Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and Management by the GITMO Group.
Consensus
Evidence-Based Medicine
Hematopoietic Stem Cell Transplantation
/ adverse effects
Hepatic Veno-Occlusive Disease
/ diagnostic imaging
Humans
Polydeoxyribonucleotides
/ adverse effects
Predictive Value of Tests
Risk Assessment
Risk Factors
Transplantation, Homologous
Treatment Outcome
Ursodeoxycholic Acid
/ adverse effects
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
pubmed:
5
12
2020
medline:
27
7
2021
entrez:
4
12
2020
Statut:
ppublish
Résumé
Variation in clinical practice affects veno-occlusive disease management, mainly in patients who undergo allogeneic hematopoietic stem cell transplantation. Disputes about diagnostic criteria, treatment, and prophylaxis, due to the lack of high-quality data, are at the base of this variability. With the aim of limiting inconsistency in clinical care, thus improving both patient outcomes and data collection reliability, the Italian Society of Stem cell transplant (Gruppo Italiano Trapianto Midollo Osseo e Terapia Cellulare) launched a collaborative effort to formulate recommendations based on integration of available evidence and expert's consensus. A systematic method, according to US National Institute of Health guidelines and Italian National System for Guidelines, was used. Twenty-nine recommendations were approved with a strong (20) or weak (9) level of agreement, while 26 were rejected. In particular, the panel pointed out the need to achieve an early diagnosis, encouraging the adoption of European Society for Blood and Marrow Transplantation criteria and the prompt use of ultrasonography. Moreover, our experts strongly recommended in favor of prophylactic use of ursodeoxycholic acid. As soon as a veno-occlusive disease diagnosis is established, treatment with defibrotide should be started for at least 21 days. A number of areas of uncertainty, particularly concerning risk stratification and use of diagnostic tools such as elastography has been identified and discussed.
Identifiants
pubmed: 33273315
pii: 00007890-202104000-00005
doi: 10.1097/TP.0000000000003569
doi:
Substances chimiques
Polydeoxyribonucleotides
0
defibrotide
438HCF2X0M
Ursodeoxycholic Acid
724L30Y2QR
Types de publication
Journal Article
Practice Guideline
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
686-694Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
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