Prevention and treatment of veno-occlusive disease.
OBJECTIVE
To review the current options for prevention and treatment of veno-occlusive disease in bone marrow transplant patients.


METHODS
Articles were selected from a MEDLINE search (1966-October 1999) using the key terms veno-occlusive disease and bone marrow transplantation. In addition, references of all articles were examined for articles not found in the computer-based search.


METHODS
All clinical trials, case-control studies, and case reports were evaluated.


RESULTS
Heparin, low-molecular-weight heparin, prostaglandin E1, ursodiol, and glutamine have been studied for prevention of veno-occlusive disease. Heparin has been studied most extensively; however, no preventive regimen has a defined role in therapy. For treatment, tissue plasminogen activator has been evaluated most thoroughly, yet its safety and efficacy have not been clearly established in patients with veno-occlusive disease. Other possible treatment options include antithrombin-III, defibrotide, glutamine plus vitamin E, and surgery.


CONCLUSIONS
Based on the available data, the most promising agents are ursodiol for prevention and defibrotide or glutamineplus vitamin E for treatment of veno-occlusive disease. Further clinical trials are needed to establish the appropriate preventive and treatment options available for bone marrow transplant patients suffering from veno-occlusive disease. To date, such decisions depend largely on poorly designed trials, case reports, and clinical experience.
Pegram
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AA
Wake Forest University Baptist Medical Center, Winston-Salem NC 27157, USA. apegram@wfubmc.edu
Kennedy
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LD
D000925:Anticoagulants / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006493:Heparin / Q000627:therapeutic use*; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans
D000925:Anticoagulants; D006493:Heparin