SUCCESSFUL TREATMENT OF VENOOCCLUSIVE DISEASE OF THE LIVER WITH UROKINASE IN A PATIENT WITH NON-HODGKINS-LYMPHOMA

A 38-year-old man with a non-Hodgkin's lymphoma of intermediate grade malignancy attained partial remission after three courses of CHOP (cyc lophosphamide + hydroxydaunorubicin + vincristine + prednisolone). He was assigned to undergo autologous bone marrow transplantation (ABMT). The conditioning regimen consisted of cyclophosphamide and whole body irradiation. Two weeks later he developed veno-occlusive disease (VOD ) of the liver. Doppler sonography confirmed the diagnosis showing a r eversal of the blood flow in the portal vein. In addition a large thro mbus was present in the interior caval vein. Protein C level was stron gly reduced (28%). Because of clinical deterioration intravenous uroki nase was started. The transaminases normalised rapidly and the patient showed a dramatic clinical improvement. There were no major bleeding complications. Repeat Doppler sonography showed a normal antegrade flo w in the portal vein. This case suggests that a coagulopathy in the he patic vascular bed might contribute to the development of VOD and that patients with VOD are st risk for other thrombotic complications. Fur thermore it shows that urokinase with platelet support can be given sa fely and effectively to a patient with VOD and severe thrombocytopenia .