Transplantation activities and treatment strategies in paediatric stem cell transplantation centres: a report from the EBMT Working Party on Paediatric Diseases

Abstract

Summary:To determine the current approach to stem cell transplantation (SCT) in centres which treat predominantly paediatric patients, a questionnaire was sent to 67 centres known by the EBMT registry to perform SCT mainly in children. Fifty-five centres from 19 countries responded. Forty centres (75%) started their transplantation activities between 1980 and 1992. Median number of transplants/centre was 95 (range 8-400). Median number of transplants/centre/year was 18 (range 5-85). On average, there was one physician responsible for seven SCT/year while one nurse was involved for a median of 1.7 SCT/year. Median four rooms/centre (range 1-17) were available for paediatric SCT. The most common isolation facilities were rooms with high efficiency particulate air filtration (HEPA). Eighty-two percent (45/55) of the centres performed allogeneic as well as autologous SCT, while 5% (three centres) offered exclusively allogeneic SCT and 13% (seven centres) used only autologous stem cell rescue. Stem cell source for allogeneic SCT was bone marrow in 87%, peripheral blood (PB) in 10% and umbilical cord blood in 3%. Donors were HLA matched related in 57%, mismatched related in 13%, and matched unrelated in 30% of allogeneic SCT. PB was the most commonly used stem cell source for autologous SCT (48%), followed by BM (41%) and the two together (11%). Data analysis revealed substantial differences in protective care, stem cell processing and transplantation procedures within the centres, irrespective of the country, centre size and transplant type. Keywords: stem cell transplantation; children; isolation rooms; staff; bone marrow harvesting; blood cell support Allogeneic (allo) and autologous (auto) stem cell transplants (SCT) are performed increasingly in children with malignancies, as well as with congenital or acquired haema-

Surveillance of nosocomial infections in paediatric recipients of bone marrow or peripheral blood stem cell transplantation during neutropenia, compared with adult recipients

“…Cytokine-mobilized peripheral stem cells and umbilical cord blood are increasingly used as the source of stem cells, and haplo-identical and unrelated donors are more common. 1,2 This results in changes in the immunosuppressive treatment and the immunological recovery of the patients. The risks of NI associated with stem cell transplantation have changed accordingly.…”

“…1,2 However, infectious complications still result in significant morbidity and mortality. Most of these infections are acquired during hospital stay, thus falling within the definition of nosocomial infections (NIs).…”

Achievement of Target Cyclosporine Concentrations as a Predictor of Severe Acute Graft Versus Host Disease in Children Undergoing Hematopoietic Stem Cell Transplantation and Receiving Cyclosporine and Methotrexate Prophylaxis

“…[8][9][10][11][12] Despite administration of aGvHD prophylaxis, 20% to 40% of recipients of unmodified human leukocyte antigen (HLA)-identical marrow grafts develop grade II to IV aGvHD. 13 The risk increases to 80% in patients receiving mismatched 14 or unrelated marrow.…”

Haematopoietic stem cell transplantation trends in children over the last three decades: a survey by the paediatric diseases working party of the European Group for Blood and Marrow Transplantation

“…There are only few, large-scale studies that report the HSCT strategies used in children. 17,18 The main aim of this survey was to describe the trends in HSCT activity for paediatric patients in European transplant centres over the last three decades. The second aim was to separately analyse the risk factors for transplantation-related mortality for auto-or allo-HSCT, taking into account patient-, disease-, transplant-related factors and centre effect, which are all associated with the outcomes.…”