Multiple Organ Dysfunction Syndrome in Bone Marrow Transplantation

Haire, William D.; Ruby, Elizabeth I.; Gordon, B. G.; Patil, Kashinath D.; Stephens, L. Clifton; Kotulak, Gail D.; Reed, Elizabeth; Vose, Julie M.; Bierman, PJ; Kessinger, Anne; Armitage, Jamés O.

doi:10.1097/00132586-199612000-00008

Cited by 29 publications

(54 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19,28,29 The degree of fall of serum ATIII showed positive correlation with severity of VOD. 19,26 In our study, the serum level of ATIII was significantly lower in the day 0 group of the patients by day 7 of BMT, which also suggested the pathogeneic role of G-CSF in VOD.…”

Section: Tablesupporting

confidence: 61%

“…It is also in agreement with a theory of a common, immunologic pathogenesis of VOD, systemic inflammatory response syndrome and multiple organ dysfunction syndrome, where proinflammatory cytokines were felt to play a central role. 26,27 A decreased serum level of protein C and ATIII has been observed during the course of VOD. 19,28,29 The degree of fall of serum ATIII showed positive correlation with severity of VOD.…”

Section: Tablementioning

confidence: 99%

See 1 more Smart Citation

Randomized comparison of two different schedules of granulocyte colony-stimulating factor administration after allogeneic bone marrow transplantation

Lee

Choi

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:We performed a randomized trial to determine whether there are differential effects of G-CSF when it is either started on the day (day 0 group) or on the 6th day of marrow infusion (day 5 group) in the allogeneic BMT setting. G-CSF 450 g was given intravenously daily until the peripheral blood ANC was over 3000/ l. Between May 1995 and April 1998, 60 patients were enrolled (30 in each group). Median number of days of G-CSF administration was significantly longer for the day 0 group (18.5 vs 14.0 days, P Ͻ 0.001). Median days to an ANC over 500/ l were the same in both groups (16 days). Median days to an unsupported platelet count of 20 000/ l did not show significant differences (29.5 vs 28 days, P = 0.202). The frequency of hepatic VOD was higher for the day 0 group (66.7 vs 40.0%, P = 0.038). Mean plasma antithrombin III level was significantly lower in the day 0 group on post-transplant day 7 (83.6 vs 93.9%, P = 0.009). Patients in the day 0 group showed significantly worse 100-day survival (25/30 vs 30/30 surviving respectively, P = 0.019). In conclusion, early initiation of G-CSF after allogeneic BMT did not facilitate marrow engraftment. In addition, early administration of G-CSF was associated with a higher frequency of VOD and a significant fall in plasma antithrombin III level.

show abstract

Section: Tablesupporting

confidence: 61%

Section: Tablementioning

confidence: 99%

Randomized comparison of two different schedules of granulocyte colony-stimulating factor administration after allogeneic bone marrow transplantation

Lee

Choi

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…These include deficiencies of protein C, antithrombin III, protein S and elevated levels of D-dimer and prothrombin fragment F1ϩ2. [20][21][22][23][24][25][26][27] Why this is so is unclear.…”

Section: Coagulation Parametersmentioning

confidence: 99%

“…[20][21][22][23][24] Faioni et al 20 reported that baseline levels of protein C were lower in patients who developed VOD and continued to decrease post transplant. Tanikawa et al 21 and Gordon et al 22 reported that protein C levels decreased post transplant in patients who developed VOD.…”

Section: Coagulation Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Avoiding hepatic veno-occlusive disease: what do we know and where are we going?

Bearman

2001

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Hepatic venocclusive disease (V0D) is a common toxicity associated with myeloablative chemotherapy or chemoradiotherapy used to prepare patients for stem cell transplantation. A sizable proportion of patients who develop VOD die. It is clear that injury to endothelial cells and hepatocytes in zone 3 of the liver acinus is the initial event in the pathogenesis of VOD. What are less clear are the mechanisms of injury and whether this knowledge can be exploited. This manuscript will briefly review some recent data and discuss how that information has influenced clinical practice. Bone Marrow Transplantation (2001) 27, 1113-1120. Keywords: veno-occlusive disease; stem cell transplantation; toxicity VOD is characterized by a syndrome of jaundice, fluid retention and painful hepatomegaly and occurs in up to half of patients who receive ablative preparative therapy. 1 As many as half of patients with VOD die, usually of multiorgan failure. Signs of VOD usually present around the day of transplant, 2 although well described 'late onset VOD' has been reported. 3,4 Fluid retention and hepatomegaly are usually the first manifestations and typically present on or around the day of transplant. Jaundice develops later, around day 6. 2 The rate of rise in bilirubin and weight is also faster for patients whose illness is likely to be severe vs those who are likely to have self-limited disease. Furthermore, fewer than 20% of patients with mild VOD and 48% with severe VOD develop ascites. 2 These observations led to the development of a model p ϭ 1/(1 ϩ e Ϫz ) which would predict which patients with VOD were likely to die. 5 In this model, z ϭ ␤ 0 ϩ ␤ 1 (in total serum bilirubin) ϩ ␤ 2 (percent weight gain). The intercepts ␤ 0 , ␤ 1 and ␤ 2 change as day relative to transplant increases. 5 For

show abstract

A prospective randomized double-blind trial of antithrombin III concentrate in the treatment of multiple-organ dysfunction syndrome during hematopoietic stem cell transplantation

Haire

1998

Biology of Blood and Marrow Transplantation

View full text Add to dashboard Cite

Many of the complications of high-dose therapy with hematopoietic stem cells are caused by or lead to the multiple-organ dysfunction syndrome (MODS). In hematopoietic stem cell transplantation (HSCT), acquired antithrombin III (ATIII) deficiency is independently associated with MODS to the exclusion of transplant type, preparative regimen, and bacteremia. In experimental settings, replacement of ATIII can ameliorate the severity of MODS that develops in response to a variety of pathologic stimuli, suggesting that ATIII supplementation might improve the clinical course of MODS in patients undergoing HSCT. We performed a study to determine if ATIII can improve the morbidity of MODS in HSCT. Forty-nine patients undergoing HSCT, who developed pulmonary dysfunction (oxygen saturation of <90%), central nervous system dysfunction (drop of >4 points in the mini-mental status exam), or hepatic dysfunction (bilirubin >34 micromol/L [2.0 mg%], weight gain of >5% over baseline, and abdominal pain, possibly of hepatic origin) with a concomitant ATIII activity of <84% were double-blind randomized to receive ATIII concentrate, 70 units/kg within 24 hours of recognition of initial organ dysfunction followed by 50 units/kg 8, 16, 48, and 72 hours later, or albumin placebo. The group randomized to ATIII had a lower severity-of-illness score (15.7 +/- 19.2 vs. 28.6 +/- 25.2, p = 0.03), shorter duration of hospitalization (14.9 +/- 16.7 vs. 25.7 /- 17.9 days, p = 0.03), and lower hospital charges ($138,700 +/- $23,500 vs. $206,400 +/- $34,000). ATIII concentrate was associated with improved morbidity of MODS in patients undergoing HSCT when given early in the evolution of the syndrome.

show abstract

Multiple Organ Dysfunction Syndrome in Bone Marrow Transplantation

Cited by 29 publications

References 0 publications

Randomized comparison of two different schedules of granulocyte colony-stimulating factor administration after allogeneic bone marrow transplantation

Randomized comparison of two different schedules of granulocyte colony-stimulating factor administration after allogeneic bone marrow transplantation

Avoiding hepatic veno-occlusive disease: what do we know and where are we going?

A prospective randomized double-blind trial of antithrombin III concentrate in the treatment of multiple-organ dysfunction syndrome during hematopoietic stem cell transplantation

Contact Info

Product

Resources

About