SUCCESSFUL TREATMENT OF AN INFANT WITH VENOOCCLUSIVE DISEASE DEVELOPED AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION BY TISSUE-PLASMINOGEN ACTIVATOR, HEPARIN AND PROSTAGLANDIN E(1)

A 15-month-old boy with severe aplastic anemia developed veno-occlusiv e disease (VOD) after allogeneic bone marrow transplantation (BMT), in which the preparative regimen included 50 mg/kg/day cyclophosphamide and anti-lymphocyte globulin for 4 consecutive days. The diagnosis was made based on clinical symptoms and data including, hepatomegaly, rig ht upper quadrant abdominal pain, jaundice, ascites, coagulopathy and thrombocytopenia which was refractory to transfusions of platelet conc entrate. We gave 2, 3, 5 and 5 mg/day/ body of recombinant tissue plas minogen activator (tPA) followed by heparin and prostaglandin E(1) (PG E(1)) effectively and without significant side effect on days 9, 10, 1 3 and 14, respectively, Clinical and biochemical improvement was stead y and dramatic. We suggest that tPA following continuous heparin and P GE(1) infusion may be useful in the treatment of VOD even in infantile cases.