Blood, Vol. 92 No. 12 (December 15), 1998:
pp. 4568-4572
Norethisterone Treatment, a Major Risk-Factor for
Veno-Occlusive Disease in the Liver After Allogeneic Bone Marrow
Transplantation
Hans Hägglund,
Mats Remberger,
Sven Klaesson,
Berit Lönnqvist,
Per Ljungman, and
Olle Ringdén
From the Departments of Transplantation Surgery, Clinical Immunology,
Paediatrics, and Medicine, Karolinska Institute, Huddinge Hospital,
Huddinge, Sweden.
In this single-center study, we retrospectively analyzed incidence
and risk factors for hepatic veno-occlusive disease (VOD) in 249 consecutive patients who underwent allogeneic hematopoietic stem cell
transplantation between January 1990 and June 1995. Twenty-four of the
249 transplanted patients developed VOD. The probabilities of
developing VOD were 17% among women and 7% in men (P = .01). In women treated with norethisterone, the incidence was 27%
compared with 3% in women without this treatment (P = .007).
One-year survival rates were 17% and 73% in patients with (n = 24)
or without VOD (n = 225), respectively. The use of heparin prophylaxis (100 IE/kg/24 hours for 1 month) did not alter the incidence or 1-year mortality of VOD. In multivariate analysis, the
following risk factors were significant: norethisterone treatment (P < .001), bilirubin >26 µmol/L before bone marrow
transplantation (BMT) (P = .002), one HLA-antigen mismatch
(P = .003), previous abdominal irradiation (P = .02), and conditioning with busulphan (P = .02). Our
conclusion is that norethisterone treatment should not be used in
patients undergoing BMT and heparin prophylaxis did not affect the
incidence or mortality of VOD.
