SEVERE HYPERCHOLESTEROLEMIA IN PATIENTS WITH GRAFT-VS-HOST DISEASE AFFECTING THE LIVER AFTER STEM CELL TRANSPLANTATION

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 Xis 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. (Endocr Pract. 2012; 18:90-97).