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Post-Transplant Complications

Veno-occlusive disease of the liver in children with solid tumors undergoing autologous hematopoietic progenitor cell transplantation: a high incidence in patients with neuroblastoma

Abstract

We retrospectively analyzed the incidence and risk factors for veno-occlusive disease (VOD) in 83 consecutive children with solid tumors, who underwent autologous blood or bone marrow (BM) transplantation at UCSF between 1992 and 2000. Forty-one patients were diagnosed with neuroblastoma and 42 had another solid tumor (Ewing's sarcoma, soft tissue sarcomas, germ cell tumors, etc). Patients with neuroblastoma were more likely than patients with other solid tumors (ST) to be 7 years of age, to have a decreased serum albumin level, and to have received abdominal radiation and surgery prior to transplant. Patients with neuroblastoma received a different conditioning regimen and a purged stem cell product. Twenty patients (24%) developed VOD. VOD was self-limited in 15 (75%) patients and severe in five (25%) patients. Univariate analysis identified the following risk factors for VOD: diagnosis of neuroblastoma (odds ratio 6.1, P < 0.01), abdominal radiation (odds ratio 4.1, P < 0.01), abdominal surgery (odds ratio 4.1, P < 0.01), and age 7 years of age (odds ratio 3.3, P = 0.02). Disease status at transplant, intensity of previous chemotherapy, conditioning regimen, progenitor cell source, ALT, AST, albumin level, renal function prior to transplant, or use of amphotericin, growth-factor or heparin during transplant, did not affect the incidence of VOD. On multivariate analysis, only the diagnosis of neuroblastoma remained significant (odds ratio 7.8, P = 0.03). Larger studies of patients with neuroblastoma are necessary in order to confirm our findings and better define the risk factors for VOD development in neuroblastoma patients.

Bone Marrow Transplantation (2002) 29, 409–415. doi:10.1038/sj.bmt.1703393

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References

  1. McDonald GB, Sharma P, Matthews DE et al. Veno-occlusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors Hepatology 1984 4: 116 122

    Article  CAS  PubMed  Google Scholar 

  2. Jones RJ, Lee KS, Beschorner WE et al. Veno-occlusive disease of the liver following bone marrow transplantation Transplantation 1987 44: 778 783

    Article  CAS  PubMed  Google Scholar 

  3. McDonald GB, Hinds MS, Fisher LD et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients Ann Intern Med 1993 118: 255 267

    Article  CAS  PubMed  Google Scholar 

  4. Carreras E, Bertz H, Arcese W et al. Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European Group for Blood and Marrow Transplantation Blood 1998 92: 3599 3604

    CAS  PubMed  Google Scholar 

  5. Brugieres L, Harmann O, Benhamou E et al. Veno-occlusive disease of the liver following high-dose chemotherapy and autologous bone marrow transplantation in children with solid tumors: incidence, clinical course and outcome Bone Marrow Transplant 1998 3: 53 58

    Google Scholar 

  6. Styler MJ, Crilley P, Briggs J et al. Hepatic dysfunction following busulfan and cyclophosphamide myeloablation: a retrospective, multicenter analysis Bone Marrow Transplant 1996 18: 171 176

    CAS  PubMed  Google Scholar 

  7. Horn B, Reiss U, Cowan M . Veno-occlusive disease (VOD) of the liver after autologous and allogeneic hematopoietic stem cell transplantation (HSCT) in children: incidence, risk factors and outcome Blood 1998 42: (Suppl. 1) 709a (Abstr. 3131)

    Google Scholar 

  8. Reynolds CP, Seeger RC, Black DD et al. Model system for removing neuroblastoma cells from bone marrow using monoclonal antibodies and magnetic immunobeads Cancer Res 1986 46: 5882 5886

    CAS  PubMed  Google Scholar 

  9. Bearman SI, Anderson GL, Mori M et al. Venoocclusive disease of the liver: development of a model for predicting fatal outcome after marrow transplantation J Clin Oncol 1993 11: 1729 1736

    Article  CAS  PubMed  Google Scholar 

  10. Marsa-Vila L, Gorin NC, Laporte JP et al. Prophylactic heparin does not prevent liver veno-occlusive disease following autologous bone marrow transplantation Eur J Haematol 1991 47: 346 354

    Article  CAS  PubMed  Google Scholar 

  11. Meresse V, Harmann O, Vassal G et al. Risk factors for hepatic veno-occlusive disease after high-dose busulfan-containing regimens followed by autologous bone marrow transplantation: a study in 136 children Bone Marrow Transplant 1992 10: 135 141

    CAS  PubMed  Google Scholar 

  12. Attal M, Huguet F, Rubie H et al. Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low-dose heparin: a prospective, randomized trial Blood 1992 79: 2834 2840

    CAS  PubMed  Google Scholar 

  13. Rosenthal J, Sender L, Secola R et al. Phase II trial of heparin prophylaxis for veno-occlusive disease of the liver in children undergoing bone marrow transplantation Bone Marrow Transplant 1996 18: 185 191

    CAS  PubMed  Google Scholar 

  14. Simon M, Hahn T, Fort OLA et al. Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecular weight heparin Bone Marrow Transplant 2001 27: 627 633

    Article  CAS  PubMed  Google Scholar 

  15. Sullivan KM, Kansu E, Storer B et al. Intravenous immunoglobulin and the risk of hepatic veno-occlusive disease after bone marrow transplantation Biol Blood Marrow Transplant 1998 4: 20 26

    Article  CAS  PubMed  Google Scholar 

  16. Matthay KK, Villablanca JG, Seeger RC et al. Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid New Engl J Med 1999 341: 1165 1173

    Article  CAS  PubMed  Google Scholar 

  17. Kamai M, Mori S, Tanikawa S et al. Risk factors for hepatic veno-occlusive disease after bone marrow transplantation: retrospective analysis of 137 cases at a single institution Bone Marrow Transplant 1997 20: 397 402

    Article  Google Scholar 

  18. Hasegawa S, Horibe K, Kawabe T et al. Veno-occlusive disease of the liver after allogeneic bone marrow transplantation in children with hematologic malignancies: incidence, onset time and risk factors Bone Marrow Transplant 1998 22: 1191 1197

    Article  CAS  PubMed  Google Scholar 

  19. Fried MW, Duncan A, Soroka S et al. Serum hyalurnoic acid in patients with veno-occlusive disease following bone marrow transplantation Bone Marrow Transplant 2001 27: 635 639

    Article  CAS  PubMed  Google Scholar 

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Horn, B., Reiss, U., Matthay, K. et al. Veno-occlusive disease of the liver in children with solid tumors undergoing autologous hematopoietic progenitor cell transplantation: a high incidence in patients with neuroblastoma. Bone Marrow Transplant 29, 409–415 (2002). https://doi.org/10.1038/sj.bmt.1703393

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