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Role of Initiating Supportive Care Preceding Veno-occlusive Disease Diagnosis Following Allogeneic Hematopoietic Stem Cell Transplantation in Children

Rayner, Patricia PharmD*; Spruit, Jessica L. DNP*; Chu, Roland MD*,†,‡; Yankelevich, Maxim MD*,†,‡; Henry, Meret MD*,†,‡; Ravindranath, Yaddanapudi MBBS*,†,‡; Savaşan, Süreyya MD*,†,‡

Journal of Pediatric Hematology/Oncology: August 2019 - Volume 41 - Issue 6 - p e395–e401
doi: 10.1097/MPH.0000000000001455
Online Articles: Original Articles
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Severe veno-occlusive disease (VOD) following hematopoietic stem cell transplantation has a high mortality rate. The clinical course of VOD, role of preemptive and aggressive supportive care, and outcomes were investigated in a retrospective study from 2007 to 2014. Defibrotide was not available in all but one case with VOD at our center during the study. Forty-nine allogeneic transplants with intravenous busulfan-based or total body irradiation-based myeloablative conditioning were included. The median after hematopoietic stem cell transplantation day for suspicion of developing VOD (pre-VOD phase) was 6 due to weight gain, hepatomegaly, and/or mild increase in total bilirubin without fulfilling the modified Seattle criteria in 22 cases (45%). Despite fluid restriction, aggressive diuresis, and fresh frozen plasma infusions, 16 patients (33%) developed VOD by +10 days. Five cases (31%) had severe, 9 (56%) moderate, and 2 (13%) mild VOD. Eight cases (50%) required transfer to intensive care. One patient was given defibrotide, which was later discontinued due to concerns of adverse effects. Day +100 survival was 100% with complete resolution of VOD. Preemptive and aggressive supportive care could help achieve favorable outcomes in VOD and may have ameliorated the severity. This approach may be combined with other measures in the prevention/treatment of VOD.

*Pediatric Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Children’s Hospital of Michigan

Barbara Ann Karmanos Cancer Center

Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI

The authors declare no conflict of interest.

Reprints: Süreyya Savaşan, MD, Children’s Hospital of Michigan, Division of Hematology/Oncology, 3901 Beaubien Blvd, Detroit, MI 48201 (e-mail: ssavasan@med.wayne.edu).

Received October 31, 2018

Accepted January 15, 2019

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