Diagnostic criteria for VOD/SOS in adults and children
| Criteria set . | Age groups . | Time of signs/symptoms onset* . | Signs/symptoms . |
|---|---|---|---|
| Baltimore (adopted for EBMT adult criteria as “classical”)80,83 | Adult and pediatric | ≤21 d post-HSCT | Bilirubin ≥2 mg/dL plus 2 or more of hepatomegaly, ascites, and weight gain >5% |
| Modified Seattle81 | Adult and pediatric | ≤20 d post-HSCT | Two or more of bilirubin >2 mg/dL, hepatomegaly or right upper quadrant pain, and weight gain >2% (weight gain threshold of >5% sometimes used) |
| Late onset (defined for adults only)83 | Adult | >21 d post-HSCT | “Classical” VOD/SOS (Baltimore criteria) OR histologically proven VOD/SOS OR 2 or more of bilirubin ≥2 mg/dL, hepatomegaly, ascites, and weight gain >5% AND hemodynamic and/or ultrasound evidence of VOD/SOS |
| Pediatric82 | Pediatric | No time frame post-HSCT | Either Baltimore (“classical”) or Seattle criteria with the following variations/exceptions: Increased bilirubin from patient’s baseline for 3 consecutive days or bilirubin ≥2 mg/dL within 72 h may replace bilirubin levels specified for adults (see previous). Weight gain on 3 consecutive days replaces the 2% weight gain required in the Seattle criteria; weight gain >5% above baseline (Baltimore criteria) is maintained as a criterion for children Addition of transfusion-refractory thrombocytopenia as 1 of the possible signs of VOD/SOS (≥2 still required for diagnosis) |
| Criteria set . | Age groups . | Time of signs/symptoms onset* . | Signs/symptoms . |
|---|---|---|---|
| Baltimore (adopted for EBMT adult criteria as “classical”)80,83 | Adult and pediatric | ≤21 d post-HSCT | Bilirubin ≥2 mg/dL plus 2 or more of hepatomegaly, ascites, and weight gain >5% |
| Modified Seattle81 | Adult and pediatric | ≤20 d post-HSCT | Two or more of bilirubin >2 mg/dL, hepatomegaly or right upper quadrant pain, and weight gain >2% (weight gain threshold of >5% sometimes used) |
| Late onset (defined for adults only)83 | Adult | >21 d post-HSCT | “Classical” VOD/SOS (Baltimore criteria) OR histologically proven VOD/SOS OR 2 or more of bilirubin ≥2 mg/dL, hepatomegaly, ascites, and weight gain >5% AND hemodynamic and/or ultrasound evidence of VOD/SOS |
| Pediatric82 | Pediatric | No time frame post-HSCT | Either Baltimore (“classical”) or Seattle criteria with the following variations/exceptions: Increased bilirubin from patient’s baseline for 3 consecutive days or bilirubin ≥2 mg/dL within 72 h may replace bilirubin levels specified for adults (see previous). Weight gain on 3 consecutive days replaces the 2% weight gain required in the Seattle criteria; weight gain >5% above baseline (Baltimore criteria) is maintained as a criterion for children Addition of transfusion-refractory thrombocytopenia as 1 of the possible signs of VOD/SOS (≥2 still required for diagnosis) |
Where specific time frames are given, onset of signs/symptoms must occur within the period indicated to meet the diagnostic criteria.