Table 3.

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

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.