Veno-occlusive disease of the liver after chemotherapy of acute leukemia. Report of two cases.

Two adult male patients with acute leukemia developed a fatal Budd-Chiari-like illness while receiving 6-thioguanine. Both had previously received cytosine arabinoside. Antemortem and postmortem specimens of liver showed changes characteristic of toxic veno-occlusive disease. Similar findings have been described after ingestion of certain plant alkaloids and after treatment with arsphenamine, urethane, and ionizing radiation to the liver. We are unaware of any published reports of veno-occlusive disease of the liver after treatment with either 6-thioguanine or cytosine arabinoside. Although 6-thioguanine was most likely responsible for this syndrome, it is not possible to eliminate cytosine arabinoside as the causative agent. Since both drugs are occasionally used for benign conditions, physicians should be aware of this possible complication.

[1]  B. Danielson,et al.  Hepatic veno-occlusive disease in a renal transplant patient receiving azathioprine. , 1975, Gastroenterology.

[2]  E. Henderson,et al.  Cytosine arabinoside and 6‐thioguanine in refractory acute lymphocytic leukemia , 1974, Cancer.

[3]  B. Leventhal,et al.  Cytosine arabinoside in acute granulocytic leukemia , 1971, Clinical pharmacology and therapeutics.

[4]  G. Bodey,et al.  Prolonged infusion of arabinosyl cytosine in childhood leukemia , 1970, Cancer.

[5]  B. Clarkson,et al.  Treatment of adult acute leukemia with arabinosylcytosine and thioguanine , 1969, Cancer.

[6]  C. Spurr,et al.  Arabinosyl cytosine: a useful agent in the treatment of acute leukemia in adults. , 1968, Blood.

[7]  A. Cox,et al.  The human liver after radiation injury. A form of veno-occlusive disease. , 1966, The American journal of pathology.

[8]  W. Crosby,et al.  THIOGUANINE IN THE TREATMENT OF CERTAIN AUTOIMMUNE, IMMUNOLOGIC AND RELATED DISEASES. , 1964, The American journal of medicine.

[9]  D. Weiss,et al.  Urethane-induced hepatic failure in man. , 1960, The American journal of medicine.

[10]  P. Magee,et al.  Further observations on the subacute and chronic liver changes in rats after a single dose of various pyrrolizidine (Senecio) alkaloids. , 1959, The Journal of pathology and bacteriology.

[11]  A. Dick,et al.  The chronic pathological effects on the liver of the rat of the pyrrolizidine alkaloids heliotrine, lasiocarpine, and their N-oxides. , 1959, The Journal of pathology and bacteriology.

[12]  D. Jelliffe,et al.  Veno-occlusive Disease of the Liver and Indian Childhood Cirrhosis , 1957, Archives of disease in childhood.

[13]  G. Bras,et al.  VENO-OCCLUSIVE DISEASE OF THE LIVER , 1956 .

[14]  D. Jelliffe,et al.  Veno-occlusive disease of liver with nonportal type of cirrhosis, occurring in Jamaica. , 1954, A.M.A. archives of pathology.

[15]  P. Hahn,et al.  Liver cirrhosis with ascites, induced in dogs by chronic massive hepatic irradiation with radioactive colloidal gold. , 1951, Science.

[16]  R. Parker,et al.  Senecio poisoning exhibiting as Chiari's syndrome; a report on twelve cases. , 1951, The American journal of pathology.

[17]  W. Moloney,et al.  Urethane toxicity; report of a case of hepatic necrosis apparently due to urethane. , 1950, The New England journal of medicine.

[18]  B. Lucké,et al.  A STUDY OF THE HISTOLOGIC CHANGES PRODUCED EXPERIMENTALLY IN RABBITS BY NEO-ARSPHENAMIN , 1921 .

[19]  B. Clarkson,et al.  The therapy of acute granulocytic leukemia in patients more than fifty years old. , 1974, Annals of internal medicine.

[20]  B. Hazlett,et al.  Fulminating hepatic necrosis in a patient with multiple myeloma treated with urethane; report of case. , 1955, Blood.

[21]  R. W. Heinle,et al.  Liver damage after prolonged urethane therapy. , 1952, American journal of clinical pathology.