Low Dose Heparin For The Prevention Of Hepatic Veno-occlusive Disease (VOD) After Allogeneic Hematopoietic Stem Cell Transplantation Conditioned With BU-CY Regimen

Objective To explore the safety and efficacy of low dose heparin for the prevention of hepatic veno-occlusive disease (VOD) after allogeneic hematopoietic stem cell transplantation conditioned with busulfan and cyclophosphamide (BU-CY2) and the better time frame of the heparin administration.Methods From April 1997 to March 2004. 100 patients, including 94 leukemia patients and 6 thalessemia patients (55 male, 45 female; median age 33 years old), were transplanted in our BMT unit. All patients were conditioned with BU-CY2 or Busulfan - based regimen and scheduled to receive a continuous injection of heparin at a dose of 100IU kg-1-d-1. The patients were divided into different groups: leukemia group: 68 patients receiving related donor transplantation and 26 patients receiving unrelated donor transplantation, and thalassemia group: 6 patients; 22 patients with abnormal liver function prior to transplantation, and the other 78 patients with normal liver function; in the leukemia group, 40 patients received heparin from day -7 to day +21 post HSCT, and the other 50 patients from day -7 to day +14. In the early 15 patients prothrombin time (PT) and activated partial thromboplastin time (APTT) were monitored and in the other 85 patients PT and APTT were not. All bleeding episodes were recorded and graded.Results None of 94 leukemia patients developed VOD (0%). but one of the 6 thalassemia patients developed severe VOD (16.7%). And there were no statistically significant differences in the incidence of VOD both between abnormal liver function group and normal liver function group, and between the group of administering heparin from day -7 to day +14 and that from day -7 to day +21. The incidence and severity of clinical bleeding events in 15 patients with monitoring of PT and APTT is comparable with those without monitoring of PT and APTT.Conclusion These results suggest that low dose heparin alone is effective and safe for the prophylaxis of VOD following allogeneic hematopoietic stem cell transplantation conditioned with BU-CY regimen. Shortening the duration of administering heparin from -7d to +21d to -7d to +14d does not affect the effectiveness of low dose heparin to prevent VOD.