Syndecan-1 is Associated With Sinusoidal Obstruction Syndrome and Severe Acute Graft-Versus-Host Disease After Pediatric Hematopoietic Stem Cell Transplantation

Endothelial damage may play a key role in several non-infectious toxicities following hematopoietic stem cell transplantation (HSCT). We explored damage to the endothelial glycocalyx in 113 children undergoing HSCT by measuring syndecan-1 plasma levels. Syndecan-1 levels were elevated in patients with severe sinusoidal obstruction syndrome (SOS) and steroid-refractory/dependent acute graft-versus-host disease, but remained low in milder cases. In patients with SOS, high syndecan-1 levels were associated with prolonged diuretic treatment and thrombocytopenia. These findings provide new insights into the pathophysiology of endothelial-related toxicities after HSCT and may lead to the development of more individualized and targeted therapeutic approaches.