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    Hematopoietic Stem

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    Hematopoietic Stem

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    Indian Journal of Practical Pediatrics 2020; 22(3):260

    HEMATO-ONCOLOGY

    HEMATOPOIETIC STEM CELL Points to Remember


    TRANSPLANTATION - WHERE WE ARE
    • Hematopoietic stem cell transplantation (HSCT) is
    AND THE WAY FORWARD potentially curative in several congenital and
    *Ramya Uppuluri acquired stem cell disorders including thalassemia
    **Venkateswaran VS major, primary immune deficiency disorders,
    ***Revathi Raj Fanconi anemia and malignancies.

    Abstract: Hematopoietic stem cell transplantation is • HLA typing of Class I (A, B, C) and Class II (DP,
    potentially curative in several stem cell disorders. DQ, DR) antigens is the key to determining the
    The process involves HLA typing, donor selection, compatibility of the donor and in planning the type
    conditioning, harvesting stem cells , infusion , supportive of HSCT namely matched related, matched
    care, engraftment and immunosuppression to prevent graft unrelated, mismatched related or unrelated and
    versus host disease and graft rejection. A team of haploidentical stem cell transplantation.
    experienced pediatric intensivists, dedicated nurses, • Although 30% of patients can find a compatible
    antibiotic stewardship and infection control measures are match within the family, alternative donor
    essential components for providing optimal care. transplantation is an option in the remaining 70%,
    With advances in molecular diagnosis and whole-exome including unrelated and haploidentical transplants.
    sequencing, the indications for hematopoietic stem cell
    transplantation-are expanding and several hitherto • The source of stem cells could be peripheral blood,
    unrecognized life-threatening conditions have a potential bone marrow or cord blood and donation of stem
    for cure. Pediatricians are the key personnel to maintain cells is safe for the donor.
    the shared care and follow up for late effects, thus ensuring • Supportive care is the key to ensuring optimal
    intact and quality survival. outcomes.
    Keywords: HSCT, Children, Survival, Cure. • Teamwork between experienced pediatric intensivists
    and nursing groups, antibiotic stewardship and
    infection control measures are the essential
    components of care.
    • Immunosuppression is only for a short duration of
    one year on average unlike solid organ
    transplantation where the children are on lifelong
    medications. However, follow up for late effects of
    chemotherapy utilizing shared care with
    pediatricians is essential for optimal outcomes.
    Acknowledgments: We would like to acknowledge the
    immense support provided by the stem cell apheresis team,
    * Consultant infectious disease specialists, and pediatric critical care
    ** Pediatric BMT fellow
    group at Apollo Hospitals, Chennai, in the management of
    these children.
    *** Senior Consultant and Head,
    Department of Pediatric Hematology, Oncology, References
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    email: [email protected]
    Indian Journal of Practical Pediatrics 2020; 22(3):261

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