Table 2 Summary of recommendations for prevention and monitoring of VOD/SOS

Avoid GO in patients with significant prior or baseline hepatic impairment or patients with R/R AML with prior HSCT

For patients proceeding to HSCT, an interval of ≥ 3 months between HSCT and last GO dose is recommended and treatment plans should be communicated to the transplant team at the outset

The risk of hepatic damage due to concomitant medications should be assessed to avoid harmful drug interactions

Prophylactic ursodeoxycholic acid is recommended

All patients receiving GO should be closely monitored for signs and symptoms of VOD/SOS (e.g., weight gain; see Table 1), especially in those receiving azoles during GO treatment

LFTs should be monitored prior to each GO dose

Close monitoring of LFTs is recommended in the post-transplant period for patients proceeding to HSCT

GO dose should be postponed in patients with total bilirubin > 2 × ULN and AST and/or ALT > 2.5 × ULN until recovery of total bilirubin to ≤ 2 × ULN and AST/ALT to ≤ 2.5 × ULN prior to each dose

Consider omitting the scheduled GO dose if the delay between sequential infusions is > 2 days