A case of veno-occlusive disease complicated by severe hemorrhagic cystitis successfully treated with recombinant plasminogen activator.
Recombinant tissue plasminogen activator (rt-PA) is an effective treatment for veno-occlusive disease (VOD) after bone marrow transplantation (BMT). However rt-PA therapy is limited by the risk of hemorrhagic complications. There is little guidance about the use of rt-PA for patients with severe VOD and severe hemorrhage. We report the case of a 16-year-old woman who developed severe VOD associated with life-threatening hemorrhagic cystitis (HC). A dramatic improvement in VOD was obtained after administration of recombinant tissue plasminogen activator (rt-PA). HC was managed with continuous bladder irrigation and blood transfusions. Administration of rt-PA was followed by a moderate increase in blood transfusion requirement but rt-PA did not cause dramatic aggravation of the HC. We conclude that severe HC might not be a contraindication to rt-PA therapy and such patients can be included in randomized trials conducted to determine the efficacy and risk benefit of rt-PA therapy for VOD.
Arsène
O
O
Service d'Oncologie Médicale et des Maladies du Sang, Tours, France.
Delain
M
M
Linassier
C
C
Bremond
J L
JL
Colombat
P
P
D000293:Adolescent; D003556:Cystitis / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
D011994:Recombinant Proteins; D010960:Plasminogen Activators