Successful therapy of transplant-associated veno-occlusive disease with a combination of tissue plasminogen activator and defibrotide.
A 36-year-old man underwent matched unrelated donor bone marrow transplantation for chronic myeloid leukaemia. He developed severe hepatic veno-occlusive disease as an early post-transplant complication. Tissue plasminogen activator was initially felt to be contraindicated since the patient had concomitant pericarditis. Defibrotide was therefore commenced as treatment for veno-occlusive disease. The pericarditis improved but the veno-occlusive disease continued to worsen (peak bilirubin 353 micromol/l). Tissue plasminogen activator followed by a heparin infusion was therefore administered. However, he proceeded to develop haemorrhagic cardiac tamponade that required drainage. Thrombolysis was therefore discontinued and treatment with defibrotide resumed after an interval of 48 h. The veno-occlusive disease gradually resolved and defibrotide was discontinued once the bilirubin had plateaued. He was discharged home on day +52 post-transplant.
Jenner
M J
MJ
Imperial Cancer Research Fund Department of Medical Oncology, St Bartholomew's Hospital, London, UK. m.j.jenner@mds.qmw.ac.uk
Micallef
I N
IN
Rohatiner
A Z
AZ
Kelsey
S M
SM
Newland
A C
AC
Cavenagh
J D
JD
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002305:Cardiac Tamponade; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006504:Hepatic Veno-Occlusive Disease / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy*; D008297:Male; D010493:Pericarditis; D011089:Polydeoxyribonucleotides / Q000627:therapeutic use*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011089:Polydeoxyribonucleotides; C036901:defibrotide; D010959:Tissue Plasminogen Activator