{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:05:57Z","timestamp":1789103157113,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023181","name":"Medical Research Agency","doi-asserted-by":"crossref","award":["EUDRA CT 2021-003832-96"],"award-info":[{"award-number":["EUDRA CT 2021-003832-96"]}],"id":[{"id":"10.13039\/501100023181","id-type":"DOI","asserted-by":"crossref"}]},{"award":["EUDRA CT 2021-003832-96"],"award-info":[{"award-number":["EUDRA CT 2021-003832-96"]}],"id":[{"id":"https:\/\/ror.org\/026nedj88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>BACKGROUND: Chemoimmunotherapy (ChIt) has been proven to be an effective treatment for patients with refractory high-risk neuroblastoma (HR-NBL). The objective was to assess the appearance of veno-occlusive disease\/sinusoidal obstruction syndrome (VOD\/SOS) after high-dose chemotherapy (HDC) and autologous stem cell transplant (ASCT) in patients previously treated with ChIt for refractory HR-NBL. METHODS: Nineteen patients were treated with ChIt based on dinutuximab beta for refractory NBL and underwent ASCT. Six patients underwent HDC with ASCT according to the SIOPEN protocol (Busulfan and Melphalan (BuMel)). Treosulfan and Melphalan (TreoMel) were used in 13 patients. The occurrence of VOD\/SOS was analysed. The Mann-Whitney U test was used to analyse the correlation between VOD\/SOS and potential risk factors. RESULTS: VOD\/SOS developed in five out of six patients when BuMel was used after ChIt (3 pts, grade 4; 2 pts, grade 3), resulting in two deaths. No VOD\/SOS was observed in patients receiving TreoMel. Other analysed factors had no influence of VOD\/SOS occurrence and the only identified risk factor was BuMel administered after ChIt. CONCLUSIONS: Patients with refractory HR-NBL treated with ChIt and DB did not present life-threatening toxicities or severe liver toxicities during the ChIt cycles and continued to HDC with ASCT according to SIOPEN guidelines. The incidence of severe VOD\/SOS after ChIt and subsequent BuMel was higher than expected, with severe course resulting in two deaths. Taking into account the possible increase in the risk of VOD\/SOS after BuMel used after chemotherapy combined with DB, careful observation with early VOD\/SOS treatment in patients after ChIt is recommended and TreoMel regimen may be considered as less toxic.<\/jats:p>","DOI":"10.3390\/cancers18182912","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:05:43Z","timestamp":1788941143000},"page":"2912","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of Veno-Occlusive Disease in Patients with Neuroblastoma Treated with Autologous Stem Cell Transplantation After Chemoimmunotherapy with Temozolomide, Irinotecan, and Dinutuximab Beta"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4924-2901","authenticated-orcid":false,"given":"Urszula","family":"\u017bebrowska","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University Children\u2019s Hospital of Krakow, 30-663 Krakow, Poland"},{"name":"Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Wielicka Street 265, 30-663\u00a0Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5379-2318","authenticated-orcid":false,"given":"Walentyna","family":"Balwierz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University Children\u2019s Hospital of Krakow, 30-663 Krakow, Poland"},{"name":"Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Wielicka Street 265, 30-663\u00a0Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Go\u017adzik","sequence":"additional","affiliation":[{"name":"Jagiellonian University Medical College, Center of Transplantation University Children\u2019s Hospital of Krakow, 30-663  Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5266-180X","authenticated-orcid":false,"given":"Aleksandra","family":"Krasowska-Kwiecie\u0144","sequence":"additional","affiliation":[{"name":"Jagiellonian University Medical College, Center of Transplantation University Children\u2019s Hospital of Krakow, 30-663  Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"D\u0142u\u017cniewska","sequence":"additional","affiliation":[{"name":"Jagiellonian University Medical College, Center of Transplantation University Children\u2019s Hospital of Krakow, 30-663  Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8197-5499","authenticated-orcid":false,"given":"Monika","family":"Richert-Przygo\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, Antoni Jurasz University Hospital, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-7518","authenticated-orcid":false,"given":"Krzysztof","family":"Czy\u017cewski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, Antoni Jurasz University Hospital, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"D\u0119bski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, Antoni Jurasz University Hospital, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Pogorza\u0142a","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, Antoni Jurasz University Hospital, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3158-119X","authenticated-orcid":false,"given":"Jan","family":"Styczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, Antoni Jurasz University Hospital, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5725-4835","authenticated-orcid":false,"given":"Marek","family":"Ussowicz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Sok\u00f3\u0142","sequence":"additional","affiliation":[{"name":"Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1174-5799","authenticated-orcid":false,"given":"Krzysztof","family":"Ka\u0142wak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwona","family":"Malinowska","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology, Bone Marrow Transplantation and Pediatrics, Medical Universit of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Romiszewski","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology, Bone Marrow Transplantation and Pediatrics, Medical Universit of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Ma\u0144ko-Gli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Regional Specialized Children\u2019s Hospital in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda","family":"Badowska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Regional Specialized Children\u2019s Hospital in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9696-1284","authenticated-orcid":false,"given":"Tomasz","family":"Brzeski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Regional Specialized Children\u2019s Hospital in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwona","family":"\u015awierczek-Skwierawska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University Children\u2019s Hospital of Krakow, 30-663 Krakow, Poland"},{"name":"Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Wielicka Street 265, 30-663\u00a0Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6867-2717","authenticated-orcid":false,"given":"Szymon","family":"Skocze\u0144","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University Children\u2019s Hospital of Krakow, 30-663 Krakow, Poland"},{"name":"Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Wielicka Street 265, 30-663\u00a0Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6750-2628","authenticated-orcid":false,"given":"Aleksandra","family":"Wieczorek","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology and Hematology, University Children\u2019s Hospital of Krakow, 30-663 Krakow, Poland"},{"name":"Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Wielicka Street 265, 30-663\u00a0Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13046-022-02281-w","article-title":"Recent advances in the developmental origin of neuroblastoma: An overview","volume":"41","author":"Ponzoni","year":"2022","journal-title":"J. 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