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 μg/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.