A variety of risk factors may be associated with an increased risk of veno-occlusive disease. Patients with one or more risk factors may benefit from closer monitoring and more aggressive therapy.


Type of Factor



pre-existing liver disease

hepatic fibrosis or cirrhosis; elevated liver function tests, low serum pseudo-cholinesterase, low albumin; presence of hepatic metastases; viral hepatitis C


radiation exposure

prior radiation therapy of the liver

total body irradiation, especially when combined with cyclophosphamide (depends on total dose and fractionation)

drug exposure

vancomycin or acyclovir exposure; use of norethisterone

methotrexate as part of GVHD prophylaxis


prior therapy with Gemtuzumab ozogamicin (Mylotarg)

high dose conditioning regimen; busulfan for conditioning, especially if high dose or combined with cyclophosphamide

possible GVHD

previous stem cell transplantation

allogeneic transplant (as compared to autologous); graft from unrelated donor; graft from related HLA mismatch


advanced age




• Norethisterone is an androgen used in treating osteoporosis (I wonder if this is a marker for advanced age).

• Gemtuzumab ozogamicin is a chemotherapy agent involving an IgG antibody targeted against CD33, which is expressed in AML and on normal hematopoietic cells.

• Previous stem cell transplantation could be a marker for refractory leukemia


Additional factors that may be implicated (not given in implementation):

(1) decreased protein C (hypercoagulability)

(2) factor V Leiden mutation (hypercoagulability)

(3) prothrombin G20210 mutation (hypercoagulability)

(4) cytomegalovirus infection (could be associated with liver disease)


To read more or access our algorithms and calculators, please log in or register.