Is veno-occlusive disease a specific syndrome or the exacerbation of physiopathologic hemostatic changes in hematopoietic stem cell transplantation (HSCT)?

The objective of the present study was to analyze whether veno-occlusive di sease (VOD) is based on specific findings or whether this syndrome is the e xacerbation of changes in hemostatic parameters that develop following hema topoietic stem cell transplantation (HSCT), 40 patients undergoing HSCT wer e enrolled (6 allogeneic bone marrow transplantation and 34 peripheral stem cell rescue-2 allogeneic, 32 autologous). Measurements of hemostatic param eters (endothelial, hypercoagulability and fibrinolytic markers) were obtai ned prior to chemotherapy and weekly thereafter for 3 weeks. The incidence of VOD was 15%. HSCT showed a state of moderate hypercoagulability (increas e of thrombin-antithrombin complex and fibrinogen, and decrease of Factor V II, Protein C, and antithombin-III), probably as a consequence of marked en dothelial damage (increase of von Willebrand Factor and tissue plasminogen activator), All these alterations create a potentially prothrombotic state, more pronounced in VOD. The decreasing incidence of VOD and the moderate d isease in all patients suggest that increasing improvements in transplant s trategies have reduced the risk and severity of a syndrome that at the begi nning of the transplantation era was a leading cause of morbidity/mortality , (C) 2000 Elsevier Science Ltd. All rights reserved.