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Next Article 
The syndrome of hepatic veno-occlusive disease after marrow transplantation
SI Bearman
Bone Marrow Transplant Program, University of Colorado Health Sciences
Center, Denver 80262, USA.
The clinical syndrome of VOD is a frequent cause of nonrelapse mortality
among patients receiving high-dose cytoreductive regimens. Patients likely
to develop VOD have existing liver dysfunction, evidence of infection
before conditioning, tend to receive more intensive preparative regimens,
and often receive marrow from alternative donors. Therapeutic drug
monitoring of busulfan and pharmacokinetic dose adjustments appear to be
useful in reducing the incidence of VOD in patients receiving this agent.
Data are contradictory as regards whether pharmacologic prophylaxis is
effective. Patients who will develop severe VOD are characterized by a
rapid increase in serum bilirubin as well as weight. Supportive management
of these patients should attempt to preserve respiratory as well as renal
function, sometimes a very difficult task. Treatment with recombinant
tissue plasminogen activator has promise. However, given its potential for
toxicity, a prospective randomized trial should be performed. Hopefully, as
more data regarding the molecular and cellular mechanisms of this illness
are elucidated, more thoughtful prevention strategies will be developed.
This will be necessary, particularly as newer, more intensive preparative
regimens are being developed, as access to alternative donors increases,
and as more diseases will be treated with this approach.
Volume 85,
Issue 11,
pp. 3005-3020,
06/01/1995
Copyright © 1995 by The American Society of Hematology
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