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Mangada KL, Moffet J, Nishitani M, Albuquerque S, Duncan CN. Interprofessional Team-based Care of the Hematopoietic Cell Transplantation Patient With Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome. J Pediatr Hematol Oncol 2023; 45:12-17. [PMID: 36598959 PMCID: PMC9809996 DOI: 10.1097/mph.0000000000002594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/13/2022] [Indexed: 01/05/2023]
Abstract
Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a well-recognized complication of allogeneic and autologous hematopoietic cell transplantation (HCT). The diagnosis and treatment of VOD/SOS require the involvement of multiple specialists covering a wide range of expertise. Interprofessional team-based medical care is standard practice for patients undergoing HCT and has been shown to improve patient and provider satisfaction, enhance efficiency, and improve patient outcomes, particularly for patients in complex medical situations like those with VOD/SOS post-HCT. Interdisciplinary team-based models focus on the synthesis and harmonization of knowledge and methods from different disciplines to create an integrative approach to patient care that both maximizes the expertise of each involved specialist and encourages thought beyond each specialist's discipline. Multidisciplinary team members provide additive support and work collaboratively with the core team to provide knowledge from their field. The composition of the interdisciplinary HCT team should center on the needs of the patient and institutional resources and involve the expertise of additional multidisciplinary team members based on clinical needs. This review focuses on interdisciplinary and multidisciplinary team-based care of patients with VOD/SOS post-HCT and provides an example of a collaborative VOD/SOS team that includes transplant physicians, nurses, pharmacists, nutrition/dietary specialists, and intensive care teams.
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Bonifazi F, Sica S, Angeletti A, Marktel S, Prete A, Iori AP, Olivari D, Rossetti G, Bertaina A, Botti S, Busca A, Carella AM, Cerretti R, Gargiulo G, Grassi A, Gualandi F, Irrera G, Milone G, Risitano AM, Santarone S, Vassallo E, Zecca M, Ciceri F, Pomponio G. Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and Management by the GITMO Group. Transplantation 2021; 105:686-694. [PMID: 33273315 DOI: 10.1097/tp.0000000000003569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
- Francesca Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria, Istituto di Ematologia "L. e A. Seràgnoli", Bologna, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italia
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italia
| | | | - Sarah Marktel
- Unità di Ematologia e Trapianto di Midollo Osseo IRCCS, Istituto Scientifico Ospedale San Raffaele, Milano, Italia
| | - Arcangelo Prete
- Dipartimento di Oncologia ed Ematologia Pediatrica, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italia
| | - Anna Paola Iori
- Dipartimento di Oncologia ed Ematologia Pediatrica IRCCS, Ospedale Bambino Gesu', Roma, Italia
| | - Diletta Olivari
- Clinica Medica, Università Politecnica delle Marche, Ancona, Italia
| | - Giulia Rossetti
- Clinica Medica, Università Politecnica delle Marche, Ancona, Italia
| | - Alice Bertaina
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA
| | - Stefano Botti
- Unità di Ematologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italia
| | - Alessandro Busca
- Dipartimento di Oncologia ed Ematologia, AOU Citta' della Salute e della Scienza, Torino, Italia
| | - Angelo Michele Carella
- Unità di Trapianto di Midollo Osseo, Dipartimento di Oncoematologia, Fondazione IRCCS "Casa Sollievo della Sofferenza" San Giovanni Rotondo, Foggia, Italia
| | - Raffaella Cerretti
- UOC Ematologia, Unità di Trapianto di Cellule Staminali, Ospedale Tor Vergata, Roma, Italia
| | - Gianpaolo Gargiulo
- Dipartimento di Oncologia ed Ematologia, Azienda Ospedaliero Universitaria Federico II, Napoli, Italia
| | - Anna Grassi
- UOS Trapianto di Midollo USC Ematologia, ASST PG23 Bergamo, Italia
| | - Francesca Gualandi
- Divisione di Ematologia e Unità di Trapianto di Cellule Staminali, Policlinico San Martino IRCCS, Genova, Italia
| | - Giuseppe Irrera
- Centro Trapianti Cellule Staminali e Terapie Cellulari "A.Neri," Grande Ospedale Metropolitano, Reggio Calabria, Italia
| | - Giuseppe Milone
- Unità di Trapianto Emopoietico, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele," San Marco, Catania, Italia
| | - Antonio Maria Risitano
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II Napoli, Napoli, Italia
| | - Stella Santarone
- Terapia Intensiva Ematologica, Dipartimento Oncologico Ematologico Ospedale Civile, Pescara, Italia
| | - Elena Vassallo
- Dipartimento di Oncoematologia, Centro Trapianti Cellule Staminali e Terapia Cellulare, Ospedale Infantile Regina Margherita, Torino, Italia
| | - Marco Zecca
- Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italia
| | - Fabio Ciceri
- Unità di Ematologia e Trapianto di Midollo Osseo IRCCS, Istituto Scientifico Ospedale San Raffaele, Milano, Italia
- Università Vita-Salute San Raffaele, Milano, Italia
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Bonifazi F, Barbato F, Ravaioli F, Sessa M, Defrancesco I, Arpinati M, Cavo M, Colecchia A. Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation. Front Immunol 2020; 11:489. [PMID: 32318059 PMCID: PMC7147118 DOI: 10.3389/fimmu.2020.00489] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 12/27/2022] Open
Abstract
Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS) is a rare complication characterized by hepatomegaly, right-upper quadrant pain, jaundice, and ascites, occurring after high-dose chemotherapy, hematopoietic stem cell transplantation (HSCT) and, less commonly, other conditions. We review pathogenesis, clinical appearance and diagnostic criteria, risk factors, prophylaxis, and treatment of the VOD occurring post-HSCT. The injury of the sinusoidal endothelial cells with loss of wall integrity and sinusoidal obstruction is the basis of development of postsinusoidal portal hypertension responsible for clinical syndrome. Risk factors associated with the onset of VOD and diagnostic tools have been recently updated both in the pediatric and adult settings and here are reported. Treatment includes supportive care, intensive management, and specific drug therapy with defibrotide. Because of its severity, particularly in VOD with associated multiorgan disease, prophylaxis approaches are under investigation. During the last years, decreased mortality associated to VOD/SOS has been reported being it attributable to a better intensive and multidisciplinary approach.
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Affiliation(s)
- Francesca Bonifazi
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Barbato
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mariarosaria Sessa
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-Bologna University School of Medicine S. Orsola's University Hospital, Bologna, Italy
| | - Irene Defrancesco
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Mario Arpinati
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michele Cavo
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy.,Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-Bologna University School of Medicine S. Orsola's University Hospital, Bologna, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Gastroenterology Unit, Borgo Trento University Hospital, Verona, Italy
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Botti S, Agreiter I, Orlando L, Gargiulo G, Bonifazi F, Banfi MM, Cappucciati L, Caffarri C, De Cecco V, Deiana GM, Gavezzotti M, Magarò A, Netti MG, Pignatelli AC, Rostagno E, Samarani E, Cardoso JS, Soave S, Valente CM, Vedovetto A, Zecca M, Luminari S, Merli F, Guberti M. Nursing role in the assessment and care of hepatic sinusoidal obstruction syndrome patients: a consensus paper by the "Gruppo Italiano Trapianto di Midollo Osseo". Support Care Cancer 2020; 28:5125-5137. [PMID: 32056012 DOI: 10.1007/s00520-020-05353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Sinusoidal obstruction syndrome (SOS) is one of the most serious complications post haematopoietic stem cell transplantation (HSCT). The diagnosis of SOS is clinical, but nurses should be involved in the pre-transplant risk assessment period and play a crucial role in the early detection of signs and symptoms during and after hospitalization. The aim of this work is to achieve a consensus on nurses' behaviour in caring for SOS. METHODS On behalf of the Italian Group for Bone and Marrow Transplantation (GITMO), a promoter committee was established to put in place a consensus conference approach. A multidisciplinary group of GITMO together with four nurses, three haematology physicians and one patient representative acted as jury, who reviewed the reports and wrote recommendations and suggestions. Recommendations gaining 100% of consensus were considered 'Golden Points of Care'; if a consensus was achieved by ≥ 75% of the jury's members, those recommendations were defined as 'Good Practices'. RESULTS Eighteen papers written by nurses as first authors have been identified. Golden Points of Care and Good Practices were worked out for the following topics: nurses' role in general, nurses' role in pre-transplant assessment, pre-transplant risk assessment and risk stratification, baseline monitoring, suspected mild or moderate SOS, suspected severe or very severe SOS and late-onset cases. CONCLUSION SOS is relatively rare; therefore, a holistic approach to the patients' needs considering nursing role as essential may result in better care outcomes.
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Affiliation(s)
- Stefano Botti
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Iris Agreiter
- Bone Marrow Transplant Unit Denis Burkitt, St. James's Hospital, Dublin, Ireland
| | - Laura Orlando
- Bone Marrow Transplant Unit, Istituto Oncologico Svizzera Italiana, Bellinzona, Switzerland
| | - Gianpaolo Gargiulo
- Haematology Unit, Federico II University Hospital of Naples, Naples, Italy
| | - Francesca Bonifazi
- Institute of Haematology "Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Marina Marialuisa Banfi
- Bone Marrow Transplant Unit, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Lorella Cappucciati
- Department of Haematology, Guglielmo da Saliceto Hospital Piacenza, Piacenza, Italy
| | - Cristiana Caffarri
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina De Cecco
- Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Marta Gavezzotti
- Haematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Magarò
- Division of Haemato-oncology, European Institute of Oncology Milan, Milan, Italy
| | - Maria Giovanna Netti
- Department of Pediatric Oncology, Neuro-Oncology Unit, Meyer Children's University Hospital Florence, Florence, Italy
| | | | - Elena Rostagno
- Paediatric Haemato-oncology and BMT Department, Azienda Ospedaliero, Universitaria S. Orsola Malpighi, Bologna, Italy
| | | | | | - Sonia Soave
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata "University Hospital" Rome, Rome, Italy
| | | | - Alessio Vedovetto
- Health Profession Direction, Nursing Course University of Padova, Padua, Italy
| | - Marco Zecca
- Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Luminari
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Haematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Health Professions Direction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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