Korean J Pediatr Hematol Oncol.  2004 Apr;11(1):80-85.

Hepatic Veno-occlusive Disease after Combination Chemotherapy with Vincristine, Actinomycin-D, Cyclophosphamide: Successful Treatment with Glutathione and Vitamin E

• Lee KH
• Bae H
• Park HJ

Abstract

Hepatic veno-occlusive disease (VOD) is characterized by the narrowing or fibrous obliteration of terminal hepatic venules and small sublobular veins. The obliteration of blood flow may lead to tender hepatomegaly, ascites, hepatocellular necrosis, and possibly encephalopathy. Hepatic VOD is a well described complication after allogeneic and autologous stem cell transplantation (SCT) for malignancy. The intergroup rhabdomyosarcoma study (IRS) group has extensively used the combination chemotherapy of vincristine, actinomycin-D, and cyclophosphamide (VAC) for the treatment of rhabdomyosarcoma and hepatic VOD was rarely reported after the administration of VAC chemotherapy. We report a case of severe hepatic VOD which occurred in a 7 year-old boy with stage III rhabdomyosarcoma after VAC chemotherapy according to IRS-IV regimen. He developed persistent thrombocytopenia, tender hepatomegaly, jaundice, weight gain due to ascites and generalized edema, and was treated successfully with N-acetylcysteine, nitrate, green tea polyphenol, glutathione and vitamin E.

Keyword

Veno-occlusive disease; Actinomycin-D; Cyclophosphamide; Rhabdomyosarcoma; Glutathione; Vitamin E

MeSH Terms

Acetylcysteine
Ascites
Child
Cyclophosphamide*
Drug Therapy
Drug Therapy, Combination*
Edema
Glutathione*
Hepatic Veno-Occlusive Disease*
Hepatomegaly
Humans
Jaundice
Male
Necrosis
Rhabdomyosarcoma
Stem Cell Transplantation
Tea
Thrombocytopenia
Veins
Venules
Vincristine*
Vitamin E*
Vitamins*
Weight Gain
Acetylcysteine
Cyclophosphamide
Glutathione
Tea
Vincristine
Vitamin E
Vitamins