Oral eicosapentaenoic acid for complications of bone marrow transplantation

The 'systemic inflammatory response syndrome' (SIRS) may represent the unde rlying cause of complications after bone marrow transplantation (BMT). This study was conducted to determine whether blocking the etiologic factors of SIRS could improve the complications of BMT. Sixteen consecutive patients with unrelated donors were allocated alternately to two groups. Seven patie nts received 1.8 g/day of eicosapentaenoic acid (EPA) orally from 3 weeks b efore to about 180 days after transplantation, while nine patients did not. These two groups were compared with respect to complications, survival, an d various cytokines and factors causing vascular endothelial damage. All se ven patients receiving EPA survived and only two had grade III graft-versus -host disease (GVHD). Among the nine patients not receiving EPA, three had grade III or IV GVHD. In addition, thrombotic microangiopathy developed in four patients and cytomegalovirus disease occurred in four. Five patients d ied in this group. The levels of leukotriene B-4, thromboxane A(2), and pro staglandin I-2 were significantly lower in patients receiving EPA than in t hose not receiving it (all P < 0.01). Cytokines such as tumor necrosis fact or-alpha, interferon-gamma, and interleukin-10 were also significantly decr eased by EPA (P < 0.05), as were factors causing vascular endothelial damag e such as thrombomodulin and plasminogen activator inhibitor-1 (P < 0.05). The survival rate was significantly higher in the group given EPA (P < 0.01 ). EPA significantly reduced the complications of BMT, indicating that thes e complications may be manifestations of the systemic inflammatory response syndrome.