Autologous bone marrow transplantation and factor XII, factor VII, and protein C deficiencies. Report of a new association and its possible relationship to endothelial cell injury.
Four patients who underwent treatment with high-dose chemotherapy (HDC) and autologous bone marrow transplantation (ABMT) and in whom posttreatment deficiencies of Factor XII and protein C subsequently developed are reported. Factor VII or Factor X deficiencies also developed in several of these patients. Three of these patients experienced chemotherapy-related cardiac, hepatic, or pulmonary toxicity. It is believed by many that endothelial cell injury may be the underlying lesion responsible for these various organ system toxicities seen in the setting of ABMT, although direct evidence of this is lacking. It is proposed that the factor deficiencies described in this report may be an additional consequence of endothelial cell injury or dysfunction. These coagulation factor deficiencies may therefore serve as both a marker to follow these organ system toxicities with and as a useful tool to better study and understand the mechanisms underlying these events. Additionally, deficiencies of either Factor VII or Factor X developed in several patients that were of a sufficient magnitude such that factor replacement therapy would be indicated before any invasive procedures or in the event of significant hemorrhage.
Kaufman
P A
PA
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Jones
R B
RB
Greenberg
C S
CS
Peters
W P
WP
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D005168:Factor VII Deficiency / Q000209:etiology*; D005169:Factor VIII / Q000378:metabolism; D005171:Factor X Deficiency / Q000209:etiology; D005173:Factor XI Deficiency / Q000209:etiology; D005175:Factor XII Deficiency / Q000209:etiology*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D020151:Protein C Deficiency
D005169:Factor VIII