International Journal of Hematology

, Volume 88, Issue 3, pp 291–293

Hepatic veno-occlusive disease after tandem autologous stem cell transplantation conditioned by melphalan

  • Sana Intidhar Labidi
  • Catherine Sebban
  • Hervé Ghesquières
  • Emmanuele Virelizier Nicolas
  • Pierre Biron
Case Report


We report the case of a 58-year-old man with multiple myeloma stage III A who received tandem autologous stem cell transplantation after induction by two courses of VAD and three cycles of bortezomib–dexamethasone, due to progression under chemotherapy. The second transplantation was complicated by severe hepatic veno-occlusive disease (HVOD). The patient received defibrotide with total recovery. The occurence of HVOD after conditioning by melphalan is uncommon and the role of bortezomib was questioned.


Bortezomib Multiple myeloma Autologous stem cell transplantation Defibrotide 


  1. 1.
    Wadleigh M, Ho V, Momtaz P, Richardson P. Hepatic veno-occlusive disease: pathogenesis, diagnosis and treatment. Curr Opin Hematol. 2003;10:451–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Attal M, Harousseau JL, Facon T, Guilhot F, Doyen C, Fuzibet JG, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med. 2003;349:2495–502.PubMedCrossRefGoogle Scholar
  3. 3.
    Moreau P, Facon T, Attal M, Hulin C, Michallet M, Maloisel F, et al. Comparison of 200 mg/m(2) melphalan and 8 Gy total body irradiation plus 140 mg/m(2) melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du Myélome 9502 randomized trial. Blood. 2002;99:731–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Richardson PG, Murakami C, Jin Z, Warren D, Momtaz P, Hoppensteadt P, et al. Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure: response without significant toxicity in a high-risk population and factors predictive of outcome. Blood. 2002;100:4337–43.PubMedCrossRefGoogle Scholar
  5. 5.
    Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation. Blood. 1995;85:3005–20.PubMedGoogle Scholar
  6. 6.
    McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M, et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med. 1993;118:255–67.PubMedGoogle Scholar
  7. 7.
    Alegre A, Diaz-Mediavilla J, San-Miguel J, Martinez R, Garcia-Larana J, Sureda A, et al. Autologous peripheral blood stem cell transplantation for multiple myeloma: a report of 259 cases from the Spanish Registry. Spanish Registry for Transplant in MM (Grupo Espanol de Trasplante Hematopoyetico-GETH) and PETHEMA. Bone Marrow Transplant. 1998;21:133–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Malhorta P, Varma S, Varma N, Sharma RR, Jain S, Kumari S, et al. Pulmonary veno-occlusive disease as a cause for reversible pulmonary hypertension in a patient with multiple myeloma undergoing peripheral blood stem cell transplantation. Am J Hematol. 2005;80:164–5.Google Scholar
  9. 9.
    Richardson PG, Barlogie B, Berenson J, Singhal S, Jagannath S, Iwin D, et al. A phase 2 study of bortezomib in relapsed, refractory myeloma. N Engl J Med. 2003;348:2609–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Harousseau JL, Attal M, Leleu X, Troncy J, Pegouie P, Stoppa AM, et al. Bortezomib plus dexamethasone as induction treatment prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma: results of an IFM phase II study. Haematologica. 2006;91:1498–505.PubMedGoogle Scholar
  11. 11.
    Rosinol L, Oriol A, Mateos MV, Sureda A, Garcia-Sanchez P, Gutierrez N, et al. Phase II PETHEMA trial of alternating bortezomib and dexamethasone as induction regimen before autologous stem-cell transplantation in younger patients with multiple myeloma: efficacy and clinical implications of tumor response kinetics. J Clin Oncol. 2007;25:4452–8.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2008

Authors and Affiliations

  • Sana Intidhar Labidi
    • 1
  • Catherine Sebban
    • 1
  • Hervé Ghesquières
    • 1
  • Emmanuele Virelizier Nicolas
    • 1
  • Pierre Biron
    • 1
  1. 1.Department of Medical OncologyCentre Léon BérardLyonFrance

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