scholarly journals Second hematopoietic stem cell transplant using unrelated donor umbilical cord blood cures 50% of pediatric patients with leukemia relapsing after prior allogeneic transplant from a matched related sibling

2004 ◽  
Vol 10 ◽  
pp. 38
Author(s):  
S.L Staba ◽  
P Szabolcs ◽  
T Driscoll ◽  
P.L Martin ◽  
J Kurtzberg
Keyword(s):  
Stem Cell ◽  
Cord Blood ◽  
Umbilical Cord Blood ◽  
Hematopoietic Stem Cell Transplant ◽  
Pediatric Patients ◽  
Stem Cell Transplant ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Allogeneic Transplant ◽  
Hematopoietic Stem

Herpesvirus Viremia and Engraftment Status of Umbilical Cord Blood in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplant

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3021-3021
Author(s):  
Ibrahim Al_Harbi ◽  
Yvonne Yau ◽  
Upton Allen ◽  
Tal Schechter ◽  
Wendy Lau ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cord Blood ◽  
Hematopoietic Stem Cell ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Engraftment Failure

Abstract Abstract 3021 Umbilical Cord Blood (UCB) is frequently used as a source of stem cells for children undergoing allogeneic hematopoietic stem cell transplant (HSCT) for both benign and malignant disorders. Despite algorithms using both nucleated cell numbers and HLA typing, the rate of engraftment failure remains higher than rates observed using other stem cell products. We conducted a retrospective review of our centre's experience with HSCT with UCB to evaluate the impact of herpesvirus viremia on the rate of engraftment. Children who underwent allogeneic HSCT with UCB between 06/2005 and 05/2010 inclusive were identified from the program database. Engraftment was defined as the first day of three consecutive absolute neutrophil counts of > 0.5 × 10[exp 9]/L within 42 days of UCB infusion and evidence of donor DNA on chimerism testing. Blood samples were sent for qualitative herpesvirus polymerase chain reaction (PCR) weekly (HHV-6, HHV-7, EBV, CMV, HSV or VZV). If either CMV or EBV results were positive, a quantitative assay was performed as well. Viremia was considered to have occurred if the qualitative assay became positive. Anti-viral therapy was initiated for measurable amounts of either CMV or EBV DNA or selectively for HHV-6 DNA. Eighty-one HSCT utilizing UCB were performed during this period. One child was unevaluable (NRM at day +15) so the analysis was performed using the remaining 80 patients. Thirty HSCT (37.5%) were performed for non-malignant indications and 50 (62.5%) for malignant disorders. Ninety per cent were performed using unrelated UCB; 27 were 6/6 HLA matched UCB, 42 were 5/6 HLA matches and 11 were 4/6 matches. Four children were recovering counts at day +42 but had not reached the threshold neutrophil value. They were considered as delayed engraftment rather than engraftment failure. Eleven (14%) failed to engraft. Forty-two (52.5%) of the transplants were complicated by the detection of 1 or more herpesviruses (24 for only 1 virus, 15 for 2 viruses and 3 for 3 viruses). None of gender, ABO matching, recipient CMV pre-HSCT serostatus, disease category, use of ATG or TBI in the conditioning regimen, use of methotrexate as GVHD prophylaxis or positivity for any single herpesvirus was associated with engraftment failure. Numbers of viable nucleated cells and CD34+ cells were not different between those that engrafted and those that failed to engraft. Transplants complicated by viremia of more than 1 herpesvirus had a significantly poorer engraftment rate than others (0.667 vs 0.933, P=0.007); more specifically viremia due to CMV and any other herpesvirus was associated with a worse engraftment rate than others (0.643 vs 0.921, P=0.006) (table). Notably viremia due to HHV-6 and others or EBV and others were not related to engraftment failure.PCR resultEngraftedFailed to engraftNo CMV516CMV positive185CMV alone90CMV plus:    HHV-632    HHV-721    EBV22    HHV-6 & HHV-710    HHV-6 & EBV10 Conclusion: A significantly poorer engraftment rate in children undergoing HSCT using UCB was seen in those with CMV viremia in the presence of another herpesvirus. Further research is needed to define cause and effect and the therapeutic strategies to prevent it. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Morbidity, Mortality, and Healthcare Utilization in a National Cohort of Pediatric Patients with Hemophagocytic Lymphohistiocytosis Who Received Hematopoietic Stem Cell Transplant

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2183-2183
Author(s):  
Archana Ramgopal ◽  
Meghan McCormick ◽  
Ram Kalpatthi ◽  
Louis Rapkin ◽  
James Zullo ◽  
...  
Keyword(s):  
Stem Cell ◽  
Resource Utilization ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Hematopoietic Stem Cell Transplant ◽  
Pediatric Patients ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Elapsed Time ◽  
Over Time

Background Hemophagocytic lymphohistiocytosis (HLH) is a severe life threatening hyper-inflammatory syndrome of abnormal immune activation and dysregulation if untreated. The 5-year probability of survival (pSu) obtained from HLH registries and treatment protocols HLH-94 and HLH-2004 ranges from 21%-64%, with improved 5-year pSu of up to 70% following hematopoietic stem cell transplant (HSCT) (Arico et al., Trottestam et al., Bergsten et al.). Despite significant advances in the management of HLH over time, survival remains low and the extent of disease morbidity and healthcare utilization is poorly characterized. In this study, we sought to investigate morbidity, mortality, and the healthcare burden in children and adolescents with HLH who underwent HSCT. Methods Using the Pediatric Health Information System (PHIS) database, we identified patients under the age of 21 years admitted between 01/01/2004 and 09/30/2018 with a primary or secondary ICD-9 or ICD-10 diagnosis codes for HLH, as well as concurrent medication charges for both dexamethasone and etoposide in the same encounter. We then identified the patients who underwent HSCT to further analyze them. We abstracted data on demographics, hospitalizations, HSCT related complications, mortality, resource utilization and costs. Results were summarized using descriptive statistics. Time to HSCT was calculated as elapsed time from the admission date of the initial encounter to the date of the encounter in which there was a procedure code for HSCT. Time to mortality event was calculated as elapsed time from the admission date of the initial encounter to the discharge date of the encounter in which mortality occurred. The PHIS database provides an encrypted patient medical record number; thus, we were able to follow patients over time. This allowed for a better visualization of the patient's hospitalizations trend over 14 years. Results A total of 493 patients met inclusion criteria for HLH during the study period from 52 children's hospitals. The majority of patients (n = 284, 58%) were less than 5 years of age. Of these, 136 patients (28%) underwent HSCT with 155 hospital encounters, including readmissions. The median age at the time HSCT was 2 years (IQR; 0-9 years) and there were 82 males (60%). The median time to HSCT was 126 days (IQR: 75-193 days) and the average length of stay for the initial HSCT hospitalization was 61.1 days. Median initial HSCT hospitalization cost was $463,630 (IQR; 230,795 - 558,533). ICU care was required for 71 (46%) of patients. Overall, 91 (67%) patients developed transplant-related complications, which included infections, sinusoidal obstruction syndrome or graft versus host disease (Table 1). Mortality after HSCT was 22% (n=30) with an increased mortality observed with advanced age at the time of HSCT (Figure 1). The median time to death after the initial HSCT admission was 65 days (IQR; 56-94 days). Conclusion This is a large in-patient cohort of pediatric patients with HLH who underwent HSCT in the US. We observed an improved overall mortality after HSCT in this population compared to previous studies. However, morbidity (particularly from infections) and heath care resource utilization remain high. This stresses the importance of novel therapeutic approaches to improve not only patient survival but also long-term quality of life. Planned future analysis of this database will be aimed at assessing treatment variability; morbidity and mortality by treatment regimen, time to HSCT, and HSCT preparative regimen; and risk factors associated with mortality in pediatric patients with HLH who do and do not undergo HSCT. Disclosures No relevant conflicts of interest to declare.

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