Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Abstract

Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

Current Prophylaxis and Treatment Approaches for Acute Graft-Versus-Host Disease in Haematopoietic Stem Cell Transplantation for Children With Acute Lymphoblastic Leukaemia

“…Supportive care during paediatric HSCT has been recently outlined in other reviews ( 176 , 177 ); therefore, only the most relevant issues to GvHD are summarised here.…”

Antimicrobial prophylaxis in adults and children undergoing hematopoietic cell transplantation: 2021 Polish recommendations

“…Antimicrobial prophylaxis plays a crucial role in lessening NRM after HCT [71]. These joint recommendations summarize the most important aspects based on available data to Table XV.…”

Infectious Complications in Paediatric Haematopoetic Cell Transplantation for Acute Lymphoblastic Leukemia: Current Status

“…Among CMV-seropositive HSCT recipients, approximately 80% develop CMV reactivation and 20-35% progress to CMV disease if no preventative steps are taken; mortality of established disease is up to 50% despite treatment. Because of the toxicities of ganciclovir, foscavir and cidofovir, pre-emptive therapy has been the preferred approach; nevertheless, pre-emptive therapy is started after CMV viraemia is detected and any level of viraemia is associated with an increased risk of overall mortality (39,(50)(51)(52)(53). Letermovir is a new antiviral agent that inhibits CMV through a novel mechanism involving the viral terminase complex (54).…”

“…Most frequently, the CNS is affected, leading to diffuse encephalitis with variable onset and a diverse pattern of clinical symptoms; other manifestations include pulmonary or disseminated disease (104)(105)(106)(107). Serological screening for toxoplasmosis prior to allo-HSCT is recommended for all patients, and screening by nucleic acid amplification by PCR of blood samples is advised in all seropositive patients for at least 6 months post HSCT (10,39,101). Diagnosis in a given patient is based on the evaluation of risk factors, clinical signs and symptoms and targeted imaging but ultimately requires the direct detection of parasites or their nucleic acids by PCR in blood, CSF, BAL or biopsies (101).…”

“…Additionally, appropriate tests for relevant viral diseases (e.g., adenovirus viraemia) that are particularly highly transmissible, CMV, EBV and toxoplasmosis are recommended to avoid their nosocomial dissemination or to initiate pre-emptive treatment ( 36 , 37 ). In the event of the detection of a highly transmissible microorganism contact precautions are a prerequisite to exclude cross-patient transfer ( 37 – 39 ). Healthcare workers with transmissible diseases should not work in direct patient care and ideally should stay at home to prevent the nosocomial spread of their disease ( 37 , 39 ).…”