Hepatic veno-occlusive disease(VOD) is a major life-threatening complication of bone marrow transplantation(BMT) caused by high-dose chemotherapy or radiotherapy. The aim of this study is to evaluate the incidence, risk factors, prophylactic effects of low-dose heparin and pentoxifylline(PTX) and therapeutic response to recombinant human tissue plasminogen activator(rt-PA) in VOD patients with leukemia after allogeneic BMT.

Thirty-two consecutive leukemia patients who underwent HLA-matched allogeneic BMT were included in this study. VOD was clinically defined as having two of the following features : hyperbilirubinemia(≥2mg/dL), tender hepatomegaly, unexplained weight gain(>2% from baseline) and/or ascites. Low-dose heparin(l00unit/kg/day, IV) and PTX(1,600mg/day, P0) were administered for the prevention of VOD.

The median age of recipients in this study was 27(17 - 44) years. Patients were treated for the following diseases : 17(53.1%) for acute myeloid leukemia(AML), 10(31.3%) for acute lymphoblastic leukemia(ALL) and 5(15.6%) for chronic myeloid leukemia(CML). Fourteen patients(43.7%) were classified as having high-risk pre-BMT status. Of the 32 consecutive patients undergoing allogeneic BMT, 5(15.6%) developed VOD. A higher risk of developing VOD was associated with pre-BMT disease status(p<0.01). All VOD patients received rt-PA-based thrombolytic therapy and complete resolution was achieved in-4(80.0%) of 5 patients without significant bleeding complications.

Further studies are needed to develop more effective prophylactic and thera-peutic approaches of VOD in patients with high-risk leukemia after allogeneic BMT.

This study was performed to evaluate the impact of various peri-transplant factors on transfusion requirements in 45 patients with leukemia or severe aplastic anemia undergoing HLA-matched allogeneic bone marrow transplantation(BMT).

All patients were treated in an isolated room with HEPA filtration, and the combination of cyclosporin and short-course of methotrexate was used for GVHD prophylaxis. Patients received irradiated packed red cells to maintain the hematocrit ≥30% and irradiated platelet pheresis to keep the platelet count ≥20,000/µl.

In the first month, the mean(range) number of red cells and platelet pheresis were 4.9(0-21), 26.7(8-61), respectively. On univariate analyses, pre-BMT status(high-risk : 7.94±5.14 vs standard-risk: 3.78±2.99, p=0.0076) and concurrent infection(present : 8.41±4.70 vs absent : 3.33±2.72, p=0.0005) and sex incompatibility(match : 4.67±3.72 vs female → male : 3.78±3.07 vs male → female : 9.13±5.74, p=0.0161) were significantly associated with red cell requirements in the first month. Also, high-risk pre-BMT status(32.25±16.15 vs 20.25±14.64, p=0.0l56), the presence of concurrent infection(39.35±16.42 vs 15.33±5.67, p=0.0001) and veno-occlusive disease(45.00±14.47 vs 22.00±14.49, p=0.0055) increased platelet requirements significantly after allogeneic BMT. In particular, pre-BMT disease status was found to be independently associated with transfusion requirements.

This study demonstrates that pre-BMT status does influence transfusion requirements in the first month after HLA-matched allogeneic BMT. Further studies are necessary to confirm these results and to define optimal transfusion strategies.

Tumor lysis syndrome(TLS) has been broadly defined as the metabolic abnormalities that occur after rapid tumor breakdown. The purpose of this study was to evaluate the types or degrees of metabolic abnormalities and clinical characteristics in patients with high-grade non-Hodgkin's lymphoma(NHL) who developed clinical TLS.

Patients were considered to have 'clinical TLS' if two of the following metabolic abnormalities occurred within 4 days of treatment : a 25% increase in the serum phosphate, potassium, uric acid, urea nitrogen concentrations, or a 25% decline in the serum calcium concentration and one of the following : a serum potassium level greater than 6.0mEq/L, a creatinine level greater than 2.5mg/dL, a calcium level less than 6.0mg/dL, the development of a life-threatening arrhythmia, or sudden death.

Clonical TLS occurred in 15 patients with advanced high-grade NHL, and these patients were associated with elevated lactate dehydrogenase(LDH) and β₂-mivtonlonulin(MG)levels. Pre-treatment TLS occurred in 10 patients(66.7%) and post-treatment TLS in 5 patients(33.3%). Most of these patients showed metabolic abnormalities including hyperuricemia, hyperphosphatemia, hypocalcemia, or acute renal insufficiency. They were treated with adequate hydration combined with allopurinol and recovered in 4 patients. In remained 11 patients, hemodialysis was required and the metabolic parameters returned to normal levels without any significant complications.

It is important to remember that patients with advanced high-grade NHL who have more increased serum LDH or β₂-MG level be carefully monitored. Further investigations of elucidating risk factors and diagnostic criteria on clinical TLS will be required.