title: Experiences of t-PA use in moderate-to-severe hepatic veno-occlusive disease after hematopoietic SCT: is it still reasonable to use t-PA?
abstract: Hepatic veno-occlusive disease (VOD) remains one of the most severe complications of hematopoietic SCT (HSCT). Anticoagulation and thrombolytic therapies using tissue-plasminogen activator (t-PA) have been used, but are reported to be ineffective and are associated with significant bleeding complications. We analyzed 56 moderate-to-severe post HSCT hepatic VOD cases treated with t-PA. We analyzed clinical outcomes according to the maximal daily dose of t-PA (t-PAmax) and the severity of VOD. Patients were stratified by t-PAmax10 mg (n=37) vs t-PAmax>10 mg (n=19). A higher t-PAmax was associated with increased mortality. Bleeding complications were more likely at higher t-PAmax in both moderate and severe VOD (P=0.036, 0.063), especially if patients had concomitant use of anticoagulants (36.4% vs 13.3%). In moderate VOD, the response rate was 86.4% for t-PAmax10 mg/day and 80% for t-PAmax>10 mg compared with 33.3% and 7.1%, respectively, for severe VOD (P=0.106). The 5-year OS in moderate and severe VOD was 49% and 7%, respectively, and it was 32% for t-PAmax10 mg and 18% for t-PAmax>10 mg. Our data demonstrate that lower bleeding complications and bleeding-related deaths may result from strict limitations on the t-PAmax without concomitant use of anticoagulation therapy. However, the overall response and survival outcomes should be re-evaluated by a well-validated study in the future.
authors.affiliation: Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Yoon
authors.forename: W-S
authors.initials: WS
authors.lastname: Min
authors.forename: H-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Shin
authors.forename: S-A
authors.initials: SA
authors.lastname: Yahng
authors.forename: S-E
authors.initials: SE
authors.lastname: Lee
authors.forename: B-S
authors.initials: BS
authors.lastname: Cho
authors.forename: K-S
authors.initials: KS
authors.lastname: Eom
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: C-K
authors.initials: CK
authors.lastname: Min
authors.forename: S-G
authors.initials: SG
authors.lastname: Cho
authors.forename: D-W
authors.initials: DW
authors.lastname: Kim
authors.forename: J-W
authors.initials: JW
authors.lastname: Lee
authors.forename: C-W
authors.initials: CW
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006504:Hepatic Veno-Occlusive Disease / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator