Plasminogen activator inhibitor-1 is an independent diagnostic marker as well as severity predictor of hepatic veno-occlusive disease after allogeneic bone marrow transplantation in adults conditioned with busulphan and cyclophosphamide

We attempted to identify the diagnostic markers and severity predictors of hepatic veno-occlusive disease (VOD) in 115 adult patients who were uniformly conditioned with busulphan and cyclophosphamide and who underwent allogeneic bone marrow transplantation (BMT). A diagnosis of VOD was made according to clinical criteria. Severity of VOD was classified as mild, moderate or severe. Various haemostatic parameters were determined at five time points (d -7, 0, 7, 14 and 21). Using clinical and haemostatic parameters, we developed multivariate models to identify diagnostic markers as well as severity predictors of VOD. Of the 115 patients included in the study, 50 (43.5%) developed VOD. Twenty-nine had mild VOD, 13 moderate and 8 severe. Multiple logistic regression models showed that plasminogen activator inhibitor-1 (PAI-1) antigen (P = 0.029), percentage change of body weight (P = 0.001) and bilirubin (P < 0.001) were independent marker variables for the occurrence of VOD, and PAI-1 antigen (P = 0.030) and bilirubin (P = 0.049) were independent marker variables for the occurrence of severe VOD. Our study suggests that PAI-1 antigen can be used as a diagnostic marker as well as a severity predictor of VOD after allogeneic BMT.