골수이식 후에 병발하는 간정맥폐쇄성질환의 발병양상과 임상검사측정에 대한 다기관 분석

초록

Veno-occlusive disease (VOD) is one of the major causes of treatment related mortality in the setting of high dose chemotherapy rescued by bone marrow transplant. Although there have been a number of studies, a clear cut answer regarding risk factors and the methods of early detection has remained controversial. The study attempted to find useful laboratory parameters for early detection or prediction of clinical courses based upon incidence rate, risk factors, and mortality rate. From January 1998 through December 1999, a total of 145 patients (median age 35, range 14-69, male 75, female 70) who underwent autologous (n=78) or allogeneic (n=67) bone marrow transplant were prospectively studied. VOD was diagnosed in 17 cases (grave 5, moderate 7, mild 5) with an incidence rate of 11.7% and mortality rate of 23.5%. Risk factors were identified as total body irradiation, previous history of hepatitis, vancomycin administration before transplant, and allogeneic transplant. Blood samples of 104 patients were measured for D-dimer, transforming growth factor β1, tissue factor pathway inhibitor, plasminogen activation inhibitor-1, thrombomodulin, fibrin monomer, and N-terminal propeptide for type III procollagen on days 0, 7, 14, and 21 as well as baseline values before transplant. Among 104 patient studied, 7 patient had VOD, whose laboratory parameters were compared with those of 13 control patients at similar settings. Only D-dimer was of a significant predictive value (p<0.01), and other parameters did not show any significant correlation with VOD.