Allogeneic hematopoietic cell transplantation (HCT) remains the definite cure for many pediatric hematologic diseases but causes profound deconditioning, which impairs daily physical functioning and may lead to further health complications. The Transplant Energize Me Patient Outcome (TEMPO) project is a standard-of-care, quality improvement (QI) project whose primary objective is to maintain physical functional mobility and strength throughout admission for pediatric allogeneic HCT patients. Specifically, TEMPO incorporates individualized and developmentally appropriate exercises and activities that are administered by a multidisciplinary team, who objectively measure and record a patient's physical stamina at predetermined frequencies. Disciplinespecific metrics at admission, at weekly intervals, at discharge, and at 100 days after graft infusion (D100) are recorded in templated flowsheets in the electronic medical record. As a secondary objective, resource utilization as measured by length of stay, duration of parenteral feeds and narcotics, readmission by D100, and infections was compared between TEMPO and historical control (pre-TEMPO) allogeneic HCT patients. TEMPO participation maintained physical endurance and functional strength throughout hospitalization, an effect that was significantly sustained or improved at D100. Resource utilization did not significantly differ between patient cohorts. Taken together, the TEMPO QI Project maintains physical functional mobility, strength, and endurance, thereby decreasing physical deconditioning in pediatric allogeneic HCT patients, an effect that is objectively sustained at D100.

The incidence of post-influenza vaccine GBS is similar to the incidence of idiopathic GBS in the general population. Although the nonnormal distribution of post-vaccination GBS suggests that some cases may be triggered by vaccination, the greater risk of complications from influenza virus infections makes vaccination the first-line strategy for infection prevention and support the current guidelines on vaccination.

Background: To assess the impact of new therapeutic strategies on outcomes and hospitalization charges among adult patients with botulism in the United States. Methods: We determined in-hospital outcomes and charges for patients with botulism hospitalized in 1993–1994 and compared them with those observed among patients hospitalized in 2006–2007. Mortality, length of stay, and hospitalization charges were calculated. Age, sex, race, ethnicity, and discharge status were also reported. Results: There were 66 and 132 admissions of adult patients with botulism in 1993–1994 and 2006–2007, respectively. Men predominance was observed in 2006–2007 compared to women predominance during the 1993–1994 time period. There was no significant difference in the average length of stay and in-hospital mortality rate between the two groups studied. However, in the 2006–2007 group, there was a significant increase in the mean hospitalization charges (USD 126,092 ± 120,535 vs. USD 83,623 ± 82,084; p = 0.0107) and in the proportion of patients requiring mechanical ventilation when compared to 1993–1994 (34 vs. 13.6%; p < 0.0001). Conclusion: Botulism continues to be an infrequent cause of hospitalization, with a significant increase in the average hospitalization charges in 2006–2007 when compared to 1993–1994, despite a nonsignificant change in the mortality rate and average length of hospitalization.

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Background: Pleraxifor for peripheral blood stem cell (PBSC) mobilization in children with malignancies is often given following failure of standard mobilization (SM) rather than as a primary mobilizing agent. Study Design and Methods: In this retrospective multicenter study, we report the safety of plerixafor-based PBSC mobilization in children with malignancies and compare outcomes between patients who received plerixafor upfront with SM (Group A) with those who received plerixafor following failure of SM (Group B). In the latter pleraxifor was given either following a low peripheral blood (PB) CD34 (<20 cells/cu.mm) (Group B1) or as a second collection process due to an unsuccessful yield (CD34 + < 2 × 10 6 /kg) (Group B2) following failed SM and first apheresis attempts.

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Events (CTCAE). We queried the BMT CTN patient database in order to examine HCT associated toxicities in the modern era (2003-2013). Six completed BMT CTN trials (0101, 0102, 0201, 0401, 0402, 0501) involving 1,868 allogeneic (mobilized blood; umbilical cord blood; and marrow grafts) and 660 autologous HCT patients were reviewed. Patient-, disease-and treatment-related characteristics as well as core (defined as toxicities collected across all BMT CTN trials) protocol-specific and infusional toxicities were examined. Most common diseases treated with allogeneic HCT included AML (N¼866), ALL (N¼477), MDS (N¼231), CML (N¼191) and MM (N¼191); for autologous HCT, 436 MM and 224 NHL patients were included. Notably, 19% (N¼372) and 48% (N¼ 880) of evaluable patients had pulmonary comorbidity with FEV1 and DLCO < 80% at time of HCT, respectively. Gastrointestinal (diarrhea, mucositis) and hepatic toxicity were most frequently identified. Pulmonary toxicity of any etiology, however, had the highest likelihood of progressing to grade 5 with death as a consequence. 207 patients had toxicity associated mortality and >75% had death-associated grade 5 hypoxia. Maximum toxicity hypoxia toxicity Grade 4/5 vs 1-3 were compared to determine if pre-HCT low FEV1 or DLCO predicted mortality. No increased likelihood of death was identified in these patients (p¼ 0.39 & p¼ 0.12, respectively) possibly suggesting that pre-transplant awareness may have guided management. Development of standard data collection instruments has facilitated a global view of regimen-related toxicities among BMT CTN clinical trials. Descriptive analyses of pre-HCT morbidity and post-HCT morbidity/mortality provide robust and reliable estimates of the toxicity burden. These preliminary studies demonstrate the immense power of the BMT CTN database for understanding transplant complications and for designing future studies.