[Fresh Frozen Plasma Provides Endothelial Protection When Administered Early after Stem Cell Transplantation]

Veno-occlusive disease(VOD)is a fatal coagulopathy, which is caused by an endothelial disorder among patients who undergo hematopoietic stem cell transplantation(SCT). Some protective agents, such as administration of fresh frozen plasma(FFP), have been evaluated for both prophylactic and targeted therapy.

We evaluated the prophylactic efficacy of FFP for VOD in a retrospective study.

We surveyed patients who received SCT in our hospital between January 2011 and December 2011. We reviewed their data and compared those who were administered prophylactic FFP in the early transplantation period(up to day 60)with those who did not receive prophylactic FFP.

A total of 14 cases were evaluated: 7 female and 7 male, with a median age of 50 years(range of 24 to 63 years). Fibrinogen significantly increased in the FFP group compared with the non-FFP group(p=0.0125). Although the hemostasis parameters of prothrombin time, activated partial thromboplastin time, and D-dimer were all comparable between the 2 groups, the level of fibrinogen degradation products(FDP)was significantly attenuated in the FFP group compared with the non-FFP group(p= 0.0140). Of note, we observed 2 peaks in the D-dimer/FDP ratio in the engraftment period(around day 18)and postengraftment( around day 35)compared with the non-FFP group. Overall survival did not significantly differ between the 2 groups(502 days for FFP, and 586 days for non-FFP, p=0.777).

Prophylactic administration of FFP improved hypofibrinogenemia and FDP accumulation in this retrospective analysis of patients who received SCT. We speculate that prophylactic FFP treatment for dyscoagulopathy is effective due to supplementation of coagulation factors. Further study, including randomized trials, is warranted in order to confirm this hypothesis.