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Hepatic dysfunction following T-cell-depleted allogeneic bone marrow transplantation
R J Soiffer1, K Dear, S N Rabinowe
1Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA 02115.
Transplantation
|December 1, 1991
Summary
Bone marrow transplantation (BMT) patients had mild liver function test abnormalities, with veno-occlusive disease (VOD) being rare. T cell-depleted BMT with specific chemotherapy and radiation showed a low VOD risk.
Area of Science:
- Hematology
- Hepatology
- Transplantation Immunology
Background:
- Bone marrow transplantation (BMT) can lead to hepatic dysfunction, including veno-occlusive disease (VOD).
- T cell-depleted allogeneic BMT using monoclonal antibody purging for graft-versus-host disease (GVHD) prophylaxis was studied.
- The incidence of hepatic dysfunction and VOD following this specific BMT protocol was investigated.
Purpose of the Study:
- To determine the incidence of hepatic dysfunction and VOD after T cell-depleted allogeneic BMT.
- To identify factors associated with hepatic dysfunction post-BMT.
- To assess the risk of VOD in patients receiving T cell-depleted BMT with cyclophosphamide and fractionated total-body irradiation.
Main Methods:
- Retrospective review of medical records for 97 patients undergoing T cell-depleted allogeneic BMT.
- Analysis of liver function tests (LFTs) including serum bilirubin, SGOT, and alkaline phosphatase.
- Logistic regression analysis to identify risk factors for hepatic dysfunction and VOD.
Main Results:
- 55% of patients experienced mild, two-fold elevations in LFTs within 30 days post-BMT.
- Only 19% had a five-fold elevation in any LFT.
- VOD was rare, with only 3.1% of patients meeting diagnostic criteria; 1.2% developed VOD with cyclophosphamide and fractionated TBI.
Conclusions:
- Hepatic dysfunction is common but generally mild after T cell-depleted allogeneic BMT.
- Graft-versus-host disease, female sex, and amphotericin B were associated with hepatic dysfunction.
- This BMT approach, using high-dose cyclophosphamide, fractionated TBI, and T cell-depleted marrow without hepatotoxic agents, poses a low risk for VOD.