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Prepublished online as a Blood First Edition Paper on September 11, 2003; DOI 10.1182/blood-2003-04-1311. This Article Full Text (PDF) All Versions of this Article: 2003-04-1311v1 103/1/78    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hogan, W. J Articles by McDonald, G. B Search for Related Content PubMed PubMed Citation Articles by Hogan, W. J Articles by McDonald, G. B Social Bookmarking                   What's this? Submitted April 28, 2003 Accepted August 29, 2003 Hepatic injury after nonmyeloablative conditioning followed by allogeneic hematopoietic cell transplantation: a study of 193 patients William J Hogan, Michael Maris, Barry Storer, Brenda M Sandmaier, David G Maloney, Gary Schoch, Ann E Woolfrey, Howard M Shulman, Rainer Storb, and George B McDonald* Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA * Corresponding author; email: gmcdonal{at}fhcrc.org. Liver injury is a frequent, serious complication of allogeneic hematopoietic cell transplantation (HCT) following myeloablative preparative regimens. We sought to determine the frequency and severity of hepatic injury after nonmyeloablative conditioning and its relationship to outcomes. One hundred ninety-three consecutive patients who received 2 Gy total body irradiation with or without fludarabine were evaluated for end points related to liver injury. Patients with diseases treatable by HCT who were ineligible for conventional myeloablative allogeneic HCT because of advanced age and/or co-morbid conditions were included. Fifty-one patients (26%) developed hyperbilirubinemia 4 mg/dL, most commonly resulting from cholestasis due to GVHD or sepsis. Pre-transplantation factors associated with liver dysfunction were a diagnosis of aggressive malignancy (HR 1.9; P=0.04) and the inclusion of fludarabine in the conditioning regimen (HR 1.8; P=0.07). Overall survival at 1 year was superior for patients who had maximal serum bilirubin levels in the normal (78%) or minimally elevated (1.3-3.9 mg/dL) ranges (69%) compared to those in the 4-6.9 mg/dL (20%), 7.0-9.9 mg/dL (17%) and 10 mg/dL (19%) groups. In summary, significant jaundice occurred in 26% of patients and was predominantly due to cholestasis resulting from GVHD and/or sepsis. Aggressive malignancies (mainly advanced disease) and later development of jaundice after transplantation predicted inferior survival. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: D. Ketelsen, W. Vogel, W. Bethge, M. Werner, K. Dietz, C. D. Claussen, and M. Horger Enlargement of the Common Bile Duct in Patients With Acute Graft-Versus-Host Disease: What Does It Mean? Am. J. Roentgenol., September 1, 2009; 193(3): W181 - W185. [Abstract] [Full Text] [PDF] G. Socie, R. P. de Latour, and G. B. McDonald Hepatitis C virus and allogeneic stem cell transplantation still matters! Haematologica, February 1, 2009; 94(2): 170 - 172. [Full Text] [PDF] E. Kusumi, M. Kami, Y. Kanda, K. Seki, M. Fujiwara, R. Koyama, T. Komatsu, Y. Kodama, T. Matsumura, K. Yuji, et al. Hepatic Injury Following Reduced-Intensity Unrelated Cord Blood Transplantation for Adult Patients with Hematological Diseases. Blood (ASH Annual Meeting Abstracts), November 16, 2006; 108(11): 5322 - 5322. [Abstract] [PDF] E. A. Copelan Hematopoietic stem-cell transplantation. N. Engl. J. Med., April 27, 2006; 354(17): 1813 - 1826. [Full Text] [PDF] B. L. Scott and B. M. Sandmaier Outcomes with Myeloid Malignancies Hematology, January 1, 2006; 2006(1): 381 - 389. [Abstract] [Full Text] [PDF] M. L. Sorror, M. B. Maris, R. Storb, F. Baron, B. M. Sandmaier, D. G. Maloney, and B. Storer Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT Blood, October 15, 2005; 106(8): 2912 - 2919. [Abstract] [Full Text] [PDF] J. J. Cornelissen and B. Lowenberg Role of Allogeneic Stem Cell Transplantation in Current Treatment of Acute Myeloid Leukemia Hematology, January 1, 2005; 2005(1): 151 - 155. [Abstract] [Full Text] [PDF] R. Diaconescu, C. R. Flowers, B. Storer, M. L. Sorror, M. B. Maris, D. G. Maloney, B. M. Sandmaier, and R. Storb Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donors Blood, September 1, 2004; 104(5): 1550 - 1558. [Abstract] [Full Text] [PDF]

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