Background:In children, the complications of severe acute respiratory syndrome coronavirus 2 infection occur less frequently than in adults but the characteristics of this disease in oncology patients are not well characterized. Methods: This was a retrospective study in patients younger than 18 years of age with coronavirus disease 2019 (COVID-19) and cancer diagnoses between April and September 2020. Demographic variables, laboratory, and radiologic findings and complications of each case were identified. A descriptive analysis was performed. Results: A total of 33 patients were identified; the median age was 10 years. Fifteen patients (42%) were in chemotherapy at the time of the infection diagnosis, in two patients the chemotherapy protocol was permanently suspended. The most common symptom was fever in 20 patients (60%). Seven patients (21.2%) showed mild pneumonia, four patients (12.1%) severe pneumonia, and three cases (9.0%) were classified as critical. In the evaluated cohort, five patients (15.1%) died, and in two of those, death was caused by COVID-19 infection. Conclusions: Children with an oncologic disease, the search for COVID cases should be oriented to patients with fever, including febrile neutropenia, the presence of respiratory symptoms, and the search for epidemiologic contact. A higher frequency of complications and mortality attributed to COVID-19, two in pediatric oncohematologic patients was found. Institutional strategies to detect the infection early and lower institutional infection are indicated.
<p><strong>Introducción.</strong> El trasplante de precursores hematopoyéticos es una alternativa en el tratamiento de diversas condiciones en la población pediátrica. La intensidad del acondicionamiento para el trasplante predispone al desarrollo de complicaciones en los receptores. Las infecciones por el virus herpes simple 1 (HSV-1), el virus herpes simple 2 (HSV-2), el citomegalovirus (CMV) humano y el virus de Epstein-Barr (EBV) son una causa importante de morbimortalidad en estos pacientes. La reactivación de infecciones latentes puede producir descargas virales asintomáticas detectables en la saliva, lo cual ayuda a determinar el comportamiento de dichas infecciones en pacientes con trasplante y a establecer el diagnóstico temprano de la reactivación.<br /><strong>Objetivo.</strong> Evaluar el comportamiento de la descarga viral de HSV-1, HSV-2, CMV y EBV en la saliva de pacientes hospitalizados en la Unidad de Trasplante de la Fundación HOMI - Hospital de la Misericordia, entre enero y noviembre de 2012.<br /><strong>Materiales y métodos.</strong> Se evaluaron muestras de saliva de 17 receptores de trasplante. La presencia de ADN de HSV-1, HSV-2, CMV y EBV en las muestras de saliva se detectó mediante reacción en cadena de la polimerasa convencional.<br /><strong>Resultados.</strong> Se detectó el ADN del HSV-2 en la saliva de cuatro pacientes, del CMV en la de cuatro y del EBV en la de nueve, lo cual se asoció con leucopenia. Cuatro de los 17 pacientes presentaron cargas simultáneas de CMV y EBV. No se detectó el ADN del HSV-1.<br /><strong>Conclusiones:</strong> Se demostró una descarga asintomática de HSV-2, CMV y EBV asociada a leucopenia en la saliva de los pacientes.</p>
Immunoglobulins are heterodimeric proteins composed of 2 heavy chains and 2 light chains. Human immunoglobulin G (IgG) is a plasma derivative and contains more than 95% of IgG. The composition of IgG subclasses is similar to that of normal human plasma. Immunoglobulin therapy was first introduced more than 50 years ago, and its use has been described in numerous diseases. In Colombia, the importance of this immunomodulatory resource prompted the need for clinical practice guidelines to be available for its use. For this reason, a multidisciplinary group of experts was brought together and distributed in working groups, by specialties, in order to develop an initial manuscript. Systematic literature searches were undertaken; identified evidences were evaluated and classified to support a preliminary draft that was discussed, analyzed and amended. Recommendations were issued on the use of intravenous immunoglobulin in pathologies that include primary and secondary immunodeficiencies, autoimmune diseases, neurological disorders, infections, transplants and miscellaneous conditions; grades were assigned to each one of them according to the GRADE system. The final result translated into recommendations that are put forth with the purpose to inform, guide and support on optimal use of this immunomodulatory resource.
Background: Iron overload has been implicated as a key co-morbid factor in post-stem cell transplant (SCT) outcomes. Quantifying iron burden has been a challenge as serum iron markers are imprecise. MRI is a relatively new and non-invasive tool that more accurately measures iron burden. We conducted a prospective study using MRI to assess iron burden in children undergoing SCT. Objective: To determine the prevalence of iron overload using R2 MRI of the liver in a pediatric allo SCT population both pre and post-SCT. Relationships between excess iron and adverse outcomes such as graft vs. host disease (GVHD), infection, and death were secondary objectives. Methods: Children $5 years old undergoing an allo SCT at Children's Hospital Boston from 2007-2009 were eligible for this study. Iron overload was defined as a liver iron concentration $ 1.5 mg iron/g dry liver tissue. A paired t-test was conducted with a 5 0.05 to compare iron load at the two specified time points. A two-sample two-sided t-test was conducted at each time point for association with risk factors described above with a 5 0.1. This study was IRB approved. Results: Twenty-eight patients were enrolled. The most common diagnoses were Pre-B ALL (N 5 7), AML (N 5 6), and aplastic anemia (N 5 5). Pre-SCT, 82% (95% CI: 66%-98%) of patients had iron overload by R2 MRI. At day 100 post-SCT, 95% (95% CI: 65%-100%) had iron overload. The mean iron concentration (6 std error) was 4.97 6 3.54 mg/g dwt liver at pre-SCT and 7.55 6 4.37 mg/ g dwt liver at day 100 post-SCT. The day 100 post-SCT mean value was significantly higher than the mean value at pre-SCT (2.15 mg/g dwt liver, p\0.0001). For patients who developed an infection during the post-SCT period, the mean iron concentration, compared to patients who did not develop an infection, was significantly higher at pre-SCT and at day 100 post-SCT (p 5 0.029 and p 5 0.0055, respectively). There was no statistically significant difference in iron concentration between patients who developed GVHD or died and those who did not. Conclusions: We found that a high proportion of pediatric allo SCT patients have iron overload pre-SCT. In addition, there is a statistically significant rise in iron post-SCT (p\0.0001) and an association with increased incidence of infection in patients with elevated iron. Larger multi-center studies should be conducted to further examine the consequences of iron overload and evaluate potential interventions in this patient population.
elevation of ALC (day 16) along with decrease in chimerism to 85%. This time alemtuzumab was used promptly, leading to successful outcome (Table 1). Conclusion: In patients with Fanconi Anemia undergoing transplant, the development of mixed chimerism may be due to incomplete lympho-depletion and return of recipient lymphocytes. In these cases, prompt and aggressive lymphoid depleting therapy is warranted to prevent graft rejection.
Unrelated umbilical cord blood (UCB) and haploidentical grafts have been used for allogeneic hematopoietic stem and progenitor cell (HSPC) transplantation in patients without a related or non-related human leukocyte antigen (HLA)-matched donor. The less stringent HLA-matching requirement in both sources raises an important possibility for patients in need of urgent transplantation to treat any hematological disease. Selection of the best alternative donor is a difficult task that will depend on donor criteria, center experience, patient disease conditions, and risk, among others. Most comparisons available in scientific publications between both graft sources are obtained from retrospective analysis in wide time windows and a heterogeneous number of patients, types of disease, disease stages, previous treatments, graft source, conditioning regimen, graft vs. host disease (GVHD) approach, and evaluable endpoints. There is also an evident impact of the economic traits since low-income countries must consider less expensive treatments to satisfy the needs of the patients in the most effective possible path. Therefore, haploidentical transplantation could be an appealing option, even though it has not been completely established if any chronic treatment derived from the procedure could become a higher cost. In Colombia, there is a huge experience in UCB transplantation especially in units of pediatric transplantation where benign indications are more common than in adults. Due to the availability of a public UCB bank and HLA high-resolution typing in Colombia, there is a wider inventory of cord blood donors. Unfortunately, we do not have an unrelated bone marrow donor registry, so UCB is an important source along with haploidentical transplantation to consider in decision-making. This minireview focuses on comparing the main issues associated with the use of both HSCP sources and provides tools for physicians who face the difficult decision between these alternative donor sources.
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