TY - JOUR
T1 - Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and Management by the GITMO Group
AU - Bonifazi, Francesca
AU - Sica, Simona
AU - Angeletti, Alessia
AU - Marktel, Sarah
AU - Prete, Arcangelo
AU - Iori, Anna Paola
AU - Olivari, Diletta
AU - Rossetti, Giulia
AU - Bertaina, Alice
AU - Botti, Stefano
AU - Busca, Alessandro
AU - Carella, Angelo Michele
AU - Cerretti, Raffaella
AU - Gargiulo, Gianpaolo
AU - Grassi, Anna
AU - Gualandi, Francesca
AU - Irrera, Giuseppe
AU - Milone, Giuseppe
AU - Risitano, Antonio Maria
AU - Santarone, Stella
AU - Vassallo, Elena
AU - Zecca, Marco
AU - Ciceri, Fabio
AU - Pomponio, Giovanni
N1 - Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - 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.
AB - 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.
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U2 - 10.1097/TP.0000000000003569
DO - 10.1097/TP.0000000000003569
M3 - Article
AN - SCOPUS:85103606769
VL - 105
SP - 686
EP - 694
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 4
ER -