Utility of the refined EBMT diagnostic and severity criteria 2023 for sinusoidal obstruction syndrome/veno-occlusive disease

Hiroya Ichikawa; Kimikazu Yakushijin; Keiji Kurata; Takahiro Tsuji; Naoko Takemoto; Miki Joyce; Yuri Okazoe; Ruri Takahashi; Sakuya Matsumoto; Rina Sakai; Akihito Kitao; Yoshiharu Miyata; Yasuyuki Saito; Shinichiro Kawamoto; Katsuya Yamamoto; Mitsuhiro Ito; Tohru Murayama; Hiroshi Matsuoka; Hironobu Minami

doi:10.1038/s41409-024-02215-4

Utility of the refined EBMT diagnostic and severity criteria 2023 for sinusoidal obstruction syndrome/veno-occlusive disease

Bone Marrow Transplant. 2024 Apr;59(4):518-525. doi: 10.1038/s41409-024-02215-4. Epub 2024 Jan 29.

Authors

Hiroya Ichikawa¹, Kimikazu Yakushijin², Keiji Kurata¹, Takahiro Tsuji¹, Naoko Takemoto¹, Miki Joyce¹, Yuri Okazoe¹, Ruri Takahashi¹, Sakuya Matsumoto¹, Rina Sakai¹, Akihito Kitao^{1

3}, Yoshiharu Miyata^{1

4}, Yasuyuki Saito^{1

5}, Shinichiro Kawamoto^{1

6}, Katsuya Yamamoto¹, Mitsuhiro Ito^{1

7}, Tohru Murayama^{1

8}, Hiroshi Matsuoka^{1

9}, Hironobu Minami¹

Affiliations

¹ Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan.
² Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan. kyakushi@med.kobe-u.ac.jp.
³ Department of Oncology and Hematology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan.
⁴ Department of Artificial Intelligence and Digital Health Science, Kobe University Graduate School of Medicine, Kobe, Japan.
⁵ Division of Molecular and Cellular Signaling, Kobe University Graduate School of Medicine, Kobe, Japan.
⁶ Transfusion Medicine and Cell Therapy, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan.
⁷ Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.
⁸ Department of Hematology, Hyogo Cancer Center, Akashi, Japan.
⁹ Department of Integrated Analyses of Bioresource and Health Care, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT). Early diagnosis of SOS/VOD is associated with improved clinical outcomes. In 2023, the refined European Society for Blood and Marrow Transplantation diagnostic and severity criteria (refined EBMT criteria 2023) have been advocated. The revision has introduced new diagnostic categories, namely; probable, clinical, and proven SOS/VOD. In addition, the Sequential Organ Failure Assessment (SOFA) score has been newly incorporated into the SOS/VOD severity grading. We performed a retrospective analysis to evaluate the utility of these criteria. We analyzed 161 cases who underwent allogeneic HSCT. We identified 53 probable, 23 clinical, and 4 proven SOS/VOD cases. Probable SOS/VOD was diagnosed a median of 5.0 days earlier (interquartile range: 2-13 days, P < 0.001) than that of clinical SOS/VOD. The development of probable SOS/VOD alone was associated with a significantly inferior survival proportion compared to non-SOS/VOD (100-day survival, 86.2% vs. 94.3%, P = 0.012). The SOFA score contributed to the prediction of prognosis. Consequently, the refined EBMT criteria 2023 demonstrated the utility of SOS/VOD diagnosis and severity grading. Further investigations and improvements in these criteria are warranted.

MeSH terms

Hematopoietic Stem Cell Transplantation* / adverse effects
Hepatic Veno-Occlusive Disease* / diagnosis
Hepatic Veno-Occlusive Disease* / etiology
Humans
Retrospective Studies
Syndrome
Vascular Diseases*