Marked reduction in the incidence of hepatic veno-occlusive disease after allogeneic hematopoietic stem cell transplantation with CD34(+) positive selection

Veno-occlusive disease of the liver (VOD) is a common and severe complicati on of allogeneic hematopoietic stem cell transplantation (HSCT), To determi ne the incidence of, and the risk factors for the development of VOD, we pe rformed a retrospective analysis of a series of 178 patients, who underwent allogeneic HSCT at our institution between 1990 and 1999, Busulfan and cyc lophosphamide constituted the conditioning regimen most frequently administ ered. Bone marrow was the source of stem cells in 129 patients (73%), and p eripheral blood (PBSC) in 49 patients (27%), Thirty-one patients of the PBS C group received CD34(+) positively selected grafts. Most patients were giv en cyclosporin A and methotrexate (MTX) as graft-versus-host disease (GVHD) prophylaxis. Overall, 30 patients (17%) developed VOD, In univariate analy ses, the incidence of VOD was significantly higher in recipients of unmanip ulated grafts (20% vs 0%; P=0.01), in patients with active malignant diseas e at transplantation (24% vs 9%; P = 0.03), in recipients of marrow from un related donors (33% vs 15%; P = 0.03), in patients grafted with bone marrow (21% vs 6%; P = 0.03), and in those receiving MTX as GVHD prophylaxis (21% vs 6%; P = 0.05), Under multivariate analysis, only CD34(+) positive selec tion (P = 0.0004) and the status of the disease at transplant (P = 0.03) we re statistically significant variables for the development of VOD, We concl ude that CD34(+) positively selected PBSC transplantation could result in a marked reduction in the incidence of VOD after allogeneic HSCT.