Veno-Occlusive Disease in Children After Intensive Chemo-and Radiotherapy and Repeated Halothane Anesthesias: A report of 2 cases

Abstract

Two cases of veno-occlusive disease (VOD) occurring in metastatic neuroblastoma patients are reported. Treatment included a remission induction by conventional chemotherapy and surgery followed by an early consolidation with massive chemotherapy, total body irradiation and cleared autologous bone marrow transplantation (ABMT). Both patients had multiple halothane anesthesias. Liver complications occurred 10 and 21 days respectively after ABMT. The first patient had a precocious and severe clinical and biological VOD, heparinotherapy and symptomatic treatment were ineffective and he died 12 days after ABMT. The second patient had a moderate and later syndrome which was controlled by heparin therapy (100 U/kg/day) delivered by continuous infusion; he is now alive free of hepatic disturbance 28 months after ABMT. The potential iatrogenic factors are discussed, with special focus on the use of halogenated anesthetic drugs.