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Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and

Francesca Bonifazi1, Simona Sica2,3, Alessia Angeletti4

  • 1IRCCS Azienda Ospedaliero-Universitaria, Istituto di Ematologia "L. e A. Seràgnoli", Bologna, Italy.

Transplantation
|December 4, 2020
PubMed

Insights

This study provides consensus recommendations for managing veno-occlusive disease (VOD) after allogeneic stem cell transplantation. Key guidelines include early diagnosis, prophylactic ursodeoxycholic acid, and prompt defibrotide treatment.

Area of Science:

  • Hematology
  • Transplantation Medicine
  • Clinical Practice Guidelines

Background:

  • Veno-occlusive disease (VOD) management varies significantly in allogeneic hematopoietic stem cell transplantation (HSCT) patients.
  • Inconsistent clinical practices stem from disputes over diagnostic criteria, treatment, and prophylaxis, largely due to limited high-quality data.
  • This variability impacts patient outcomes and the reliability of data collection.

Purpose of the Study:

  • To reduce inconsistency in clinical care for VOD following HSCT.
  • To improve patient outcomes and enhance the reliability of data collection.
  • To establish evidence-based and expert-consensus recommendations for VOD management.

Main Methods:

  • A collaborative effort by the Italian Society of Stem cell transplant (GISCT) was initiated.
  • Recommendations were formulated by integrating available evidence and expert consensus.
  • A systematic methodology aligned with US NIH and Italian National System for Guidelines was employed.

Main Results:

  • Twenty-nine recommendations were approved, with 20 showing strong agreement and 9 with weak agreement.
  • Twenty-six recommendations were rejected.
  • Key approved recommendations emphasize early VOD diagnosis using European Society for Blood and Marrow Transplantation (EBMT) criteria and ultrasonography, prophylactic ursodeoxycholic acid, and prompt defibrotide treatment for at least 21 days.

Conclusions:

  • The guidelines aim to standardize VOD management in HSCT recipients.
  • Early diagnosis and prompt initiation of specific therapies are strongly advocated.
  • Areas requiring further research include risk stratification and advanced diagnostic tools like elastography.

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