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

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.