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Monitoring

Readiness and recognition are critical to immediateVOD/SOS identification

Daily monitoring is recommended for up to 14 to 21 days post HSCT1,2

Chart 21 day: desktopChart 21 day: mobile
Although VOD/SOS generally emerges within the first 21 days post HSCT, it CAN occur later3-5

Monitor for signs and symptoms

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Platelet-refractory thrombocytopenia6,7

  • Is the patient receiving excessive platelet transfusions consistent with refractory thrombocytopenia?
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Weight gain6,7

  • Is weight gain ‚Č•5% above the baseline weight at the start of the conditioning regimen?
  • Has the patient gained weight on 3 consecutive days despite the use of diuretics?
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Edema and ascites6,7

  • Is edema present?
  • Is abdominal distension/ascites present?
  • Is patient experiencing shortness of breath?
  • Has a change from baseline been confirmed by ultrasound or physical exam?
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Abdominal discomfort/pain1,6,7

  • Is patient experiencing abdominal discomfort/pain?
  • Is pain localized to right upper quadrant?
  • Is there liver tenderness?
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Hepatomegaly6,7

  • Is hepatomegaly present?
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Jaundice1,6

  • Have bilirubin levels increased from baseline?
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Liver function1,6,8

  • Are any liver function tests elevated?
    • Alkaline phosphatase
    • Aspartate aminotransferase (AST)
    • Alanine aminotransferase (ALT)
    • Gamma-glutamyl transpeptidase (GGT)
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Fluid retention6

  • Is fluid retention present?
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Renal function6,7

  • Has urinary output decreased?
  • Is serum creatinine elevated relative to the start of conditioning regimen?
  • Is glomerular filtration rate below normal?
  • Does patient require dialysis?
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Pulmonary function6

  • Does patient have blood oxygen saturation below normal?
  • Does patient require oxygen support?
  • Does patient require mechanical ventilation?

HSCT=hematopoietic stem-cell transplantation; SOS=sinusoidal obstruction syndrome; VOD=veno-occlusive disease.

References: 1. Carreras E. How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation. Br J Haematol. 2015;168(4):481-491. 2. Dalle JH, Giralt SA. Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: risk factors and stratification, prophylaxis, and treatment. Biol Blood Marrow Transplant. 2016;22(3):400-409. 3. Carreras E. Early complications after HSCT. In: Apperley J, Carreras E, Gluckman E, et al, eds. The EBMT Handbook. 6th ed. Paris, France: European School of Haematology; 2012:176-195. 4. Mohty M, Malard F, Abecassis M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2016;51(7):906-912. 5. Corbacioglu S, Carreras E, Ansari M, et al. Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2018;53(2):138-145. 6. Cairo MS, Cooke KR, Lazarus HM, et al. Modified diagnostic criteria, grading classification and newly elucidated pathophysiology of hepatic SOS/VOD after haematopoietic cell transplantation. Br J Haematol. 2020;190(6):822-836. 7. Mahadeo KM, Bajwa R, Abdel-Azim H, et al; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network; Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation. Diagnosis, grading, and treatment recommendations for children, adolescents, and young adults with sinusoidal obstructive syndrome: an international expert position statement. Lancet Haematol. 2020;7(1):e61-e72. 8. Dalle JH, Giralt SA. Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: risk factors and stratification, prophylaxis, and treatment. Biol Blood Marrow Transplant. 2016;22(3):400-409.