Pediatric Sibling Research Articles

Comparison between COVID-19 and DHF co-disease with COVID-19 alone in two pediatric sibling patients

We report herein the difference between Corona virus disease-19 (COVID-19) and dengue hemorrhagic fever (DHF) co-infection compared with COVID-19 alone in two pediatric sibling patients. This case report highlights a 10-year-old boy with both COVID-19 and DHF who had less severe coagulation disorder than his sister with COVID-19 alone. In a patient with a dual infection, the presence of dengue antibodies may induce immunological protection against COVID-19. We found reports of milder symptoms in patients who had dengue prior to SARS- CoV-2 infection; however, the opposite occured when SARS-CoV-2 infection precedes dengue.

Quality of Life in Ugandan Children and Young Adults After Surgery for Congenital Heart Disease: Mixed Methods Approach.

Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute. One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings. Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization. Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions.

Can the bone marrow harvest volume be reduced safely in hematopoietic stem cell transplantation with pediatric sibling donors?

Reduced harvest volumes in pediatric donors appear to have the potential to reduce donor-associated risks while maintaining engraftment in recipients; however, the allowable harvest volume reduction remains undefined. We retrospectively analyzed the data pairs of 553 bone marrow (BM) harvests from pediatric (age at harvest <18 yr) sibling donors and clinical outcomes of 553 pediatric (age at infusion <14 yr) transplant-naïve recipients to assess the optimal BM harvest volume needed from pediatric donors to obtain the desired CD34+ cell count (≥3.0×106 cells per kg of recipient weight), and to study its impact on the clinical outcomes of transplantation in pediatric recipients. The minimum desired CD34+ cell count of ≥3.0×106 per kg of recipient weight was achieved for 506 (95.3%) of donor-recipient pairs. The median CD34+ cell yield was 6.4×106 per kg of recipient weight (range, 1.2‒33.8×106) in donors younger than 5 years old at harvest, 4.7×106 (range, 0.3‒28.5×106) in donors aged 5‒10 years and 2.1×106 (range, 0.3‒11.3×106) in donors older than 10 years (P<0.001). The infused CD34+ cell dose (×106 cells/kg of recipient weight) had no impact on GRFS; however, a CD34+ cell dose of ＞7×106 cells/kg of recipient weight did not improve hematopoietic recovery.

Frey procedure for hereditary chronic pancreatitis in pediatric sibling.

Frey procedure for hereditary chronic pancreatitis in pediatric sibling.

Identification of potential barriers for timely access to pediatric sibling eye check-up in a tertiary eye care hospital.

To identify socio-economic, demographic, and clinical factors that may be associated with sibling access to ophthalmic check-up. A cross-sectional, descriptive study investigated children in the age group of 0-15 years under a project on Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS project). The siblings of pediatric patients (proband) with refractive errors, strabismus, cataract, glaucoma, and retinal pathologies were given a referral card for ophthalmic check-up. If parents do not bring siblings for check-up within 1 month of initial information and even after 2 SMS reminders, it was considered as failure to uptake of services. On follow-up later, they were provided a questionnaire. A questionnaire was given to the parent by interview through a project coordinator, and details were obtained from the parents or caretaker. Parents who were willing for telephonic interview were asked to respond to the questionnaire over phone on the scheduled date. The sibling details, parent-related details, and data from questionnaire forms were entered and analyzed. The mean age of 300 siblings was 9.3 ± 4.0 years with the majority of them being female (158). The most common reasons quoted by parents in the rural area compared with the urban area for not bringing siblings for eye exams were the travel distance from home to the hospital (n = 118, 83.7%), the travel time from home to the hospital (n = 109, 77.3%), more than one vehicle required to change (n = 111, 78.7%), and the transportation cost more than rupees 100 (INR) (n = 89, 63.1%) (p < 0.05). Unable to leave work responsibilities (n = 126, 79.3%) was stated more frequently by urban parents compared to rural (p = 0.039). Our study suggests that the financial factor, the distance factor, and social belief play an important role in timely uptake of sibling eye check-up. Targeting siblings with treatable pediatric eye diseases could help in reducing the burden of refractive error, strabismus, and cataract in the pediatric population.

Bone Marrow Harvest Volume and CD34+ Cell Count in Pediatric Sibling Donors: A Single Centre Retrospective Analysis

INTRODUCTION: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only treatment modality offering cure or long-term survival for many hematologic malignancies, and non-malignant diseases in children. HLA-matched siblings are considered the best donors because of reduced risks of transplant-related complications and better clinical outcome. According to the National Marrow Donor Program Guidelines, the maximum amount of bone marrow harvest is limited to 20ml/kg donor's body weight. The aim of this retrospective study was to assess the optimal bone marrow harvest volume in pediatric donors needed to obtain the desired CD34+ cell count. METHODS: We reviewed medical charts of 553 pediatric (age at harvest &lt;18 years) sibling donors who were harvested for bone marrow from Jan 2007 to Dec 2017 at our institution for pediatric (age at infusion &lt; 14 years) transplant naïve recipients in order to examine the volume harvested per donor's weight, the percentage of harvests that reached the minimum desired CD34+ cell count of ≥3.0X10^6 per Kg of recipient weight, harvest related hospitalization days and side effects related to the procedure and the impact of granulocyte-colony stimulating factor (GCSF) priming on CD34 count of harvested bone marrow. RESULTS: 288 out of 553 donors were male. 155 (28%) were below 5 years of age at harvest, 189 (34.2%) were between 5-10 and remaining 209 (37.8%) were 10 years and above, with a median of 8.4 years (range: 0.2-17.9). Primary indication for transplant among 131 (23.7%) of our pediatric recipients were Malignant Disorders, Non-Malignant Disorders in 214 (38.7%) and Primary Immunodeficiency and Histiocytic Disorders in 208 (37.6%). GCSF priming was carried out in 219 (39.6%) donors. The minimum desired CD34+ cell count of ≥3.0X10^6 per Kg of recipient weight was reached in 517 (93.5%) harvests. Post infusion Absolute Neutrophil Counts (ANC) recovery within Day+28 was recorded among 472 (85.4%) of the transplant naïve recipients, while in 72 (13%) cases ANC never recovered and in remaining 9 (1.6%) time to recovery was beyond Day+28. ANC recovery within Day+28 was significantly associated with CD34+ cell dose of ≥3.0X10^6 per Kg of recipient weight (n=441, 93.4% vs. 31, 6.6%; P-Value&lt;0.001). Median CD34+ cells (X10^6) collected per Kg of donor weight were significantly higher among donors younger than 5 years of age when compared to those 10 and beyond (P-Value &lt;0.001) with a median harvested volume of 13.7, 12.0 and 8.3 mL/Kg (P-Value&lt;0.001, Table 1). On the same note, median CD34+ cells collected per donor weight were significantly higher among donors primed with GCSF in contrast to those who did not (6.02 X10^6 vs. 3.1 X10^6, P-value &lt;0.001). 54 (9.8%) of our donors required PRBC transfusion; among whom 34 (63%) were below 5 years of age at harvest, 15 (27.8%) 5-10 years and remaining 5 (9.3%) were 10 and above (P-Value&lt;0.001). 2 (0.5%) donors were hospitalized for four days, 12 (3.2%) for three, 201 (54.3%) for two and 155 (42%) for one day only. No significant side effects were noted among our donor population. CONCLUSION: Our study confirmed that CD34 cell count were significantly higher among younger donors. The use of Higher CD34 cell dose is significantly associated with engraftment. Priming with G-CSF had significant impact on CD34+ cell count. These large data confirm the suggestion that the volume of bone marrow harvested can be decreased among younger donors without significantly changing the overall CD34 cell count. Disclosures No relevant conflicts of interest to declare.

Factors Influencing Pediatric Cochlear Implant Outcomes: Carolina Sibling Study.

To determine the correlation between speech perception performance between pediatric sibling pairs with severe to profound sensory hearing loss receiving cochlear implants, and in cases of discordance in performance, determine which variables negatively impacted performance. Retrospective chart review. Tertiary academic referral center. Eighty-nine pediatric subjects, 43 sibling groups, under the age of 18 with severe to profound sensory hearing loss who received a cochlear implant with a sibling who also received a cochlear implant. Cochlear implantation. Speech perception scores, consonant-nucleus- consonant score. A statistically significant correlation was found between speech perception performance of pediatric siblings. Depth of insertion is positively correlated with better speech perception in siblings with discordant results. There was no significant relationship with either electrode type, unilateral/bilateral status, or age of implantation. Pediatric siblings have a high correlation in speech perception outcomes following cochlear implantation, suggesting family environment plays a strong role. In circumstances in which outcomes between siblings are substantially different, greater depth of implant insertion is correlated with better consonant-nucleus- consonant word scores.

607 - Detection of Abnormalities during Evaluation of Pediatric Sibling Bone Marrow Donors

607 - Detection of Abnormalities during Evaluation of Pediatric Sibling Bone Marrow Donors

Bone Marrow Harvest in Pediatric Sibling Donors: Role of Granulocyte Colony-Stimulating Factor Priming and CD34+ Cell Dose

To ensure optimal clinical outcomes for patients while retaining adequate protection for donors, the National Marrow Donor Program developed guidelines specifying that up to 20 mL/kg of bone marrow can be harvested from donors. These guidelines, originally developed for unrelated adult donors, are followed in children as well. We studied the impact of granulocyte colony-stimulating factor (G-CSF) priming on the cellular composition of harvested bone marrow, sought to develop an algorithm to optimize bone marrow harvest volume from pediatric matched sibling donors, and studied the impact of CD34+ cell dose on clinical outcomes. We analyzed data from 92 bone marrow harvests and clinical outcomes for 69 sibling recipient-donor duos, The mean age of recipients was 9.85 ± 5.90 years, and that of donors was 11.85 ± 6.36 years. G-CSF priming was not associated with higher yield of CD34+ cells/µL. The median CD34+ cell count obtained from donors was 700 cells/µL (range, 400-1700 cells/µL) in donors age <6 years, 360 cells/µL (range, 100-1100 cells/µL) in donors age 6 to 12 years, and 300 cells/µL (range, 80-800 cells/µL) in donors age >12 years (P < .001). The number of CD34+ cells infused had no impact on traditional clinical outcomes; however, it was significantly related to graft-versus-host disease/relapse/rejection-free survival. Our investigation revealed that ultimately, a CD34+ cell count of approximately 3 to 5 × 106/kg was a threshold beyond which increasing CD34+ cell dose did not impact outcome. In this study, we addressed the broad question of whether harvesting up to 20 mL/kg of bone marrow from a child donor is truly necessary for optimal outcomes in every pediatric case.

Hematopoietic stem cell donation: psychological perspectives of pediatric sibling donors and their parents.

Allogeneic stem cell transplantation (SCT) is widely used for treatment of various life-threatening pediatric diseases. It is an intensive process that psychologically affects the whole family. Pediatric donors represent a very unique, underreported, group. The aim of this study is to investigate the sibling donors' and their parents' perspective on the donation process. The cohort included 36 sibling donors and 50 parents of pediatric patients who underwent allogeneic SCT between 1995 and 2010 and were alive at the time of the study. Mean age at donation was 14.78±8.350 years in donors' group and 8.22±4.639 years in parents' group. Data were collected by anonymous questionnaires. Three psychological dimensions were analyzed: donors' personal perspective; donor-recipient interpersonal relationship and the influence of the donation on the family unit. Results showed that the donors experienced a wide range of complex emotional responses, positive and negative, whereas the parents' responses were mainly positive and less complex. This study presents both the sibling donor's and parents' perspective, giving a more complete picture of the donation process within the family. The effects of this intense experience of SCT has a long-term impact on the whole family, indicating the need for follow-up and psychosocial support.

Through the Eyes of Young Sibling Donors: The Hematopoietic Stem Cell Donation Experience

This qualitative study used a grounded theory approach to explore how pediatric sibling donors of a successful hematopoietic stem cell transplantation conceptualized their donation experiences. Saving my sister's (or brother's) life describes the central phenomenon identified by this purposive sample of 8 sibling donors. Five themes captured their memories: being the perfect match, stepping up, worrying about the outcome, the waiting process, and sharing a special bond. Further research surrounding changes in relational issues will provide insight into inter-sibling support and the developmental course of the sibling relationship into adulthood when intensified by a health crisis.

Young Female Donors Do Not Confer an Increased Risk of Graft-Versus-Host Disease in Pediatric Hematopoietic Stem Cell Transplant

Backgrond: Donor selection is a critical step for the success of hematopoietic stem cell transplantation (HSCT). Donor/recipient sex-mismatch, donor age, and donor parity have been found to play an important role in the adult setting, and minor histocompatibility antigens (mHCA) encoded by the Y-chromosome presumed to be in the causal pathway. The pediatric sibling HSCT setting offers a special opportunity to evaluate donors and to see whether the observed importance of donor sex and age holds true when the donors are young and presumably immunologically naïve to Y-chromosome mHCAs. We hypothesized that if the presence of acquired T and B cells sensitized to H-Y antigens are in fact a major contributing factor to differences in outcomes between sex-matched and sex -mismatched transplants, there should be no such difference when a non-exposed (non-alloimmunized) female donor is involved.Methods: Retrospective review of pediatric patients receiving myeloablative sibling-donor HSCT from 1996 to 2012 in our institution. Donor sex, donor age, and sex-match were included among clinical predictors. Outcomes included acute and chronic graft versus host disease (aGVHD and cGVHD, respectively). Univariate and multivariate analyses were performed.Results: Of 244 patients included in this study, 50% were ≤10 years, 61% had a donor ≤12 years of age, 53% had a sex-matched donor, 46% had a female donor, 64% had an oncologic diagnosis, 62% were transplanted between 2005 and 2012, 96% were fully HLA-matched, 96% received bone marrow stem cells, and 91% received cyclosporine and methotrexate for GVHD prophylaxis. Forty-one (17%) patients developed acute GVHD, 31 (14%) of 229 patients alive past 100 days developed chronic GVHD, and 141 (73%) patients were alive at 5 years. No cGVHD was observed among 109 patients <10 years of age who received a 5/5 HLA-matched HSCT using bone marrow as the cell source; regardless of donor age or sex. However, 24 of 113 (21%) of patients ≥10 years of age developed cGVHD despite receiving 5/5 HLA-matched HSCT using bone marrow cells. Multivariate analysis showed older patient age, earlier transplant date and conditioning with cyclophosphamide and total body irradiation as significant predictors of acute GVHD. For cGVHD, older patient age and female donor increased risk of cGVHD while HLA-full match and use of bone marrow as stem cell source decreased risk of cGVHD. Effect modification occurred between donor age and donor sex (p=0.0473). The effect of female donor sex on cGVHD noted in the model adjusted for patient age, HLA-match, and cell source (OR 4.5; 95%CI 1.8-11.6), turned not significant if the donor was <12 years old (OR 2.6; 95%CI 0.7-10.2) and increased in magnitude and significance if the donor was ≥12 years old (OR 13.6; 95%CI 2.8-39.6).Conclusions: Patient age is a significant predictor of acute and chronic GVHD. However, our results suggest that in the pediatric population, younger donors (<12 years old) can be chosen to be good candidates for their siblings, independent of sex.Table IMultivariate analysis and stratification of cGVHD results by donor ageOdds Ratio (CI)Waldp-valueMax-Rescaled R-SquareaGVHDPatient age1.1 (1.04, 1.2)0.00180.26Year of SCT0.8 (0.7, 0.9)<0.0001Cy-TBI Conditioning3.2 (1.4, 7.3)0.0059cGVHDPatient age1.2 (1.1, 1.3)<0.00010.27Female donor4.5 (1.8, 11.6)0.0017HLA-full match0.2 (0.04, 0.93)0.0405BM stem cells source0.2 (0.03, 0.91)0.0385cGVHD for Donor <12y/oPatient age1.3 (1.1, 1.5)0.00050.32Female donor2.6 (0.7, 10.2)0.1737HLA-full match0.13 (0.02, 1.2)0.0698BM stem cells source0.3 (0.04, 2.2)0.2250cGVHD for Donor ≥12y/oPatient age1.3 (1.06, 1.4)0.00660.33Female donor13.6 (2.8, 39.6)0.0011HLA-full match0.8 (0.03, 28.7)0.9237BM stem cells source0.03 (<0.001, 2.7)0.1308 DisclosuresNo relevant conflicts of interest to declare.

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion.

We retrospectively studied 108 marrow harvests from 105 pediatric sibling donors. The median age of donors was 8 years (range: 1-15) and the median body weight was 27 kg (range: 10-100). The volumes of aspirated marrow were 5.0-23.8 mL/kg donor body weight, and harvested bone marrow volume exceeded 15 mL/kg in 42% of the donors. A total of 100 autologous blood donations were performed, and eight donors had red cells salvaged from their harvests reinfused. The median Hb levels before and after harvests were 12.3 g/dL (range: 10.0-14.7) and 11.0 g/dL (range: 8.9-13.8), respectively. None of the donors received allogeneic blood transfusions or hematopoietic growth factors such as EPO and G-CSF before or after collection. Transplanted dose was 1.4-10.8 × 10(8) cells/kg recipient body weight without differences due to donor age. Higher concentrations of nucleated and CD34(+) cells were obtained from younger donors. All donors tolerated the procedures well, with no serious complications. Thus, children may safely donate marrow for allogeneic transplantation, and the yields of nucleated cells for engraftment are substantial.

No Major Complications In Children After Stem Cell Donation At One Year Follow-Up: EBMT Pediatric Diseases Working Party Study

BackgroundWe previously reported (Styczynski et al, Blood, 2012) that hematopoietic stem cells (HSC) collection from bone marrow (BM) or peripheral blood (PB) in pediatric sibling donors is safe, however there is a risk of mild, short-term early side effects. No data are available so far on follow-up in children donating HSC. ObjectiveTo analyze donor safety and side effects related to HSC collection from BM or PB in pediatric sibling donors after 1-year. Donors171 children: 90 male (M), 81 female (F), median age 9.2 (range: 0.7-17.3) yrs, including 45 children's weight <20 kg, 64 between 20-40 kg, 82 weight >40 kg; 31 donors were <4 yrs, 40 at 4-8 yrs, 100 at age >8 yrs. There were 25 PB donors 9 (PBD) (18 M, 7 F; median age 11.0, range: 1.3-17.3 yrs ) and 146 BM donors (BMD) (72 M, 74 F; median age 8.3, range: 0.7-17.3 yrs). MethodsData from 14 participating EBMT Centers were registered on specific forms, sent to the PDWP office and statistically analyzed. ResultsDuring follow-up local pain was reported by 16/161 (9.9%) donors at catheter site (n=1) or collection site in 16 (14/137 BM; 2/24 PB, ns). 14 (8.1%) donors complained for pain persistence for 1-6 months (1mo-5, 2mo-5, 3mo-2, 5mo-1, 6mo-1). Late vomiting was observed in 7/163 (4.3%) (BMD only), and hematuria in 1 donor. Fever episodes were observed in 21/164 (12.8%) (21/140 BMD, p=0.045), lower respiratory tract infection in 3/164 (1.8%) (1/140 BMD, 2/25 PBD, p=0.056), upper respiratory tract infection in 21/171 (12.3%) (21/146 BM, p=0.046) and urinary tract infection in 5/171 (2.9%) (5/146 BMD, ns). No other infections (including gastroenterocolitis or hepatitis) were reported. Anemia was diagnosed in 6/164 (3.6%) (6/140 BMD, ns). At 1 year follow-up iron was supplemented in 24/164 (14.6%) (22/140 BMD, 2/24 PBD, ns) and folinic acid in 2/163 (1.2%) (BMD only). No other hematological problems (including thrombotic events) were reported. One donor was diagnosed for chronic disease (0.6%) (asthma), 4 (2.4%) had another hospital stay: physiotherapy (n=1), circumcision (n=1), plastic surgery due to an accident (n=1), and donation for MSC (n=1). Assessment of profile of psychological status consisted of a six item questionnaire. At 1-year follow-up, donors felt helpful in 132/154 (85.7%) cases (BMD 109/130, PBD 23/24, ns); happy in 117/149 (78.5%) cases (BMD 93/125, PBD 24/24, p=0.011); proud in 113/147 (76.8%) cases (BMD 91/124, PBD 22/23, p=0.039); depressed in 11/147 (7.5%) cases (BMD 11/124, PBD 0/23, ns) and responsible for recipient in 97/145 (66.9%) cases (BMD 83/122, PBD 14/23, ns). Willingness for subsequent HSC donation was reported by 113/147 (76.8%) children (BMD 94/125, PBD 19/22, ns). ConclusionsAt one-year follow-up after BM or PB HSC collection in pediatric sibling donors no major side effects were reported, however there is a risk of mild side effects. A donor registry should document and evaluate the course of minors who donate hematopoietic stem cells to better define possible risk factors of BM or PBSC harvest. Disclosures:Dreger:Riemser Pharma : Consultancy, Honoraria, Research Funding.

The Pediatric Sibling Donor Experience in Hematopoietic Stem Cell Transplant: An Integrative Review of the Literature

This integrative review explored and described published research findings focused on the experiences of pediatric sibling hematopoietic stem cell donors. After a comprehensive search, nine studies met the inclusion criteria of the study. There was no evidence of coordinated programs of research to effectively advance and build knowledge about the experiences of pediatric sibling donors. The limited descriptive evidence revealed that differences in the experiences of sibling donors vary by age and developmental stages; however, the use of small or repeated samples and qualitative methods limited the generalizability of study findings. Collaborative research using prospective, longitudinal designs will build and advance the evidence base for the design of developmentally appropriate interventions for pediatric sibling donors and their families.

Risk of complications during hematopoietic stem cell collection in pediatric sibling donors: a prospective European Group for Blood and Marrow Transplantation Pediatric Diseases Working Party study

AbstractWe investigated prospectively factors influencing the safety of hematopoietic stem cell (HSC) collection in 453 pediatric donors. The children in the study donated either BM or peripheral blood stem cells (PBSCs) according to center policy. A large variability in approach to donor issues was observed between the participating centers. Significant differences were observed between BM and PBSC donors regarding pain, blood allotransfusion, duration of hospital stay, and iron supplementation; however, differences between the groups undergoing BM vs PBSC donation preclude direct risk comparisons between the 2 procedures. The most common adverse event was pain, reported mainly by older children after BM harvest, but also observed after central venous catheter (CVC) placement for PBSC collection. With regard to severe adverse events, one patient (0.7%) developed a pneumothorax with hydrothorax after CVC placement for PBSC collection. The risk of allotransfusion after BM harvest was associated with a donor age of < 4 years and a BM harvest volume of > 20 mL/kg. Children < 4 years were at higher risk than older children for allotransfusion after BM harvest and there was a higher risk of complications from CVC placement before apheresis. We conclude that PBSC and BM collection are safe procedures in children.

The Management of the Sibling Hematopoietic Stem Cell Donor

Hematopoietic stem cell transplants are procedures with curative potential for patients with diseased, damaged, or absent stem cells. Because a sibling has the best chance of immunocompatibility with one in need of a transplant, siblings are the most suitable donors of stem cells. However, when siblings are stem cell donors, various ethical issues arise concerning the risks and benefits to the pediatric donor. Because of the critical and potential rapid deterioration of the recipient's condition, the needs of the sibling donor may be overlooked. This potential lack of advocacy for the pediatric sibling donor creates a role for the primary care provider to assess the child's physical and psychological ability to undergo the donation procedure, examine the ethical issues in choosing to use the pediatric sibling as the stem cell donor, prepare the child for the procedure, and follow-up with the sibling donor once the procedure is completed.

Pediatric Sibling Donor Complications of Hematopoietic Stem Cell Collection: EBMT Pediatric Diseases Working Party Study.

Abstract 806 Objective:The analysis of donor safety and early side effects related to hematopoietic stem cells (HSC) collection from bone marrow (BM) or peripheral blood (PB) in pediatric HLA-identical sibling donors. Methods:From 2005 to 2009, data regarding pediatric (<18 years) sibling donors undergoing HSC collection from 38 participating EBMT Centers were registered on specific forms sent to the PDWP Office. Data were centrally analyzed as of July 2009. A multiple logistic regression was performed to express an estimate of the relative risk of BM versus PB donation for the following variables: pain, blood transfusion, prolonged hospital stay, and need for iron supplementation. Results:A total number of 410 pediatric sibling donors with median age of 9 (range; 0.3-18) years were enrolled into the study; including 12% aged <4 yrs and 64% with body weight <40 kg. Children donated BM in 272 (66%), and PB in 138 (34%) cases. The criteria used by transplant centers for PB-HSC collection in children were: discrepancy between donor and recipient body weight, parents decision, undergoing clinical trial (pediatric centers), or transplant protocol (adult centers). Consents for donation were given by parents (49%), court (23%), ethical committee (28%) or social board (0.4%). All BM and 56% of PB donors had general anesthesia (PB donors for central catheter placement), for a median 90 (range; 30-300) and 30 (range 8-285) minutes, respectively. One (0.2%) serious adverse event (SAE) was reported (pneumothorax+hydrothorax) after catheter placement for PB collection. Tachycardia, decrease of blood pressure, sore throat or vomiting after anesthesia occurred in 5-11% cases. Autologous blood transfusion was done in 26% of BM and 7% of PB donors, at median age of 12 years (range 2.8-18). Erythropoietin was administered in 23 BM donors. BM was collected in median volume 18.8 (range; 2-49) ml/kg of donor weight and no severe complications of BM collection were observed. G-CSF priming was performed in all PB donors with median G-CSF dose of 10 (range; 5-20) mcg/kg/day. Median WBC count before collection was 46 (range; 24-101) G/L. Muscle/bone pain, fever, headache, abdominal or back pain, nausea or vomiting related to G-SCF were reported only in 6% of PB donors. Median number of apheresis was 1 (range; 1-3), which lasted for a median of 4 (range; 2-8) hrs. 21% donors experienced hypocalcemia. Thrombocytopenia <70G/L occurred in 3% of PB donors, however platelet transfusion was not required in any case. Blood allotransfusion was done in 23% of BM and 2.6% of PB donors. Iron was supplemented in 73% of BM and 31% of PB donors (p<0.001). Pain after collection occurred in 64% of BM and 15% of PB donors (p<0.001) and persisted for median of 1 day (range; 1-21 for BM and 1-3 for PB donors, respectively). No infections or thrombotic events were reported. Median number of nights spent in hospital before collection was 1 (range; 0-14) for BM and 3 (range; 0-7) for PB donors; while after collection 1 (range; 0-7) for BM and 0 (range; 0-6) for PB donors (p<0.001). Donors felt helpful, happy and proud in most cases, irrespectively of stem cell source. They felt responsible for recipient in 58% of BM and 53% of PB of donors (ns). Willingness to donate again was expressed by 86% and 71% of the BM and PB of donors, respectively (p=0.007). In multiple logistic regression analysis following complications and risk factors were determined: pain (BM collection, OR=12.3, p<0.001; age >4 yrs, OR=9.9, p<0.001), blood allotransfusion (BM collection, OR=22.7, p<0.001; body weight <40 kg, OR=4, p=0.004), prolonged hospital stay (BM collection, OR=3.5, p<0.001), and need for iron supplementation (BM collection, OR=6.9, p<0.001). Conclusions:BM or PB HSC collection in pediatric sibling donors is safe, however there is a risk of mild, short-term and easy to prevent or control early side effects. The risk of SAE in healthy pediatric donors exists, although it is small. Donors and parents must be informed about the risk of possible complication. There is a need of donor outcome and follow-up registry. Disclosures:No relevant conflicts of interest to declare.

Pediatric sibling donor bone marrow transplant: Assessing distress in donors and family members

e20625 Background: When a child is diagnosed with cancer, the entire family is affected. In qualitative studies, 28–81% of siblings of children with cancer display behavioral maladjustment. Quantitative studies show similar findings, documenting up to a three-fold increase in clinically significant behavioral problems among siblings of children with cancer. Methods: In order to better understand sibling distress we conducted 3–4 interviews using grounded theory methodology (a qualitative strategy to explore common themes and develop theory) with each family member over 9 years old of 7 families with a child undergoing a sibling donor bone marrow transplant for cancer or sickle cell anemia. Participants also completed standardized scales related to coping. Results: Of the 29 subjects interviewed, 6 were African American, 4 Hispanic and 19 white. Six parents had at least a college degree and income was evenly distributed from $5,000 to &gt;$80,000 a year. Children, including 4 patients, 6 donor siblings and 5 other siblings, ranged in age from 9 to 18. Based on the grounded theory analysis of each interview, we theorize that siblings experience less distress if the parents share the patient care giving. Our data support this hypothesis, with analysis of interviews indicating improved coping in families that shared care giving for the transplant recipient, and increased distress in families in which all the patient care giving was performed by the mother, a commonly used strategy. Conclusion: In order to potentially facilitate increased family functioning and decrease caregiver burden, parents should be encouraged to share care giving when feasible. Our study shows that systematic interviews can explore the family experience of pediatric transplantation and allow development of improved support systems for families of children undergoing sibling donor bone marrow transplantation. No significant financial relationships to disclose.

Hematopoietic Stem Cell Donation in Children

Hematopoietic Stem Cell Transplant (HSCT) represents the second most frequent major organ transplant in the United States. Compared with other family members, siblings are more likely to be immunologically matched with the recipient and therefore are often the most suitable donors. Due to a dearth of information on the positive and adverse effects of HSCT on pediatric sibling donors, we sought to examine available data. Eight published reports assessing the pediatric sibling donor experience were identified in the literature. Studies were predominately small (n < 44) and cross-sectional. Results suggest a range of psychological distress responses with higher distress in pediatric donor than non-donor siblings. Recommendations include future longitudinal research on sibling donor psychosocial adjustment, identification of sibling donors at high risk for maladaptive responses, and development of educational and psychosocial interventions for this overlooked pediatric population.