Dr. Jonas Mattsson
Director, Hans Messner Allogeneic BMT Program
Nurse Practitioner, Hans Messner Allogeneic BMT Program
Dr. Arjun Law
Staff Physician, Hans Messner Allogeneic BMT Program
Bone marrow transplantation (BMT) saves lives and has many benefits. But it’s important to be aware of the potentially life-threatening complications.
One of those is veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS) of the liver. SOS occurs when the small blood vessels inside and leading to the liver become blocked. “Though this happens on a very small scale, it can become widespread over time, causing lasting and even permanent damage,” says Dr. Arjun Law, Staff Physician at the Hans Messner Allogeneic BMT Program at Princess Margaret Cancer Centre. Symptoms can include jaundice, liver tenderness, liver enlargement, and even liver failure.
BMT, also known as HSCT (hematopoietic stem cell transplant) are commonly used to treat patients with leukemia. To prevent the body from rejecting the new bone marrow or stem cells, patients are prepared with a conditioning regimen of chemotherapy, radiation, and immune-suppressing drugs to wipe out their existing immune system.
With no immune system to protect them, and the new bone marrow or stem cells not kicking in for two to four weeks post-transplant, patients are very vulnerable during this time to complications like SOS. “Fortunately, thanks to advances in the field and therapies tailored to the individual patient, incidences of SOS have decreased in the last decade,” says Dr. Jonas Mattsson, Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation and Director of the Hans Messner Allogeneic Transplant Program.
Picking up on [SOS] symptoms early gives us more time to intervene and get better outcomes.Dr. Arjun Law, Staff Physician at the Hans Messner Allogeneic BMT Program
Signs and symptoms not always obvious
“Unfortunately, SOS is not something you can diagnose visually or with a test, so you just have to keep it in the back of your mind as a potential complication,” says Dr. Law. Some early clinical signs are weight gain from fluid retention and mild hepatic (liver) dysfunction. “Picking up on these symptoms early gives us more time to intervene and get better outcomes,” says Dr. Law.
Dr. Mattsson agrees, stressing that, “it’s extremely important to see your patients every day and carefully evaluate them for appearance, because a weight increase may not be significant, or sometimes you won’t see things in a lab that you will see in a patient; so bedside treatment has a critical role in bone marrow transplantation.”
From a nursing perspective, “Education is paramount because the nurses are with the patient 24 hours a day,” says Zoe Evans, Nurse Practitioner at the Hans Messner Allogeneic BMT Program. “If they know what to look for, they act as our eyes and ears to ensure we can intervene as soon as possible.”
This article was made possible with support from Jazz Pharmaceutical.