HYPERCOAGULABILITY IN PATIENTS UNDERGOING AUTOLOGOUS OR ALLOGENEIC BMT FOR HEMATOLOGICAL MALIGNANCIES

Severe thrombotic alterations, such as veno-occlusive disease of the l iver, may occur in the early phase following high-dose chemoradiothera py and BMT. In this study, performed in patients with hematological ma lignancies subjected to allogeneic (10 cases) and autologous (20 cases ) BMT, we have monitored laboratory hemostatic parameters to better un derstand the pathogenetic mechanism of thrombosis and particularly of veno-occlusive disease. Prothrombin time, activated partial thrombopla stin time, plasma fibrinogen, markers of hypercoagulability (thrombin- antithrombin complex and prothrombin fragment F1 + 2); natural anticoa gulants (protein C, protein S and antithrombin) together with fibrinol itic parameters (plasminogen, alpha2-antiplasmin, tissue-plasminogen a ctivator, plasminogen activator inhibitor and D-dimer) were assessed b efore transplant, on day 0 and weekly for 1 month thereafter. A hyperc oagulability state, not related to an impairment of the anticoagulant and fibrinolytic systems, was documented before and after autologous a nd allogeneic transplant. Two patients developed veno-occlusive diseas e: they did not show any difference from the other patients before tra nsplant while they presented a decrease of the natural anticoagulants along with altered fibrinolytic parameters only at the clinical onset of veno-occlusive disease. In conclusion, in this study a state of mar ked hypercoagulability was documented in BMT patients and the hemostat ic laboratory parameters evaluated were not able to predict the occurr ence of the thrombotic complications.