Veno-occlusive disease of the liver after allogeneic bone marrow transplantation in children with hematologic malignancies: incidence, onset time and risk factors

被引:69
作者
Hasegawa, S
Horibe, K
Kawabe, T
Kato, K
Kojima, S
Matsuyama, T
Hirabayashi, N
机构
[1] Nagoya Univ, Sch Med, Dept Pediat, Showa Ku, Nagaoka, Niigata 4668550, Japan
[2] Nagoya First Hosp, Japanese Red Cross, Dept Pathol, Nagoya, Aichi, Japan
[3] Childrens Med Ctr, Div Hematol Oncol, Nagoya, Aichi, Japan
关键词
veno-occlusive disease (VOD); bone marrow transplantation (BMT); children; late onset; risk factor;
D O I
10.1038/sj.bmt.1701506
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
One hundred and forty children with hematologic malignancies undergoing allogeneic BMT were reviewed in order to clarify the incidence, onset time, and risk factors for veno-occlusive disease (VOD) of the liver. Thirty-eight patients (27.1%) developed VOD diagnosed according to the Seattle clinical criteria. Seventeen patients developed VOD within 20 days of transplantation (early-onset) and in 21 patients developed after day 20 (late-onset) including eight patients with histological confirmation, Late-onset VOD occurred from day 21 to day 508 (median day 39), Moderate or severe VOD developed in 11 early-onset and 13 late-onset patients, Death occurred in eight early-onset and 10 late-onset patients, Serum albumin and cholinesterase levels prior to the start of pretransplant conditioning were significantly lower in early-onset VOD than in late-onset VOD, Multivariate analysis showed that low serum albumin levels (less than or equal to 3.7 g/dl) prior to the start of pretransplant conditioning was most strongly associated with the development of VOD, Donor mismatch (other than HLA-matched relatives), use of minocycline, and a long interval (greater than or equal to 13 months) between diagnosis and BMT were also significantly associated with the development of VOD, In contrast, use of fosfomycin was associated with a decreased risk. Our data suggest that hepatic function reserve is important in the development and onset time of VOD, Veno-occlusive disease of the liver is a complication which may occur a long time after transplantation.
引用
收藏
页码:1191 / 1197
页数:7
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