HEPATIC-DYSFUNCTION FOLLOWING BUSULFAN AND CYCLOPHOSPHAMIDE MYELOABLATION - A RETROSPECTIVE, MULTICENTER ANALYSIS

Veno-occlusive disease continues to be a significant cause of morbidit y and early mortality following bone marrow transplantation. This stud y retrospectively analyzes the incidence and risk factors for severe V OD in 350 patients treated with 4 days of busulfan (total 16 mg/kg) an d 2 days of cyclophosphamide (120 mg/kg) at four marrow transplant cen ters, Using the criteria defined by McDonald et al (Hepafology 1984; 4 : 161-122), 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 transaminas e and alkaline phosphatase elevation, ciprofloxacin antibiotic prophyl axis, use of estrogen/progestins or vancomycin during the peritranspla nt period and methotrexate for GVHD prophylaxis, Mild to moderate grad es of VOD were not associated with significantly increased mortality b ut mortality was higher in patients with severe VOD (31%, P = 0.0013). These data suggest that risk factors for VOD may depend on the prepar ative regimen used and suggest that use of these risk factors may iden tify a subgroup of patients that can be targetted for studies of preve ntion of VOD.