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Recombinant human tissue plasminogen activator for the treatment of
established severe venocclusive disease of the liver after bone marrow
transplantation
SI Bearman, MC Shuhart, MS Hinds and GB McDonald
Division of Clinical Research, Fred Hutchinson Cancer Research Center,
Seattle.
Seven patients were treated with recombinant human tissue plasminogen
activator (tPA) for severe hepatic venocclusive disease (VOD) that
developed after bone marrow transplantation for hematologic malignancy.
Recombinant human tPA (10 mg/d x 2 days) and heparin (1,000 U bolus
followed by continuous intravenous infusion of 150 U/kg/d x 10 days) were
begun a median of 9 days (range, 4 to 18 days) posttransplant. The median
total serum bilirubin and percent weight gain from baseline were 19.4 mg/dL
(range, 14.6 to 34.9 mg/dL) and 9.1% (range, 1% to 18.5%), respectively, at
the start of tPA administration. Five patients responded to therapy with
prompt reduction in total serum bilirubin within 96 hours of starting tPA.
Three patients are alive 178 to 379 days posttransplant without evidence of
VOD. No patient had significant hemorrhagic complications with tPA. We
conclude that recombinant human tPA can be administered to patients with
severe VOD at the dosage described. Whereas preliminary data suggests that
recombinant human tPA can alter the natural history of severe VOD, further
study is necessary to determine its efficacy.
Volume 80,
Issue 10,
pp. 2458-2462,
11/15/1992
Copyright © 1992 by The American Society of Hematology
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