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We retrospectively investigated 372 patients undergoing myeloablative conditioning with oral busulfan (Bu) and cyclophosphamide before allogeneic HSCT during 1990\u20132015. Patients' supportive care was changed in order to reduce the regimen\u2010related toxicities. Norethisterone use was terminated in 1998, therapeutic drug monitoring of Bu was initiated in 2000, and the use of liver supportive drugs, such as ursodeoxycholic acid and N\u2010acetyl\u2010L\u2010cysteine, were started in 2002 and 2009, respectively. In total, 26 patients (7.0%) developed SOS at a median of 19\u00a0days after transplantation. Of these 26 patients, 20 died at a median of 119\u00a0days after HSCT and 102\u00a0days after the diagnosis of SOS. The incidence of SOS decreased over time in accordance with the improvements in supportive care. The highest incidence of SOS was during 1995\u20131999 (16.2%) compared with 2.3% during 2010\u20132015. Overall survival for patients with SOS was 62%, 46%, and 27% at 100\u00a0days, 1\u00a0year, and 5\u00a0years after HSCT, respectively, compared with 92%, 77%, and 66% for those who did not develop SOS (<jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001). In conclusion, the incidence of SOS and related deaths were significantly decreased over the last years. Our institution pursues massive preventative and personalized measures for SOS. This strategy may also be applicable in other conditioning protocols in order to reduce the incidence of SOS and, hence, improve the clinical outcome.<\/jats:p>","DOI":"10.1111\/cts.12709","type":"journal-article","created":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T14:21:26Z","timestamp":1572618086000},"page":"293-300","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Reduced Risk of Sinusoidal Obstruction Syndrome of the Liver after Busulfan\u2010Cyclophosphamide Conditioning Prior to Allogeneic Hematopoietic Stem Cell Transplantation"],"prefix":"10.1111","volume":"13","author":[{"given":"Ibrahim","family":"El\u2010Serafi","sequence":"first","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institutet Stockholm Sweden"},{"name":"Department of Clinical and Experimental Medicine Link\u00f6ping University Link\u00f6ping Sweden"},{"name":"Department of Biochemistry Faculty of Medicine Port\u2010Said University Port\u2010Said Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats","family":"Remberger","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University and KFUE Uppsala University Hospital Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olle","family":"Ringd\u00e8n","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"T\u00f6rl\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institutet Stockholm Sweden"},{"name":"Cell Therapies and Allogeneic Stem Cell Transplantation (CAST) Karolinska University Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Sundin","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Department of Clinical Science, Intervention, and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden"},{"name":"Hematology\/Immunology Section Astrid Lindgren Children's Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Bj\u00f6rklund","sequence":"additional","affiliation":[{"name":"Cell Therapies and Allogeneic Stem Cell Transplantation (CAST) Karolinska University Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Winiarski","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Department of Clinical Science, Intervention, and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden"},{"name":"Hematology\/Immunology Section Astrid Lindgren Children's Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Mattsson","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institutet Stockholm Sweden"},{"name":"Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation and Princess Margaret Cancer Centre University of Toronto Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,6]]},"reference":[{"key":"e_1_2_9_1_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V85.11.3005.bloodjournal85113005"},{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-198712000-00011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840190515"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.08.024"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13215"},{"key":"e_1_2_9_6_1","first-page":"3599","article-title":"Incidence and outcome of hepatic veno\u2010occlusive disease after blood or marrow transplantation: a prospective cohort study of the European Group for Blood and Marrow Transplantation. 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