Emergent Complications in the Pediatric Hematopoietic Stem Cell Transplant Patient

Abstract

Hematopoietic cell transplantation is the only potentially curative option for a variety of pediatric malignant and nonmalignant disorders. Despite advances in transplantation biology and immunology as well as in posttransplant management that have contributed to improved survival and decreased transplant-related mortality, hematopoietic cell transplantation does not come without significant risk of complications. When patients who have undergone hematopoietic cell transplantation present to the emergency department, it is important to consider a variety of therapy-related complications to optimize management and outcome. In this article, we use clinical cases to highlight some of the more common emergent complications after hematopoietic cell transplantation.

Health-Related Quality of Life among Children and Adolescents during Hematopoietic Stem Cell Transplant Recovery

“…During the first year following HSCT, children receiving an unrelated HSCT reported lower HRQoL scores than children receiving a related HSCT, likely due to the increased occurrence of comorbidities associated with unrelated HSCTs (Rodday et al, 2013; Packman et al, 2010; Leung et al, 2011). Although mismatched HSCTs have an increased risk of complications such as graft-versus-host disease (Munchel, Chen, & Symons, 2011), which could affect HRQoL, no study has evaluated if matched and mismatched HSCTs affect HRQoL differentially.…”

“…Allogeneic HSCTs pose higher risks for complications due to the intensity of the conditioning regimen, graft type, and prolonged duration of immunosuppression (Munchel, Chen, & Symons, 2011). Complications from allogeneic HSCT include infection, graft-versus-host disease, and organ dysfunction or damage (Munchel, Chen, & Symons, 2011).…”

“…Allogeneic HSCTs pose higher risks for complications due to the intensity of the conditioning regimen, graft type, and prolonged duration of immunosuppression (Munchel, Chen, & Symons, 2011). Complications from allogeneic HSCT include infection, graft-versus-host disease, and organ dysfunction or damage (Munchel, Chen, & Symons, 2011). Despite these complications, pediatric survival rates have significantly improved due to advances in therapy and supportive care (Packman, Weber, Wallace, & Bugescu, 2010).…”

“…Approximately 2500 children in the United States younger than 20 years of age undergo hematopoietic stem cell transplant (HSCT) each year for the treatment of malignant diseases, and 65% of these children receive an allogeneic HSCT (Pasquini & Wang, 2013). Allogeneic HSCTs pose higher risks for complications due to the intensity of the conditioning regimen, graft type, and prolonged duration of immunosuppression (Munchel, Chen, & Symons, 2011). Complications from allogeneic HSCT include infection, graft-versus-host disease, and organ dysfunction or damage (Munchel et al, 2011).…”

Compassionate de-escalation of life-sustaining treatments in pediatric oncology: An opportunity for palliative care and intensive care collaboration

“…The majority of patients had leukemia, which was not surprising, as leukemia is the most common oncologic diagnosis in children (30). Additionally, HCT is performed primarily for hematologic malignancies at the study institution, as noticed in over half of the study cohort, and is associated with significant risk for treatment-related toxicity, including death (31)(32)(33)(34). Despite medical advances in the treatment of childhood cancer, 1 in 5 patients will still succumb to their disease (35), and it is well documented that the EOL period can be complicated by physical, psychosocial, emotional, and spiritual suffering (5,31,(35)(36)(37).…”