Veno-occlusive disease (VOD) of the liver, also termed as sinusoidal obstruction syndrome, constitutes a well-known complication of high-dose cytoreductive chemotherapy prior to allogeneic or autologous bone marrow transplantation and is associated with the intensity of treatment [1]. On the contrary, there is only one report of VOD during induction therapy for acute lymphoblastic leukemia in a patient with Marfan syndrome, who was successfully treated with defibrotide [2]. In this article, we present the first fatal case of VOD during induction therapy for acute lymphoblastic leukemia.