PO-01. Autologous hematopoietic stem cell transplantation in children under one year of age: Experience of the N. Blokhina National Medical Research Center of Oncology
Teymur Z. Aliev, Kirill I. Kirgizov, Natalia V. Sidorova, Amina M. Suleimanova, Denis V. Shevtsov, Elena B. Machneva, Yuri V. Lozovan, Irina O. Kostareva, Svetlana R. Varfolomeeva
N. N. Blokhin National Medical Centre of Oncology, Moscow, Russia
Contact: Dr. Aliev Teymur, Pediatric Oncology, e-mail: firstname.lastname@example.org
Autologous hematopoietic stem cell transplantation (auto-HSCT) is an important stage of therapy, increasing the survival rates among children with malignant neoplasms (MNO). This therapy is rarely performed in infants due to high risk of severe complications arising at early stages after reinfusion of peripheral stem cells (PSC). Particular difficulties arise during the period of aplasia and restoration of hematopoietic lineages, as well as over the posttransplant period. The purpose of this work was to assess features of auto-HSCT for infants in the 1st year of their life.
Patients and methods
Since January to August 2020, two auto-HSCTs were performed in the female children under 12 months of age at the Research Institute of Pediatric Oncology and Hematology (N. Blokhin Center of Oncology). This treatment option was performed in patients with the primary clinical diagnoses of neuroblastoma and medulloblastoma. Both patients underwent a comprehensive examination according to the institutional transplant protocol. In accordance with the patients’ age, we carried out daily monitoring of mass/growth parameters, assessment of nutritional state, and functioning of organs and systems. The patients with their guardian with monitored in an isolated individual box in a sterile mode since the beginning of conditioning treatment until normalization of blood counts and resolution of complications that arised at the early stages after auto-HSCT.
The patients had successfully tolerated the stage of therapy and auto-HSCT. High-dose chemotherapy (HDCT) with Treosulfan and Melphalan, Thiophosphamide and Carboplatin, Vincristine/Cisplatin/Thiophosphamide was carried out according to appropriate protocols, with drug doses calculated per body mass and area. Some complications were noted at the early stages after PSC reinfusion, i.e., treosulfan-associated toxidermia up to grade 2, oropharyngeal mucositis (grade 1), neutropenic enterocolitis (grade 1). These complications were mitigated by means of topical therapy (glucocorticosteroids, skin moisturizers), treatment of oral mucosa with antiseptics, and oral administration of antidiarrheal and sorbent drugs. Nutritional deficiencies (enteral nutrition in the form of balanced low-calorie therapeutic mixtures, parenteral nutrition using three-component containers, with an adequate donation of anabolic substances (amino acids, carbohydrates), energy substrates (fats, carbohydrates), vitamins, trace elements, taking into account physiological needs.
The children over first 12 months of their life may exhibit high toxicity and severity of post-transplant care with development of hypercatabolism-hypermetabolism syndromes, nutritional deficiencies, decreased lean body mass (metabolically active tissue), eating disorders (impaired appetite, taste perversion, high emetogenic potential of high-dose chemotherapy). Therefore, conditioning in auto-HSCT is one of the most difficult stages of therapy. To prevent complications arising after the reinfusion of peripheral stem cells, they should be consulted by the following specialists: neonatologist, neurologist, ophthalmologist, otolaryngologist, nutritionist, dermatologist, gastroenterologist, cardiologist, endocrinologist, rehabilitologist.
Autologous hematopoietic stem cell transplantation, malignant diseases, infants under 1 year.