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Readiness and recognition are critical to immediateVOD identification

Vigilant monitoring for the first 21 days is critical to VOD detection1-3

Chart 21 day: desktop Chart 21 day: mobile
Although VOD generally emerges within the first 21 days post HSCT, it can occur later2,4,5
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Weight gain

  • Is weight gain >2% above the baseline weight at the start of the conditioning regimen?
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Edema and ascites

  • Is edema present?
  • Is abdominal distension/ascites present?
  • Is patient experiencing shortness of breath?
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Abdominal discomfort/pain

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

  • Is hepatomegaly present?
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Jaundice

  • Is bilirubin >2 mg/dL?
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Liver function

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

  • Is fluid retention present?
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Renal function

  • 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 function

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

HSCT=hematopoietic stem-cell transplantation; VOD=veno-occlusive disease (also known as sinusoidal obstruction syndrome, or SOS).

References: 1. Carreras E, Díaz-Beyá M, Rosiñol L, et al. The incidence of veno-occlusive disease following allogeneic hematopoietic stem cell transplantation has diminished and the outcome improved over the last decade. Biol Blood Marrow Transplant. 2011;17(11):1713-1720. 2. 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. 3. Tsirigotis PD, Resnick IB, Avni B, et al. Incidence and risk factors for moderate-to-severe veno-occlusive disease of the liver after allogeneic stem cell transplantation using a reduced intensity conditioning regimen. Bone Marrow Transplant. 2014;49(11):1389-1392. 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.