ABNORMAL LIVER-FUNCTION IN PATIENTS UNDERGOING AUTOLOGOUS BONE-MARROWTRANSPLANTATION FOR HEMATOLOGICAL MALIGNANCIES

Autologous bone marrow transplantation (AuBMT) is an accepted treatmen t modality for patients with high-risk or relapsed hematological malig nancies. Hepatotoxicity, in particular veno-occlusive disease (VOD), i s a significant complication of this therapy. The purpose of this stud y was to determine the clinical relevance of abnormal liver function i n the patients who received high-dose cytotoxic therapy and AuBMT for hematological malignancies at Memorial Sloan Kettering Cancer Center. Medical records of 180 consecutive patients between 1984 and 1991 trea ted with cytotoxic chemotherapy and AuBMT for acute myelogenous leukem ia, non-Hodgkin's lymphoma, and Hodgkin's disease were reviewed. Forty -six patients (26%) developed jaundice with bilirubin >4 mg/dl. These patients had a 43% toxic death rate compared to an 11% toxic death rat e in patients with lower bilirubins (p < 0.001). The main etiology of hyperbilirubinemia was VOD of the liver noted in 22 of the 180 patient s (12%). Other etiologies of jaundice included hepatitis, sepsis with multiorgan dysfunction, cholecystitis, and recurrent disease. Hyperbil irubinemia of various etiologies is a significant complication of AuBM T. Several new strategies are under investigation to decrease the toxi city of intensive therapy.