Styler M J, Crilley P, Biggs J, Moul J, Copelan E, Topolsky D, Avalos B, Penza S, Sabol P, Downs K, Szer J, Brodsky I, Marks D I
Department of Neoplastic Diseases, Hahnemann University Hospital, Philadelphia, PA 19102, USA.
Bone Marrow Transplant. 1996 Jul;18(1):171-6.
Veno-occlusive disease continues to be a significant cause of morbidity and early mortality following bone marrow transplantation. This study retrospectively analyzes the incidence and risk factors for severe VOD in 350 patients treated with 4 days of busulfan (total 16 mg/kg) and 2 days of cyclophosphamide (120 mg/kg) at four marrow transplant centers. Using the criteria defined by McDonald et al (Hepatology 1984; 4: 116-122), 93/350 (27%) developed VOD (11% mild, 5% moderate and 11% severe). Multivariate analysis revealed the following risk factors to be significantly associated with severe VOD: pretransplant transaminase and alkaline phosphatase elevation, ciprofloxacin antibiotic prophylaxis, use of estrogen/progestins or vancomycin during the peritransplant period and methotrexate for GVHD prophylaxis. Mild to moderate grades of VOD were not associated with significantly increased mortality but mortality was higher in patients with severe VOD (31%, P = 0.0013). These data suggest that risk factors for VOD may depend on the preparative regimen used and suggest that use of these risk factors may identify a subgroup of patients that can be targetted for studies of prevention of VOD.
静脉闭塞性疾病仍然是骨髓移植后发病和早期死亡的重要原因。本研究回顾性分析了四个骨髓移植中心350例接受4天白消安（总量16mg/kg）和2天环磷酰胺（120mg/kg）治疗的患者中严重静脉闭塞性疾病的发病率和危险因素。采用McDonald等人定义的标准（《肝脏病学》1984年；4：116 - 122），93/350（27%）发生了静脉闭塞性疾病（11%为轻度，5%为中度，11%为重度）。多变量分析显示，以下危险因素与严重静脉闭塞性疾病显著相关：移植前转氨酶和碱性磷酸酶升高、环丙沙星抗生素预防、移植期间使用雌激素/孕激素或万古霉素以及使用甲氨蝶呤预防移植物抗宿主病。轻度至中度的静脉闭塞性疾病与死亡率显著增加无关，但严重静脉闭塞性疾病患者的死亡率更高（31%，P = 0.0013）。这些数据表明，静脉闭塞性疾病的危险因素可能取决于所使用的预处理方案，并表明使用这些危险因素可能识别出一组可作为预防静脉闭塞性疾病研究目标的患者亚组。
