Introduction: Hepatic VOD, a rare and underrecognized complication in pediatric oncology patients receiving chemotherapy outside of stem cell transplant (SCT), can result in multi-organ dysfunction (MOD) requiring critical care interventions. To better understand this, we aimed to 1) clinically characterize patients with VOD and 2) determine the use of critical care interventions. Methods: This retrospective review included patients aged 0-21 years diagnosed with VOD after non-SCT-associated chemotherapy between January 1, 2010, and October 1, 2023. Patients were identified by EMR interrogation for the term “veno-occlusive disease”. Descriptive data was collected until 10/1/2023 or to the last follow-up, whichever was later. MOD was defined as renal dysfunction (serum creatinine ≥3x from baseline or dialysis) ± pulmonary dysfunction (requiring oxygen support). Critical care interventions and cause of death (if any) were recorded per the clinician’s judgment on chart review. Results: Thirty patients met the inclusion criteria, with four patients excluded for inadequate EMR documentation. The most common chemotherapeutic regimen was vincristine/6TG/cyclophosphamide/cytarabine during delayed intensification for acute lymphoblastic leukemia (eight patients, 31%). The median time from day one of the current chemotherapy cycle to VOD diagnosis was 14 days. Patients were diagnosed using various diagnostic criteria, although Seattle and pEBMT criteria were met in all patients. 20 patients (77%) received diuretics, and 12 patients (46%) received defibrotide. Twenty patients (77%) had MOD, with 15 patients (58%) requiring critical care (median 10 days). Critical interventions included renal replacement therapy (3 patients, median 11 days), mechanical ventilation (4 patients, median 10 days), non-invasive ventilation (6 patients, median 2 days), chest tube/abdominal drain placement (4 patients, median 9 days). Eight patients died (31%); VOD was the cause of death in one patient (13%). Conclusions: Chemotherapy-induced VOD confers limited mortality in pediatric patients with oncologic diagnoses. However, it contributes to increased length of ICU hospital stay and need for invasive critical care interventions, thus warranting close monitoring by oncologists for this underrecognized complication.
Shah et al. (Sun,) studied this question.