Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2012
Severe hypercholesterolemia in patients with graft-vs-host disease affecting the liver after stem cell transplantation.
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Joukhadar Rene, Chiu Ken
Аннотация
OBJECTIVE: To review the available literature on severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver.
METHODS: A literature search was conducted in PubMed for articles on hypercholesterolemia occurring in the context of graft-vs-host disease after allogeneic hematopoietic stem cell transplantation. The review included the type of lipid abnormalities observed, complications, and available management strategies.
RESULTS: Severe hypercholesterolemia can occur in patients who develop graft-vs-host disease after transplant. We describe 8 patients with severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver after hematopoietic stem cell transplantation (7 from the literature and 1 from our institution). No association was observed with a specific age, sex, type of hematologic malignancy, or use of a specific immunosuppressant. The elevated cholesterol is either due to high concentrations of lipoprotein X or low-density lipoprotein. Unlike low-density lipoprotein, lipoprotein X may not be atherogenic.
CONCLUSIONS: Treatment may not be required when lipoprotein X is the major elevated lipoprotein unless hyperviscosity occurs, but treatment is indicated when there is elevation in low-density lipoprotein. Plasmapheresis may be necessary. Ultimate treatment is control of the graft-vs-host disease affecting the liver that would improve or completely resolve the hyperlipidemia.
METHODS: A literature search was conducted in PubMed for articles on hypercholesterolemia occurring in the context of graft-vs-host disease after allogeneic hematopoietic stem cell transplantation. The review included the type of lipid abnormalities observed, complications, and available management strategies.
RESULTS: Severe hypercholesterolemia can occur in patients who develop graft-vs-host disease after transplant. We describe 8 patients with severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver after hematopoietic stem cell transplantation (7 from the literature and 1 from our institution). No association was observed with a specific age, sex, type of hematologic malignancy, or use of a specific immunosuppressant. The elevated cholesterol is either due to high concentrations of lipoprotein X or low-density lipoprotein. Unlike low-density lipoprotein, lipoprotein X may not be atherogenic.
CONCLUSIONS: Treatment may not be required when lipoprotein X is the major elevated lipoprotein unless hyperviscosity occurs, but treatment is indicated when there is elevation in low-density lipoprotein. Plasmapheresis may be necessary. Ultimate treatment is control of the graft-vs-host disease affecting the liver that would improve or completely resolve the hyperlipidemia.
Предметные рубрики MeSH
AdolescentAdultAgedCholesterolFatal OutcomeFemaleGraft vs Host DiseaseHumansHypercholesterolemiaImmunosuppressive AgentsLeukemia, Biphenotypic, AcuteLeukemia, Myelogenous, Chronic, BCR-ABL PositiveLeukemia, Myeloid, AcuteLipoproteinsLiver DiseasesLiver FailureMaleMiddle AgedPrecursor Cell Lymphoblastic Leukemia-LymphomaStem Cell TransplantationYoung Adult