Two hundred fifty-five patients received chemoradiotherapy and a marrow graft for treatment of malignancy. Fifty-three developed venocclusive disease (VOD) of the liver. The clinical presentation was characterized by jaundice, fluid retention, ascites, upper abdominal pain, and encephalopathy. Insidious weight gain was the first sign of VOD, occurring a mean of 6.2 +/- 5.2 days after transplantation, followed shortly by jaundice. Twenty-four patients (45%) had a serious, progressive liver disease, but the others recovered a mean of 21.6 days after the onset of jaundice. Analysis of pretransplant factors did not disclose a significant association with serious VOD. Patients with serious VOD had significantly higher maximal values for bilirubin and SGOT, gained more weight, and were more likely to have encephalopathy. Supportive treatment did not appear to influence the outcome.