Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives—a position statement from the European Society for Blood and Marrow Transplantation (EBMT)

Abstract

Sinusoidal obstruction syndrome or veno-occlusive disease (SOS/VOD) is a potentially life-threatening complication of hematopoietic SCT (HSCT). This review aims to highlight, on behalf of the European Society for Blood and Marrow Transplantation, the current knowledge on SOS/VOD pathophysiology, risk factors, diagnosis and treatments. Our perspectives on SOS/VOD are (i) to accurately identify its risk factors; (ii) to define new criteria for its diagnosis; (iii) to search for SOS/VOD biomarkers and (iv) to propose prospective studies evaluating SOS/VOD prevention and treatment in adults and children.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…6,87 The use of Defibrotide, as well as the increasing use of RIC, could play a role in decreasing veno-occlusive disease incidence. 38,88 Moreover, progress in selecting patients has been made, particularly in refining risk strategies and evaluating comorbidity. 5,76 Interestingly, patients who actually undergo transplantation are older, carrying more comorbid conditions and with more advanced disease than 10 years ago.…”

“…111 Moreover, allo-HSCT patients are exposed to late complications, including infections, chronic GvHD, second cancers, iron overload and liver, endocrine, ocular, musculoskeletal, vascular, renal and neurologic disorders responsible for substantial morbidity. 112 The psychosocial aspect and quality of life is a major issue for these patients, with depression, anxiety, fatigue and sexual dysfunction being 34 Platelet count 35,37 Bilirubin level 13,24 Urea or creatinine level 24,37,38 Time between HSCT and ICU admission 13 Bacterial infections 25 ICU admission for neurological dysfunction 34 Abbreviations: APACHE II = Acute Physiology And Chronic Health Evaluation II; HCT-CI = hematopoietic cell transplantation comorbidity index; HSCT = hematopoietic stem cell transplantation; ICU = intensive care unit; MAC = myeloablative conditioning; MV = mechanical ventilation; RIC = reduced-intensity conditioning; RRT = renal replacement therapy; SAPS II = Simplified Acute Physiology Score II; SOFA = Sepsis Related Organ Failure Assessment.…”

Prophylactic Danshen Injection Combined with Prostaglandin E1 and Low-dose Heparin may prevent Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation: A Single-center Study in China

“…The risk factors for VOD include older age, advanced disease, conditioning regimen especially oral Busulfan regimen, HLA mismatched, unrelated donors, non-T-cell depleted graft and positive serology results for Cytomegalovirus (CMV), Hepatitis B virus (HBV), or Hepatitis C virus (HCV) [2,3]. The mortality rate of VOD is nearly 50% [4]. Currently, there is no standard prophylactic regimen for this serious complication.…”

Device and application development for haematopoietic stem and progenitor cell (HSPC) and mesenchymal stromal cell (MSC) 3D spheroid cultures

“…Steroid hormones are administered to manage aGvHD, as well as other immunosuppressive drug treatments in the case of refractiveness. SOS is a complication that affects liver sinusoidal endothelial cells and hepatocytes in the liver as a result of toxic metabolites generated during the conditioning regimen [33]. The occurrence of SOS has been correlated with more intense conditioning regimens, with an incidence of 10--15% for myeloablative conditioning, compared to <5% for reduced intensity conditioning [33].…”

“…SOS is a complication that affects liver sinusoidal endothelial cells and hepatocytes in the liver as a result of toxic metabolites generated during the conditioning regimen [33]. The occurrence of SOS has been correlated with more intense conditioning regimens, with an incidence of 10--15% for myeloablative conditioning, compared to <5% for reduced intensity conditioning [33]. With the advent of reduced conditioning regimens, better diagnostic methods and new treatments, the overall risk and outcome for SOS have greatly improved in recent years.…”