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High-dose Methylprednisolone for Veno-occlusive Disease of the Liver in Pediatric Hematopoietic Stem Cell Transplant Recipients.
MedLine Citation:
PMID:  23211838     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Veno-occlusive disease (VOD) of the liver is a well-recognized serious complication of hematopoietic stem cell transplantation (HSCT) with few successful treatment modalities available for severe disease. While there have been some reports demonstrating success in adults with high dose steroid therapy, experience in the pediatric population is lacking. We retrospectively reviewed HSCT patients treated at our institution since 2003 and identified 15 (2.4%) who developed VOD. Of these 9 (60%) were treated with high-dose Methylprednisolone (500 mg/m(2)/dose IV every 12 hours for 6 doses). Steroid therapy was initiated at or prior to first ultrasound evidence of reversal of portal venous flow, and prior to meeting criteria for initiation of defibrotide therapy. Four of the patients were also treated with defibrotide starting 2 to 5 days following initiation of steroids. Eight of 9 patients (88%) with VOD were diagnosed with multi-organ failure (MOF). Response to high dose steroid therapy as defined by decrease in bilirubin by 50% by ten days from therapy initiation was noted in 6/9 (67%) patients, occurring within 3 to 6 days of steroid therapy. Two patients died due to VOD with MOF. Seven survivors of VOD recovered from VOD at the median 6 days (range 5-38) from VOD diagnosis. Overall VOD survival as a group was 78% however survival amongst responders was 100%. No serious toxicities related to high dose steroid therapy were observed. We conclude that high dose steroid therapy if initiated early may reverse VOD of the liver in pediatric HSCT patients, abrogating the need for defibrotide therapy with its associated toxicities and regulatory difficulties.
Authors:
Kasiani C Myers; Julia Lawrence; Rebecca A Marsh; Stella M Davies; Sonata Jodele
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-1
Journal Detail:
Title:  Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation     Volume:  -     ISSN:  1523-6536     ISO Abbreviation:  Biol. Blood Marrow Transplant.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9600628     Medline TA:  Biol Blood Marrow Transplant     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA. Electronic address: kasiani.myers@cchmc.org.
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