title: Plasma protein C is a useful clinical marker for hepatic veno-occlusive disease (VOD) in stem cell transplantation.
abstract: BACKGROUND
  Hepatic veno-occlusive disease (VOD) is one of the most serious complications in stem cell transplantation (SCT). Although plasma protein C activity decreases in VOD after SCT, the timeframe of plasma protein C activity decreases during SCT is not known.
  
  
  METHODS
  We examined levels of plasma protein C serially during the course of SCT to determine the critical level and risk factors for VOD.
  
  
  RESULTS
  Of 151 children who received SCT, 12 of them (7.9%) developed VOD. The mean minimum protein C activity in patients with VOD was significantly lower compared to that in patients without VOD (P < 0.0001). Receiver operating characteristic curve analysis revealed that the critical plasma protein C activity (cut-off point) for VOD was identified to be 34.5% with high sensitivity (100%) and specificity (83.3%), and the reduction of plasma protein C below the cut-off level (day +6.50 +/- 2.43) was observed mostly prior to the onset of VOD (day +7.33 +/- 2.64). The patients receiving melphalan in conditioning were found to be at high risk for VOD (P = 0.003). Among the melphalan containing regimens, melphalan + carboplatin + etoposide was a significant risk factor for depression of plasma protein C (P = 0.037).
  
  
  CONCLUSIONS
  Plasma protein C level was a useful parameter of VOD after SCT, and activity below 34.5% was critical for VOD. The use of melphalan in conditioning causes a high risk for VOD.
authors.affiliation: Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan. akihiro.iguchi@city.chitose.hokkaido.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Iguchi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Makoto
authors.initials: M
authors.lastname: Kaneda
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002802:Cholinesterases / Q000097:blood; D005260:Female; D006086:Graft vs Host Disease / Q000201:enzymology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000201:enzymology / Q000628:therapy; D006504:Hepatic Veno-Occlusive Disease / Q000201:enzymology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000201:enzymology / Q000628:therapy; D011486:Protein C / Q000378:metabolism*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D019172:Transplantation Conditioning; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011486:Protein C; D002802:Cholinesterases