EBMT scale for grading VOD/SOS severity in pediatric patients
| Clinical measure . | Mild . | Moderate . | Severe . | Very severe (all patients with MOD/MOF) . |
|---|---|---|---|---|
| CTCAE | 1 | 2 | 3 | 4 |
| Liver function tests (ALT, AST, GLDH)* | ≤2× normal | >2 and ≤ 5× normal | >5 | >5 |
| Persistent RT* | <3 d | 3-7 d | ≥7 d | ≥7 d |
| Bilirubin, mg/dL*† | <2 | <2 | ≥2 | ≥2 |
| Bilirubin, μmol/L | <34 | <34 | ≥34 | ≥34 |
| Ascites* | Minimal | Moderate | Necessity for paracentesis (external drainage) | |
| Bilirubin kinetics | Doubling within 48 h | |||
| Coagulation | Normal | Normal | Impaired coagulation | Impaired coagulation with need for replacement of coagulation factors |
| Renal function GFR, mL/min | 89-60 | 59-30 | 29-15 | <15 (renal failure) |
| Pulmonary function (oxygen requirement) | Absent or <2 L/min | >2 L/min | Need for ventilator support (including CPAP) | |
| CNS | Normal | Normal | Normal | New onset cognitive impairment |
| Clinical measure . | Mild . | Moderate . | Severe . | Very severe (all patients with MOD/MOF) . |
|---|---|---|---|---|
| CTCAE | 1 | 2 | 3 | 4 |
| Liver function tests (ALT, AST, GLDH)* | ≤2× normal | >2 and ≤ 5× normal | >5 | >5 |
| Persistent RT* | <3 d | 3-7 d | ≥7 d | ≥7 d |
| Bilirubin, mg/dL*† | <2 | <2 | ≥2 | ≥2 |
| Bilirubin, μmol/L | <34 | <34 | ≥34 | ≥34 |
| Ascites* | Minimal | Moderate | Necessity for paracentesis (external drainage) | |
| Bilirubin kinetics | Doubling within 48 h | |||
| Coagulation | Normal | Normal | Impaired coagulation | Impaired coagulation with need for replacement of coagulation factors |
| Renal function GFR, mL/min | 89-60 | 59-30 | 29-15 | <15 (renal failure) |
| Pulmonary function (oxygen requirement) | Absent or <2 L/min | >2 L/min | Need for ventilator support (including CPAP) | |
| CNS | Normal | Normal | Normal | New onset cognitive impairment |
Patients who fulfill criteria in different categories must be classified in the most severe category; the kinetics of the evolution of cumulative symptoms within 48 h predicts severe disease.
Adapted from Corbacioglu et al.
RT, refractory thrombocytopenia.
Presence of ≥2 of these criteria qualifies for an upgrade to very severe VOD/SOS.
Preexistent hyperbilirubinemia resulting from primary disease was excluded.