ACTINOMYCIN-D ASSOCIATED HEPATIC VENOOCCLUSIVE DISEASE - A REPORT OF 2 CASES

Until recently, actinomycin D (AMD), a cytotoxic antibiotic, was consi dered to cause little or no liver damage. There are now reports of liv er failure following treatment of childhood cancers with AMD. This rep ort describes the pathological changes in liver biopsy samples taken f rom 2 children who developed liver failure after combined chemotherapy for Wilms' tumor. The changes were those of nodular hyperplasia, scle rosis of terminal hepatic venules with associated zone 3 hemorrhagic n ecrosis, and sinusoidal fibrosis. These features were initially ascrib ed to the veno-occlusive disease caused by pyrrolizidine alkaloids, ra diotherapy and some therapeutic drugs but have not been described in d etail as a complication of AMD therapy. An additional feature peculiar to these 2 cases was the presence of unexplained extramedullary hemat opoiesis.