title: Low incidence of hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation attributed to a combination of intravenous heparin, oral glutamine, and ursodiol at a single transplant institution.
abstract: We report the low incidence of hepatic VOD in pediatric patients with various diagnoses including hematologic malignancies and non-malignant conditions transplanted at our institution. Retrospective review of 188 patients who underwent HSCT and received a combined prophylactic regimen of intravenous heparin, oral glutamine, and ursodiol was undertaken. Analysis of the outcome of VOD revealed only one clinical case with acute myeloid leukemia; the patient developed hepatic VOD 10 days after receiving myeloablative chemotherapy with busulfan and CTX followed by HLA-matched related peripheral blood stem cell transplantation. The low incidence of hepatic VOD in an otherwise high-risk pediatric transplant population is an important observation, which may be partly attributed to this prophylactic regimen, and warrants further randomized clinical trials for confirmation.
authors.affiliation: Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11040, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Lakshminarayanan
authors.forename: Indira
authors.initials: I
authors.lastname: Sahdev
authors.forename: Meena
authors.initials: M
authors.lastname: Goyal
authors.forename: Adrianna
authors.initials: A
authors.lastname: Vlachos
authors.forename: Mark
authors.initials: M
authors.lastname: Atlas
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lipton
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D018890:Chemoprevention; D002648:Child; D002675:Child, Preschool; D005260:Female; D005973:Glutamine / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use*; D006504:Hepatic Veno-Occlusive Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005973:Glutamine; D014580:Ursodeoxycholic Acid; D006493:Heparin