Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 39, Issue 2
Displaying 1-30 of 30 articles from this issue
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  • Severe Hepatic Veno-occlusive Disease (VOD) which was Successfully Treated with Supportive Therapy, but Subsequently Developed Late-Recurrence
    Sahoko MATSUOKA, Shin-ichiro OKAMOTO, Akaru ISHIDA, Masatoshi WAKUI, R ...
    1998 Volume 39 Issue 2 Pages 139-145
    Published: 1998
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.39.139
    JOURNAL RESTRICTED ACCESS
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    A 40-year-old man with chronic myelogenous leukemia in chronic phase received an allogeneic marrow graft from his HLA identical brother. He was conditioned with busulfan (16mg/kg) and cyclophosphamide (120mg/kg). Graft-versus-host disease (GVHD) prophylaxis was attempted with cyclosporine A (CYA) and methotrexate. On day 30, weight gain, ascites and hepatomegaly developed in addition to an elevation of total bilirubin (TB). He was diagnosed as having veno-occlusive disease (VOD) and treated conservatively. The TB level increased up to 20.1mg/dl on day 66, then reduced to 2.1mg/dl on day 129. By that time ascites and hepatomegaly also had completely resolved. However, on day 134, The TB level started to increase again, when the lesions of chronic GVHD were observed in the eye, the mouth, and the skin. CYA was started on day 142, and FK506 was substituted for CYA on day 161. Despite the improvement of oral and skin lesions, TB level continued to rise, and he died of respiratory failure due to ARDS on day 186. Autopsy revealed both acute and old hepatic VOD lesions, suggesting the occurrence of late-onset VOD which probably contributed to the liver dysfunction observed after clinical resolution of the first episode of VOD.
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