Critical Complications In Pediatric Oncology and Hematopoietic Cell Transplant

Hematopoietic stem cell transplantation (HSCT) is a powerful tool for treating malignant diseases, but can cause systemic multi-organ toxicities. Pulmonary complications are a common and serious issue for children post-HCT, and diagnosis can be difficult and require imaging and invasive testing. Opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant, and the risk for and type of infection changes throughout the HCT course due to various factors.

This research topic highlights the importance of early detection and management of complications associated with HSCT. Outcomes can be improved with early mechanical ventilation, anti-infectious prophylaxis, and mobility quality improvement initiatives. Liquid biopsy may also improve prompt detection of organ failure and prognostication in this population. Inter-professional staff members need to be aware of the general principles of diagnosis and management of CAR therapies.

• Mortality in hemato-oncologic patients admitted to a PICU was lower than previously reported, and the total number of PICU admissions of these patients rose over time.
• Early mechanical ventilation should be started in cases of severe respiratory distress in immunocompromised patients, and close monitoring and appropriate anti-infectious prophylaxis is needed after HSCT.
• Flexible bronchoscopy with bronchoalveolar lavage is safe and provides diagnostic and/or therapeutic benefits for pediatric cancer patients.
• ECMO use for pediatric patients treated with HCT and CAR-T therapy is generally acceptable amongst physicians.
• Hyponatremia is a common adverse event of vincristine therapy in Caucasian children with ALL.
• Dengue induced-hemophagocytic lymphohistiocytosis (HLH) is an important cause of secondary HLH and early identification and treatment with steroids can improve outcomes.
• Stenotrophomonas maltophilia is an emerging cause of infectious morbidity in pediatric hematology and oncology patients, with a high case fatality rate of 40-50%.
• Positive and increasing early cumulative fluid