title: Severe hypercholesterolemia in patients with graft-vs-host disease affecting the liver after stem cell transplantation.
abstract: OBJECTIVE
  To review the available literature on severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver.
  
  
  METHODS
  A literature search was conducted in PubMed for articles on hypercholesterolemia occurring in the context of graft-vs-host disease after allogeneic hematopoietic stem cell transplantation. The review included the type of lipid abnormalities observed, complications, and available management strategies.
  
  
  RESULTS
  Severe hypercholesterolemia can occur in patients who develop graft-vs-host disease after transplant. We describe 8 patients with severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver after hematopoietic stem cell transplantation (7 from the literature and 1 from our institution). No association was observed with a specific age, sex, type of hematologic malignancy, or use of a specific immunosuppressant. The elevated cholesterol is either due to high concentrations of lipoprotein X or low-density lipoprotein. Unlike low-density lipoprotein, lipoprotein X may not be atherogenic.
  
  
  CONCLUSIONS
  Treatment may not be required when lipoprotein X is the major elevated lipoprotein unless hyperviscosity occurs, but treatment is indicated when there is elevation in low-density lipoprotein. Plasmapheresis may be necessary. Ultimate treatment is control of the graft-vs-host disease affecting the liver that would improve or completely resolve the hyperlipidemia.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, California 91010, USA. rjoukhadar@coh.org
authors.forename: Rene
authors.initials: R
authors.lastname: Joukhadar
authors.forename: Ken
authors.initials: K
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015456:Leukemia, Biphenotypic, Acute / Q000628:therapy; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008074:Lipoproteins / Q000097:blood; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology*; D017093:Liver Failure / Q000209:etiology; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D008074:Lipoproteins; D002784:Cholesterol