Severe Hypercholesterolemia Associated with Steroid-Refractory Acute Liver GVHD: Unusual Complication of Allogeneic Hematopoietic Cell Transplantation

Severe hypercholesterolemia is an uncommon complication of allogenic hematopoietic cell transplantation (HCT). Treatment options for hypercholesterolemia due to liver graft-versus-host disease (GVHD) are limited because many antilipidemic medications are known to worsen hepatic functions. We report our experience on a case of a 38-year-old male with Philadelphia chromosome positive acute lymphoblastic leukemia presenting with steroid-refractory hepatic and lower gastrointestinal acute GVHD after matched sibling donor peripheral blood myeloablative HCT who developed severe hypercholesterolemia (>1,000mg/dl). The patient was effectively treated with extracorporeal photopheresis for GVHD and severe hypercholesterolemia resolved after weeks of therapy with lipoprotein apheresis.