How to prevent sinusoidal obstruction syndrome/veno-occlusive disease?

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication following hematopoietic stem cell transplantation (HSCT). It clinically manifests as a syndrome of symptoms, with the most important ones being jaundice, weight gain, ascites, and painful hepatomegaly. In patients with severe SOS/VOD, serious complications such as respiratory failure, renal dysfunction, and cardiovascular insufficiency occur, ultimately leading to multi-organ failure, associated with a mortality rate exceeding 80%. The incidence of SOS/VOD after HSCT is estimated to be around 5–15%, but it significantly depends on the patient population, including age, indications for transplantation, conditioning regimen intensity, and diagnostic criteria. The highest frequency of this complication occurred during decades when myeloablative conditioning based on oral busulfan was dominant in HSCT. The introduction of monoclonal antibody-drug conjugates with ozogamicin in the treatment of acute leukemias has renewed interest in the prevention and treatment of SOS/VOD due to the increased incidence of this complication in patients undergoing transplantation preceded by the new drugs. This paper provides an overview of contemporary knowledge regarding diagnostic criteria, risk factors, biomarkers, diagnostic techniques, pharmacological and non-pharmacological prophylaxis of SOS/VOD.