Table 1 Differences between adults and children.

From: Defibrotide for prophylaxis of sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) in pediatric high-risk patients: consensus guidelines from the European Society for Blood and Marrow Transplantation (EBMT)

Criteria

Children

Adults

Incidence

• Approximately 20%

• Up to 60% in high-risk patients

• Approximately 10%

Risk factors

• Additional paed risk factors

• Infants

• Paed/genetic diseases with incidences above average

• Established risk factors

Clinical presentation

• Late-onset hepatic VOD in 20%

• Anicteric hepatic VOD in 30%

• Hyperbilirubinaemia, if present

 —Is frequently pre-existent

 —Occurs late during hepatic VOD

 —Is typical of severe hepatic VOD

• Late-onset hepatic VOD is rare

• Anicteric hepatic VOD is rare

Need for proper assessment of ascites and hepatomegaly

• High incidence of disease-related hepatomegaly and ascites pre-HCT

–

Treatment

• Defibrotide for severe hepatic VOD with MOD/MOF was associated with better results in children compared with adults

  1. Adapted from Corbacioglu S et al. Bone Marrow Transplant. 2018;138–145.
  2. MOD multi-organ dysfunction, MOF multi-organ failure.
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