Overview
Sinusoidal obstruction syndrome (SOS), also known as veno-occlusive disease, is a severe complication characterized by hepatic sinusoidal injury leading to impaired blood flow, often triggered by chemotherapeutic agents, particularly in hematopoietic stem cell transplantation (HSCT) recipients 14.Diagnosis
Clinical Criteria: Elevated liver enzymes, especially aspartate aminotransferase, and isolated thrombocytopenia suggest SEC injury 2.
Diagnostic Tests: Imaging (e.g., MRI) and liver biopsy may be necessary for definitive diagnosis 2.
Risk Factors: Allogeneic HSCT, use of busulfan, imatinib, and elevated pre-transplant serum ferritin >1000 ng/dL 5.Management
First-Line Treatment: Early initiation of defibrotide for suspected severe SOS 4.
Preventive Measures: Strict monitoring of weight and fluid balance during HSCT 4.
Adjunctive Therapies: Management of hepatorenal syndrome and supportive care including fluid management and potential use of other agents based on clinical judgment 4.Special Populations
Comorbidities: Elevated serum ferritin levels are a risk factor across various patient profiles undergoing HSCT 5.
No Specific Guidance: Abstracts do not provide detailed guidance for pregnancy, pediatrics, or elderly populations specifically related to SOS management 12345.Key Recommendations
Monitor High-Risk Patients Closely: Implement strict daily monitoring of weight and fluid balance in HSCT patients at high risk for SOS (Evidence: Moderate 4).
Early Defibrotide Use: Initiate defibrotide early in patients with suspected severe SOS to improve outcomes (Evidence: Expert opinion 4).
Consider Ferritin Levels: Evaluate pre-transplant serum ferritin levels >1000 ng/dL as a risk factor for SOS development (Evidence: Moderate 5).
Differentiate SOS from Other Conditions: Utilize appropriate diagnostic tools including reticulin stain, VEGFR2, CD34, and CD41 IHC stains to differentiate SOS from other liver pathologies (Evidence: Moderate 2).
Manage Multi-Organ Dysfunction: Address multi-organ dysfunction aggressively in SOS cases, given the high mortality rate associated with severe SOS (Evidence: Moderate 3).References
1 Sun C, Yang X, Wang L, Tang L, Chen J. Drug-induced sinusoidal obstruction syndrome: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System (FEARS). BMC pharmacology & toxicology 2025. link
2 Kohnken R, Falahatpisheh H, Janardhan KS, Guffroy M. Anatomic and Clinical Pathology Characterization of Drug-Induced Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease) in Cynomolgus Macaques. Toxicologic pathology 2022. link
3 Cao Z, Villa KF, Lipkin CB, Robinson SB, Nejadnik B, Dvorak CC. Burden of illness associated with sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation. Journal of medical economics 2017. link
4 Carreras E. How I manage sinusoidal obstruction syndrome after haematopoietic cell transplantation. British journal of haematology 2015. link
5 Maradei SC, Maiolino A, de Azevedo AM, Colares M, Bouzas LF, Nucci M. Serum ferritin as risk factor for sinusoidal obstruction syndrome of the liver in patients undergoing hematopoietic stem cell transplantation. Blood 2009. link