Use of prostaglandin E1 for prevention of liver veno‐occlusive disease in leukaemic patients treated by allogeneic bone marrow transplantation

Abstract

Prostaglandin E1 (PGE1) was used to prevent veno-occlusive disease (VOD) of the liver after allogeneic bone marrow transplantation (BMT) for leukaemia. It was given in continuous i.v. infusion from day--8 to day 30 after BMT at a dose of 0.3 micrograms/kg/h. The patients were studied according to the risk factors for VOD: diagnosis, intensification of the conditioning and previous liver abnormalities. The diagnosis of VOD was made on at least two of the following factors: weight gain, hepatomegaly, jaundice, ascitis, pain of the right upper quadrant, increased platelet consumption. 109 patients were studied, 50 were treated by PGE1 and 59 did not receive it. The actuarial incidence of VOD was 12.2% in the PGE1 group and 25.5% in the non PGE1 group (P = 0.05). In acute leukaemia, the incidence was 39.1% in the non-treated group and 12.8% in the PGE1 treated group (P = 0.02). Patients with previous hepatitis had an incidence of 62.5% in the non treated group and 15.5% in the treated group (P = 0.05). A positive cytomegalovirus (CMV) serology seemed to increase the risk of VOD: the incidence of VOD was 31.4% in non-treated patients and 22% in PGE1 treated patients. The multivariate analysis of the risk factors for VOD shows that unfavourable factors were: recipient positive CMV serology (P = 0.06), hepatic disease prior to transplant (P = 0.02) and the absence of PGE1 treatment (P = 0.02). This study suggests that prophylactic PGE1 treatment may decrease the incidence of VOD in patients treated for leukaemia by allogeneic bone marrow transplantation.

Retrospective multivariate analysis of hepatic veno-occlusive disease after blood or marrow transplantation: possible beneficial use of low molecular weight heparin

“…Although our study was not randomized, we found a similar incidence of VOD in the no prophylaxis group as several other studies. 1,3,7,8,10,13 We confirmed previous findings that unrelated donor, decreased performance status and elevated AST are significant risk factors for developing VOD. We concluded that a significantly lower incidence of VOD developed in patients treated with Hep Ϯ PGE1 or LMWH than in the control patients.…”

“…[7][8][9][10][11][12] Nevertheless, these studies demonstrated that low doses of Hep could be safely administered to BMT patients. Prostaglandin E1 (PGE1) was used as a VOD prophylactic regimen by Gluckman et al, 13 who found a decreased incidence of VOD in patients treated with PGE1, whereas Bearman et al, 14 concluded that PGE1 was too toxic. Previous work has demonstrated the efficacy and safety of low molecular weight heparin (LMWH) for deep venous thrombosis prophylaxis and treatment.…”

Changes in hemostatic parameters in hepatic veno-occlusive disease following bone marrow transplantation

“…Although various drugs such as heparin, pentoxifylline, prostaglandin E1 (PGE1), ursodepxycholic acid are used to prevent VOD, their efficacy is uncertain. [19][20][21][22][23] There is no consistently effective therapy for VOD, although a few case reports recommend recombinant tissue plasminogen activator (rt-PA) as treatment. [24][25][26][27] All VOD patients in this study received continuous infusions of heparin, and two received AT-III to keep the and two received prophylactic AT-III.…”

A Successful Liver Transplantation for Refractory Hepatic Veno‐Occlusive Disease Originating from Cord Blood Transplantation

“…As prophylaxis against hepatic VOD, UDCA, LMWH and PGE1 have been favorably reported (18)(19)(20), while conservative treatments of hepatic VOD include rt-PA, DF, AT-III and PGE1 (6,7,21). In this case, we tried all of the above -except for rt-PA -and all failed.…”