Successful therapy of transplant-associated veno-occlusive disease with a combination of tissue plasminogen activator and defibrotide |
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Authors: | MJ Jenner INM Micallef AZ Rohatiner SM Kelsey AC Newland JD Cavenagh |
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Institution: | (1) Imperial Cancer Research Fund Department of Medical Oncology, St Bartholomew's Hospital, 45 Little Britain, EC1A 7BE London, UK;(2) Department of Haematology, St Bartholomew's Hospital, 45 Little Britain, EC1A 7BE London, UK |
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Abstract: | A 36-year-old man underwent matched unrelated donor bone marrow transplantation for chronic myeloid leukaemia. He developed
severe hepatic veno-occlusive disease as an early post-transplant complication. Tissue plasminogen activator was initially
felt to be contraindicated since the patient had concomitant pericarditis. Defibrotide was therefore commenced as treatment
for veno-occlusive disease. The pericarditis improved but the veno-occlusive disease continued to worsen (peak bilirubin 353
μmol/I). Tissue plasminogen activator followed by a heparin infusion was therefore administered. However, he proceeded to
develop haemorrhagic cardiac tamponade that required drainage. Thrombolysis was therefore discontinued and treatment with
defibrotide resumed after an interval of 48 h. The veno-occlusive disease gradually resolved and defibrotide was discontinued
once the bilirubin had plateaued. He was discharged home on day +52 post-transplant. |
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Keywords: | veno-occlusive disease tissue plasminogen activator defibrotide bone marrow transplantation |
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