Patient description: A 16-year-old girl came to the clinic complaining of weight gain and abnormal menstrual cycles. Her BMI was 24, but she has gained 5 kg in the past few weeks. She gets tired more frequently and does not have energy to go dancing with her friends. Her lab results were remarkable for high TSH levels (15 mU/L) and low free T4 levels (0.18 ng/dl). Her anti-TPO levels were extremely high (136 IU/ml). She was diagnosed with Hashimoto disease. She does not smoke and she is not sexually active.

Clinical trial eligibility criteria: eligible ages (years): 0.0-18.0,  Veno-occlusive Disease Clinical diagnosis of VOD defined by Jaundice (bilirubin ≥ 2 mg/dL) and 2 or more of the following: ascites, weight gain > 5% above baseline weight (see Section 5.2), hepatomegaly, RUQ pain Patients with jaundice and reversal of flow on Doppler examination of the portal vein will be eligible with one of the following: ascites, weight gain > 5% above baseline weight, hepatomegaly, RUQ pain Patients with pre-existing hepatomegaly must have documentation by physical exam or imaging that liver size is increased over baseline at admission Patients who do not meet the in Section 3.1.1 (ie. have two of the major but not three) and have biopsy proven VOD are eligible in the presence of characteristics consistent with severe disease (see below) Patients with concurrent, confounding causes of liver dysfunction clinically evident or evident on ultrasound or other radiographic imaging (such as evidence of biliary ductal dilatation or focal tissue defects) may require biopsy-proven VOD and/or elevated wedged trans-hepatic venous pressure gradient measurement ( ≥10 mm mercury) to be considered eligible. Best medical judgment and further imaging studies can be used to clarify the diagnosis and determine confounding causes of liver dysfunction Severity of VOD defined by For patients addressed by the Bearman model (i.e. within 16 days of SCT and conditioned with either BU/CY, CY/TBI or CBV), there must be a 30% or greater risk of severe VOD (see Appendix B) For all other patients who are not addressed by the Bearman model (ie. beyond 16 days of SCT and/or not conditioned with either BU/CY CY/TBI or CBV), there must be concomitant multi-organ failure defined as presence of one or more of the following   Patients receiving concomitant heparin or other anticoagulants unless being used for routine CVL management, fibrinolytic instillation for CVL occlusion, intermittent dialysis or ultrafiltration are excluded. Patients who have received systemic t-PA (concomitant or prior) are excluded Patients with significant uncontrolled acute bleeding, defined as hemorrhage requiring > 15 cc/kg of packed red blood cells (ie. a pediatric patient weighing 20 kg and requiring > 300cc of packed red blood cells /24 hours or an adult patient weighing 70 kg and requiring >3 units of packed red blood cells/24 hours) to replace blood loss are excluded. These parameters must be reviewed prior to enrollment by the PI or his/her designate Patients with hemodynamic instability as defined below Hemodynamic stability is defined as having no requirement for pressor support OR being able to maintain mean arterial pressure within 1 SD of age-adjusted levels with pressor support (see Appendix D) Patients requiring renal dose dopamine alone (2-5 mcg/kg/min) are eligible without measurement of mean arterial pressure Patients with Grade B-D GVHD, graded according to the IBMTR Severity Index (see Appendix G). Please note patients with Grade B skin only are eligible Patients intubated for documented intrinsic lung disease -- Patients intubated secondary to a mechanical barrier to ventilation, e.g.pulmonary edema or ascites, will be eligible as long as the PaO2/FiO2 ratio is ≥ 300 and/or the oxygen index (OI={MAP x FiO2}÷ PaO2 x 100) is ≤ 25% at the time of enrollment Patients who meet Grade IV common toxicity for neurotoxicity (other than Grade IV confusion and/or delirium), i.e. coma, seizures, toxic psychosis Patients who are currently receiving treatment with another experimental agent