Late onset veno-occlusive disease following high-dose chemotherapy and stem cell transplantation

The original definition of hepatic veno-occlusive disease (VOD), which is s till widely accepted, includes onset of the clinical syndrome before day +2 0 following high-dose chemotherapy (HDC) and stem cell transplantation (SCT ), We retrospectively identified four patients following HDC and SCT presen ting with late onset VOD occurring at day +24, day +27, day +34 and day +42 post SCT, All patients had moderate VOD, with successful resolution of the VOD before day +100 with optimal supportive therapy. Common risk factors f or VOD shared by all four patients included an older age (median age: 60 ye ars), and use of a busulphan-containing regimen. Mean and maximum bilirubin levels for all patients during the VOD syndrome,were 2.02, 1.76, 5.09, 2.8 7 mg/dl and 2.5, 2.2, 8.9 and 4.1 mg/dl, respectively, which correlated wel l with duration of VOD, All patients encountered platelet transfusion-depen dent thrombocytopenia during VOD, Ursodeoxycholic acid was used as VOD prop hylaxis beginning at a mean of 33 days prior to onset of VOD, As the cellul ar target of hepatic VOD is as yet unidentified, it is uncertain whether ur sodiol or other common characteristics of patients with late onset VOD infl uence the pathogenesis and natural history of this disease, We believe that the uncommon clinical entity of late onset VOD, a potentially fatal regime n-related toxicity, should not be ignored as a diagnosis of liver disease a fter 3 or more weeks following HDC and SCT.