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Introduction Hematopoietic stem cell transplantation (HSCT) has been particularly challenging during the COVID-19 pandemic. We aimed to analyse the impact of infection with COVID-19 in children post-HSCT and describe the clinical syndromes and the disease manifestations in this cohort. Patients and methods: Children who underwent HSCT between January 2019 to June 2021 and acquired COVID-19 infection were included in the study. The symptomatic children were hospitalized for supportive care. Asymptomatic children were treated in home isolation with azithromycin and zinc supplements. Children who were on immunosuppressants were continued on it. Results: A total of 9/265 children who underwent HSCT in the study period were diagnosed with COVID-19, the incidence being 3.3%. The cycle threshold value in all children was low (≤17), indicating a profound viremia. All children had cytopenia, four had hyponatremia, and two had grade 2 cytokine release syndrome. The severity of the disease was mild in 5 children, moderate in 1 child, and severe in 3 children. Post COVID sequelae included ARDS (n = 1), MIS-C and DVT (n = 1), rhinocerebral rhizopus infection (n = 1). Three children with severe infection died, two due to multiorgan dysfunction and one due to fungal infection. Conclusion: The presence of GVHD, opportunistic fungal infection, and hyponatremia help predict a severe course and mortality in children post HSCT who are diagnosed to have COVID-19 infection. Prophylaxis for mucormycosis in high-risk children with GVHD is an essential aspect of management.

Background: Infection and relapse constitute the two main challenges in the management of acute myeloid leukemia (AML) in children. Real-world data in children treated in low-and-middle income countries are sparse as the cost of supportive care is high. Patients and Methods: We present data on children up to 18 years of age undergoing chemotherapy for AML as per UKMRC AML protocol from 2002 to June 2019 and pattern of sepsis. Results: The incidence of culture-positive sepsis was similar pre- and post-2012 (52.6% vs. 72.4%), Klebsiella pneumoniae being the most common organism. There was a significant increase in carbapenem resistance post 2012 (14% vs. 67%, P = 0.032). Sepsis-related induction mortality has remained at 6.2% despite an increase in drug-resistant bacterial infections over two decades. The overall survival was 53% (n=48), with a plateau in the survival curve after 24 months, relapse being the most common cause of death (69%). Conclusions: Sepsis-related induction mortality can be maintained at less than 10% in children undergoing chemotherapy for AML, despite increasing drug-resistant bacteremia, with adequate supportive care and trained personnel including pediatric intensivists and nurses.

Alternate donor HSCT for thalassemia major from a matched unrelated donor or haploidentical family donor is a feasible therapeutic option in children with no matched family donor. Aggressive pretransplant immunosuppression, reduced toxicity conditioning, and PTCY result in excellent thalassemia‐free survival. We describe here our experience in this cohort. We performed a retrospective analysis of the data on children who underwent a haploidentical HSCT for thalassemia major with PTCY at our center from August 2017 to August 2019. All children received pretransplant immune suppression for 6 weeks with fludarabine and dexamethasone, hypertransfusion and chelation with intravenous desferrioxamine. Conditioning included thiotepa, fludarabine, rabbit ATG, and cyclophosphamide, and GvHD prophylaxis included PTCY with tacrolimus. Twenty children were included and nineteen children engrafted. Acute hypertension occurred in five children, bacterial infection in eight children and viral respiratory infection in three children. Three children suffered from graft rejection. Reactivation of viruses namely CMV, adenovirus, and BK virus was seen in 60% of children. Grades 1‐2 acute GvHD of the skin in four children (20%) and limited chronic GvHD of the skin in four children (20%). Immune cytopenia was documented in three children (15%). Haploidentical HSCT offers a therapeutic option for children with thalassemia major with no suitably matched family or unrelated donors. Our reduced toxicity regimen with PTCY offers a DFS of 75% and OS of 95% with low transplant‐related mortality of 5%.

Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.