A variety of risk factors may be associated with an increased risk of veno-occlusive disease. Patients with one or more risk factors may benefit from closer monitoring and more aggressive therapy.
Type of Factor
pre-existing liver disease
hepatic fibrosis or cirrhosis; elevated liver function tests, low serum pseudo-cholinesterase, low albumin; presence of hepatic metastases; viral hepatitis C
prior radiation therapy of the liver
total body irradiation, especially when combined with cyclophosphamide (depends on total dose and fractionation)
vancomycin or acyclovir exposure; use of norethisterone
methotrexate as part of GVHD prophylaxis
prior therapy with Gemtuzumab ozogamicin (Mylotarg)
high dose conditioning regimen; busulfan for conditioning, especially if high dose or combined with cyclophosphamide
previous stem cell transplantation
allogeneic transplant (as compared to autologous); graft from unrelated donor; graft from related HLA mismatch
• Norethisterone is an androgen used in treating osteoporosis (I wonder if this is a marker for advanced age).
• Gemtuzumab ozogamicin is a chemotherapy agent involving an IgG antibody targeted against CD33, which is expressed in AML and on normal hematopoietic cells.
• Previous stem cell transplantation could be a marker for refractory leukemia
Additional factors that may be implicated (not given in implementation):
(1) decreased protein C (hypercoagulability)
(2) factor V Leiden mutation (hypercoagulability)
(3) prothrombin G20210 mutation (hypercoagulability)
(4) cytomegalovirus infection (could be associated with liver disease)
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Specialty: Gastroenterology, Toxicology, Surgery, general