MONITORING OF VENOOCCLUSIVE DISEASE AFTER BONE-MARROW TRANSPLANTATIONBY SERUM AMINOPROPEPTIDE OF TYPE-III PROCOLLAGEN

Differential diagnosis of hepatic complications after bone marrow tran splantation (BMT) is often difficult. To assess whether serum concentr ations of the aminopropeptide of type III procollagen (PIIINP) could f acilitate diagnosis,we measured serum PIIINP, corrected for age by con version to standard deviation scores (SDS), serially after BMT in 27 c hildren. A preliminary study of 11 patients showed that a PNIIINP-SDS cutoff of 8.0 was an optimum for diagnosis of veno-occlusive disease ( VOD). PIIINP-SDS was increased above cut-off 1-25 days before the onse t of clinical signs in the 12 patients (4 from the preliminary group, the others from a group of 16 studied prospectively) who developed VOD , with subsequent changes in PIIINP-SDS mirroring the course of VOD. B y contrast, PIIINP-SDS remained below cut-off in all other patients, i ncluding 7 with liver graft-versus-host disease and 3 with drug hepato toxicity. PIIINP-SDS values greater than 8.0 predict, diagnose, and mo nitor VOD after BMT.