Veno-Occlusive Disease: A Life-saving Novel Approach With Plasma Exchange, IVIG, and Steroid, Without Defibrotide

Area of Science:

• Hematology
• Oncology
• Hepatology

Background:

• Hepatic veno-occlusive disease (VOD) is a life-threatening complication of hematopoietic stem cell transplantation and chemotherapy.
• Defibrotide is the sole approved agent for VOD, but alternative treatments are needed.
• Acute lymphoblastic leukemia (ALL) patients undergoing treatment are at risk for VOD.

Observation:

• A case of severe VOD in an ALL patient is presented.
• The patient received a combination of therapeutic plasma exchange (TPE), intravenous immunoglobulin (IVIG), and methylprednisolone (MPZ).

Findings:

• The combined therapeutic approach led to rapid and significant clinical and laboratory improvement.
• This treatment strategy demonstrated effectiveness in managing severe VOD.

Implications:

• Therapeutic plasma exchange (TPE), IVIG, and MPZ represent a viable alternative treatment for severe VOD in ALL patients.
• These findings offer crucial insights for managing VOD when Defibrotide is unavailable.
• This approach may improve outcomes for VOD patients in resource-limited settings.