Spanish expert agreement with the 2023 EBMT framework for adult sinusoidal obstruction syndrome/veno-occlusive disease management: a Delphi study

Introduction: Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) represents a serious complication of hematopoietic stem cell transplant (HSCT), manifesting as both classical and late-onset presentations. Diagnosis and management remain challenging due to diverse diagnostic and severity criteria, persistent uncertainties around defibrotide use, and difficulties in identifying high-risk patients. Objective: The aim of the study was to assess national agreement with the 2023 European Society for Blood and Marrow Transplantation (EBMT) adult framework for SOS/VOD management and to identify areas of consensus, residual uncertainty, and potential implementation challenges in Spanish HSCT practice. Materials and methods: A Delphi consensus study based on the RAND/UCLA methodology was conducted. Spanish hematologists with expertise in HSCT evaluated 33 statements covering key aspects of adult SOS/VOD management in a 2-round online Delphi process. Results: After 2 Delphi rounds, consensus was reached on 30 out of 33 statements (90.9%). Thirty-one statements were deemed appropriate, including 1 with neutral agreement, while 2 were considered doubtful withdisagreement among panelists. Conclusion: Spanish hematologists involved in HSCT demonstrated strong agreement withmost of the components of the 2023 EBMT adult framework for SOS/VOD management. These findings identified residualuncertainties that may inform future implementation and educational initiatives in Spanish HSCT practice.