Second allogeneic transplants in children: twelve years of experience

CMV Infection after Transplant from Cord Blood Compared to Other Alternative Donors: The Importance of Donor-Negative CMV Serostatus

Early (Day −7) versus Conventional (Day −1) Inception of Cyclosporine-A for Graft-versus-Host Disease Prophylaxis after Unrelated Donor Hematopoietic Stem Cell Transplantation in Children. Long-Term Results of an AIEOP Prospective, Randomized Study

Human Cytomegalovirus and Kidney Transplantation: A Clinician's Update

Hematopoietic stem cells can be found in the bloodstream and have the ability to grow into any type of blood cell. These stem cells can be removed from the blood stream and then given to a patient to treat different types of cancerous and noncancerous diseases. You can learn more about stem cells and hematopoietic stem cell transplantation on the next page. ### Hematopoietic Stem Cell Transplantation Hematopoietic stem cell transplantation is the main treatment for a number of inherited and acquired diseases. In this issue of Neurology , Faraci et al. (Faraci M, Lanino E, Dini G, et al. Severe neurologic complications after hematopoietic stem cell transplantation in children. Neurology 2002;59:1895–1904.) describe severe neurologic complications in 272 children who underwent hematopoietic stem cell transplantation. Nervous system complications are a common cause of side effects of stem cell transplantation, and little has been written about them in children. ### How the Study Was Performed The authors studied the medical records of children who had hematopoietic stem cell transplantation to see what kinds of serious nervous system complications occurred. They also collected other information to see if any of the following factors were linked to serious nervous system complications: ### How Common Were Serious Nervous System Complications? Serious nervous system complications were seen in 14% of the children in this study and a cause of death in 8.5%. These complications commonly occurred in the first year after the transplantation was performed. The main risk factors for serious nervous system complications can be found …

Comparable Clinical Outcomes between Haploidentical Family Donor and Other Donor Types after Hematopoietic Stem Cell Transplantation for Rare Pediatric Rare non-Malignant Diseases

Hematopoietic stem cell transplantation in 746 children with osteopetrosis: A study of the inborn errors working party of the EBMT

Osteochondroma after Hematopoietic Stem Cell Transplantation in Childhood. An Italian Study on Behalf of the AIEOP-HSCT Group

Thyroid dysfunction (hypo- and hyperthyroidism) has been reported as a late effect after hematopoietic stem cell transplantation (HSCT) in children. Short-term effects of HSCT on thyroid function parameters are, however, unclear. We prospectively evaluated thyroid function parameters before and 3 months after HSCT in all children (<21 years) who underwent HSCT during a 2-year period in the Princess Máxima Center, the Netherlands. Among 72 children, none had thyroidal hypothyroidism or hyperthyroidism 3 months after HSCT. Changes in thyroid function parameters (either aberrant thyroid-stimulating hormone [TSH] or free thyroxine [FT4] concentrations) were found in 16% before and in 10% 3 months after HSCT. Reverse triiodothyronine (rT3) was found elevated in 9.3% before and in 37% 3 months after HSCT, which could be related to poor physical condition. An individual decline in FT4 concentration of ≥20% was found in 10.5% (6/57) 3 months after HSCT. In conclusion, thyroidal hypo- and hyperthyroidism are very rare 3 months after HSCT. These results indicate that surveillance for hypo- and hyperthyroidism may start later in time. The changes in thyroid function parameters found 3 months after HSCT might reflect euthyroid sick syndrome.

Allogeneic Hematopoietic Stem Cell Transplantation for Children with Myelodysplastic Syndrome: A Report of a Korean Single Center Experience

Our primary objective was to describe the incidence of proven or probable invasive fungal infections (IFIs), a devastating complication of hematopoietic stem cell transplant (HSCT), in HCST in a middle-income country. Secondary objectives were to describe factors associated with IFIs and outcomes. In this single center retrospective study, pediatric patients who underwent a first allogeneic or autologous HSCT from 1998 to 2016 were included. Of the 251 HSCT recipients: 143 transplants were allogeneic and 108 were autologous. Overall, 23 (9%) experienced an IFI, mostly due to yeasts (83%). IFIs were more common in allogeneic HSCT (18/143, 13%) than in autologous HSCT (5/108, 5%; P=.045). Of the 23 patients with IFIs, 14 (61%) died, but only 1 directly from IFI (pulmonary aspergillosis). Overall survival at 3years was 0.42±0.11 in patients with IFIs and 0.60±0.37 in those without IFIs (P=.049). In Argentina, IFIs during HSCT are common. Recipients of allogeneic HSCT are at higher risk, and IFI is associated with reduced overall survival. Future work should focus on interventions to reduce and improve IFI outcomes in children undergoing transplants in low- and middle-income countries.

Objective To explore the clinical features of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infection after second hematopoietic stem cell transplantation (HSCT). Methods Twenty-five patients after second HSCT from Sep. 2009 to Oct. 2016 were collected, and CMV and EBV DNA in peripheral blood was detected regularly by polymerase chain reaction (PCR). Factors associated were compared by univariate analysis. Results The total incidence of CMV infection was 52.0% (13/25) after second HSCT. The incidence of CMV infection was 100% (2/2), 33.3% (5/15) and 75% (6/8) in bone marrow group, peripheral blood stem cell group, and mixed group, respectively. Stem cell sources were significantly correlated with CMV infection (P=0.038), however, there was no significant difference in CMV infection rate among three groups (P>0.05). None of preconditioning regimen, GVHD prophylaxis programs or severity of aGVHD were correlated with CMV infection after second HSCT (P>0.05). The total incidence of EBV infection was 24.0% (6/25) after second HSCT. The incidence of EBV infection was 100% (2/2), 6.7% (1/15) and 37.5% (3/8) in bone marrow group, peripheral blood stem cell group, and mixed group, respectively. Stem cell sources were significantly correlated with EBV infection (P=0.008). The EBV infection rate in bone marrow group was significantly higher than that in peripheral blood group (P=0.022), however, no significant differences were found between bone marrow group and mixed group, as well as between peripheral blood group and mixed group (P>0.05). Transplant methods were significantly correlated with EBV infection (P=0.007). The EBV infection rate in haplo-identical HSCT group (71.4%) was significantly higher than that in HLA-matched sibling HSCT group (0%) and autologous HSCT group (0%) (P=0.021 and 0.028), however, no significant differences were found between any other two groups (P>0.05). None of preconditioning regimen, GVHD prophylaxis programs or severity of aGVHD were correlated with EBV infection after second HSCT (P>0.05). Conclusion The incidence of CMV and EBV infection in patients undergoing second HSCT is high. Stem cell sources and transplant methods are associated with CMV and EBV infection after second HSCT. Key words: Hematopoietic stem cell transplantation; Cytomegalovirus; Epstein-Barr virus

Immune reactions are among the most serious complications observed after hematopoietic stem cell transplantation (HSCT) in children. Microarray technique allows for simultaneous assessment of expression of nearly all human genes. The objective of the study was to compare the whole genome expression in children before and after HSCT. A total of 33 children referred for HSCT were enrolled in the study. In 70% of the patients HSCT was performed for the treatment of neoplasms. Blood samples were obtained before HSCT and six months after the procedure. Subsequently, the whole genome expression was assessed in leukocytes using GeneChip Human Gene 1.0 ST microarray. The analysis of genomic profiles before and after HSCT revealed altered expression of 124 genes. Pathway enrichment analysis revealed upregulation of five pathways after HSCT: allograft rejection, graft-versus-host disease, type I diabetes mellitus, autoimmune thyroid disease, and viral myocarditis. The activation of those pathways seems to be related to immune reactions commonly observed after HSCT. Our results contribute to better understanding of the genomic background of the immunologic complications of HSCT.

Infectious complications remain one of the main problems contributing to significant morbidity and mortality after hematopoietic allogeneic stem cell transplantation (HSCT), and Human cytomegalovirus (HCMV) infection is one of the most frequent and well-known among them. In the last two decades, progress has been made in the diagnosis and monitoring of HCMV infection in HSCT recipients, thanks to the introduction of quantitation of pp65 in peripheral blood leukocytes (antigenemia) and quantitation of viral genome in the blood (DNAemia). This has allowed treatment to be administered during the pre-symptomatic phase of HCMV infection (pre-emptive therapy) and has greatly reduced HCMV-related morbidity and mortality. The advantages of the pre-emptive treatment approach include (i) treating a lower number of patients for shorter periods of time and (ii) avoiding the reported emergence of HCMV disease after discontinuing anti-HCMV prophylaxis. Our aims are to describe the pathogenesis of HCMV reactivation and disease and to analyze the risk factors and mechanisms of the immune response as well as the clinical history of HCMV-disease and the HCMV management in HSCT patients, through an overview of the recent literature.

Hematopoietic Stem Cell Transplantation in Children with Refractory Acute Lymphoblastic Leukemia

Non-T-Cell-Depleted HLA-Haploidentical Hematopoietic Stem Cell Transplantation for Children with Hematological Malignancies: Single-Center Pilot Study