Anti-thrombin III in the management of hematopoietic stem-cell transplantation-associated toxicity.
OBJECTIVE
To describe the evidence assessing the use of anti-thrombin III (AT-III) in the management of toxicity associated with hematopoietic stem-cell transplantation (HSCT)-conditioning regimens.


METHODS
Clinical literature was accessed through conference proceedings, EMBASE, the Cochrane database, and MEDLINE (1966-December 2003).


METHODS
Case reports, small case series, case-control and cohort studies, and randomized controlled trials of AT-III in HSCT were evaluated. Publications examining AT-III use in the non-HSCT setting were also explored. Key search terms included AT-III, transplantation, and veno-occlusive disease (VOD).


RESULTS
Severe VOD and ensuing multiple organ dysfunction is associated with high mortality in HSCT. A low AT-III level has been shown to correlate with the development of organ dysfunction. Phase II trials, case series, and one small, randomized, placebo-controlled study suggest a benefit when AT-III therapy is instituted early in the course of VOD/multiple organ dysfunction syndrome. In all of these reports, AT-III use was devoid of adverse events.


CONCLUSIONS
Although further studies are needed to ascertain the optimal target level, method, and duration of administration, AT-III is still a viable alternative for the treatment of severe VOD and ensuing multiple organ dysfunction.
Ibrahim
Rami B
RB
Karmanos Cancer Institute, Harper University Hospital, The Detroit Medical Center, 3990 John R, Detroit, MI 48201-2020, USA. ribrahim@dmc.org
Peres
Edward
E
Dansey
Roger
R
Abidi
Muneer H
MH
Abella
Esteban M
EM
Klein
Jared
J
D000990:Antithrombin III / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology / Q000517:prevention & control
D000990:Antithrombin III