Operational procedure sharing pathway in veno-occlusive disease: a Delphi consensus-based recommendations.

Area of Science:

• Hematology
• Transplantation Medicine
• Gastroenterology

Background:

• Veno-Occlusive Disease (VOD), or Sinusoidal Obstruction Syndrome (SOS), is a severe complication post-chemotherapy and hematopoietic stem cell transplantation (HSCT).
• Significant regional disparities exist in Italy regarding VOD diagnosis and management practices.

Purpose of the Study:

• To standardize diagnostic and therapeutic pathways for VOD in Italian clinical practice.
• To address variability in VOD management across different Italian regions.

Main Methods:

• A 12-month Delphi consensus project involving a methodologist, scientific board, and 45 specialist clinicians.
• Independent contributions, harmonization, and web meeting discussions were employed.

Main Results:

• Identified 15 clinical topics across five key areas, including pre-HSCT evaluation, diagnosis, therapy, EBMT criteria integration, imaging, and defibrotide management.
• Recommended weekly imaging for VOD monitoring, early diagnosis and defibrotide treatment, and a unified approach across centers.

Conclusions:

• Significant variability in VOD management across Italian centers necessitates a multidisciplinary approach.
• Establishing a national network, standardizing protocols, and utilizing advanced imaging are crucial for improving VOD diagnosis and treatment outcomes in HSCT.