HEPATIC VENO-OCCLUSIVE DISEASE AFTER MYLOTARG (CD 33 ANTIBODY) TREATMENT

Abstract

Gemtuzumab ozogamicin (Mylotarg™) is a novel monoclonal antibody directed against the CD33 antigen present on myeloid leukemic blasts. It is approved for the treatment of relapsed acute myelogenous leukemia (AML) in patients greater than 60 years of age. We report a case of rapidly progressive hepatic veno-occlusive disease and fulminant hepatic failure associated with Mylotarg treatment. A 69 year old male with relapsed AML, chronic renal failure and no previous hepatic disorder was given standard dose mylotarg treatment (9mg/m2 IV on day 1). Five days later, he developed abdominal pain, vomiting, diarrhea, and low-grade fever. He also developed progressive abdominal distention and jaundice. He did not have hematemesis, melena, constipation or confusion. Physical examination revealed ascites, jaundice, absent hepato jugular reflex, absent hepatic bruit, and no stigmata of chronic liver disease. Laboratory data were consistent with acute liver injury(Table). Ascitic fluid was transudative with serum ascites albumin gradient of 1.2. Hepatic vascular ultrasound demonstrated portal vein thrombosis (figure). His clinical status continued to deteriorate and he expired due to hepatorenal dysfunction despite maximal supportive therapy, [figure 1]Table: Progressive hepatorenal dysfucnction and neutropenia after Mylotarg treatmentFigure