure (i.e.,
 pulmonary and/or renal dysfunction). This represents a group of patients in whom mortality at
 Day+100 has been estimated to be >80%.

 Comparisons: The primary parameter is Complete Response at 100 days following stem cell
 transplant, utilizing historical controls as a comparator. The historical control database
 will be generated through a retrospective medical chart review performed at participating
 centers; the survival outcome of patients who would otherwise have met eligibility criteria
 for this trial will be compared to the survival observed in patients prospectively treated
 with Defibrotide. Secondary parameters include survival rate at 100 days and 6 months post
 stem cell transplantation (SCT), and special studies of endothelial and serum markers for
 VOD. This study will assess safety of the dose and schedule in this setting.
Inclusion Criteria:

 -  Clinical diagnosis of VOD, defined by jaundice (bilirubin >/= 2 mg/dL) and at least 2
 of the following clinical findings, by Day+21 post stem cell transplant: ascites;
 weight gain >/= 5% above baseline weight; hepatomegaly.

 -  Severe VOD, defined as VOD with multi-organ failure, i.e., presence of one or both of
 the following, by Day+28 post stem cell transplant: renal or pulmonary dysfunction.

 -  Provide voluntary written informed consent.

 Exclusion Criteria:

 -  Pre-existing (prior to SCT) cirrhosis

 -  An alternative diagnosis for weight gain, ascites and jaundice

 -  Graft-versus-host disease (GVHD) grade B or higher involving liver or gut or grade C
 or higher involving skin

 -  Prior solid organ transplant

 -  Dependent on dialysis prior to and/or at the time of SCT

 -  Dependent on oxygen supplementation prior to SCT

 -  Significant acute bleeding or hemodynamic instability

 -  Requirement for the use of any medications that increase risk of hemorrhage will be
 excluded from the treatment group