title: Excess of veno-occlusive disease in a randomized clinical trial on a higher trigger for red blood cell transfusion after bone marrow transplantation: a canadian blood and marrow transplant group trial.
abstract: Previous studies have shown that maintaining high hemoglobin levels in patients after chemotherapy reduced the length of neutropenia. Thus, we undertook a randomized, controlled, clinical trial in children undergoing allogeneic bone marrow transplantation after receiving a myeloablative conditioning regimen to compare 2 hemoglobin thresholds as triggers for red blood cell transfusion: 120 g/L in the experimental arm and 70 g/L in the control arm. The Data and Safety Monitoring Board closed the study after enrollment of the sixth patient because 3 patients in the experimental arm contracted veno-occlusive disease, but none in the control arm did (P = .05). Ascites was present in all 3 patients, pleura effusion in 2, and portal vein thrombosis in 2. One patient experienced hepatic failure and required treatment with the molecular adsorbent recycling system. Another patient required hemodialysis for renal failure. No major imbalance between groups was seen with regard to risk factors for veno-occlusive disease. Therefore, maintaining the hemoglobin at higher levels should be avoided after hematopoietic stem cell transplantation.
authors.affiliation: Service d'Hématologie-Oncologie, Centre de Cancérologie Charles-Bruneau, Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine,Montréal, Quebec, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Robitaille
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.forename: Lubomir
authors.initials: L
authors.lastname: Alexandrov
authors.forename: Lucy
authors.initials: L
authors.lastname: Clayton
authors.forename: Marion
authors.initials: M
authors.lastname: Cortier
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.forename: Henrique
authors.initials: H
authors.lastname: Bittencourt
authors.forename: Michel
authors.initials: M
authors.lastname: Duval
mesh_terms: D000293:Adolescent; D001201:Ascites / Q000209:etiology / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology* / Q000473:pathology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000473:pathology / Q000628:therapy; D010996:Pleural Effusion / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000473:pathology; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D006454:Hemoglobins; D019653:Myeloablative Agonists