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Severe blood disorders and cancer are the leading cause of death and disability from noncommunicable diseases in the global pediatric population and a major financial burden. The most frequent of these conditions, namely sickle cell disease and severe thalassemia, are highly curable by blood or bone marrow transplantation (BMT) which can restore a normal health-related quality of life and be cost-effective. This position paper summarizes critical issues in extending global access to BMT based on ground experience in the start-up of several BMT units in middle-income countries (MICs) across South-East Asia and the Middle East where close to 700 allogeneic BMTs have been performed over a 10-year period. Basic requirements in terms of support systems, equipment, and consumables are summarized keeping in mind WHO's model essential lists and recommendations. BMT unit setup and maintenance costs are summarized as well as those per transplant. Low-risk BMT is feasible and safe in MICs with outcomes comparable to high-income countries but at a fraction of the cost. This report might be of assistance to health care institutions in MICs interested in developing hematopoietic stem cell transplantation services and strengthening context appropriate tertiary care and higher medical education.

The article presents abstracts of articles on stem cell transplantation. One of the abstracts is about real-time PCR detection of human herpesvirus 6 in patients after allogeneic hematopoietic stem cell transplantation. Infection or reactivation with human herpesvirus 6 (HHV6) can complicate the early period after hematopoietic stem cell transplantation (HSCT). The clinical impact of HHV6 in patients with severe immunosuppression is still being discussed. During the period 2001 - 2003, 70 children and adolescents aged 0,2-20,5 years underwent allogeneic HSCT. Two patients underwent their second HSCT and 3 had to be re-transplanted during surveillance period.

The Ethics Working Group of the World Marrow Donor Association (WMDA) was established to address the increasing and complex number of ethical issues surrounding unrelated haematopoietic stem cell donation where the selected donor and recipient reside in different countries. This paper considers the topic of informed donor consent, but recognises that the recommendations contained within the paper may be subject to cultural variances in interpretation, and to adjustment to meet the legal requirements of individual countries. Nevertheless, the extent of international cooperation establishes sufficient common denominators for the recommendations to be widely adhered to in the interests of best practice.Bone Marrow Transplantation (2003) 31, 539-545. doi:10.1038/sj.bmt.1703851 [ABSTRACT FROM AUTHOR]

In 2005, the National Institutes of Health (NIH) consensus conference published a series of papers recommending methods to improve the conduct of clinical trials in chronic GVHD. Although the NIH recommendations were primarily aimed at strengthening research, several papers addressed issues relevant for clinical practice, particularly diagnosis, severity scoring, and ancillary and supportive care practices. We conducted an international survey to assess the uptake of these recommendations, identify barriers to greater use and document the use and perceived effectiveness of available treatments. The response rate for the American survey of 1387 practitioners was 21.8%, and it was 24.6% for 407 centers surveyed in Europe, Asia, Australia and Africa. Most respondents were familiar with the NIH consensus recommendations (94-96%) and used them in practice. Multiple barriers to greater use were reported. Besides lack of time (55-62%), unfamiliarity with the recommendations, scarcity of evidence supporting the impact of recommendations on outcomes, insufficient training/experience in chronic GVHD management and inaccessibility of subspecialists were also endorsed. Systemic corticosteroids were reported to be the most effective treatment for chronic GVHD, but many others were perceived to have moderate or great success. Therapeutic management of steroid-refractory chronic GVHD was identified as the highest priority for research. [ABSTRACT FROM AUTHOR]

In 2005, several groups, including the European Group for Blood and Marrow Transplantation, the European Organization for Treatment and Research of Cancer, the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia (ECIL). The main goal of ECIL is to elaborate guidelines, or recommendations, for the management of infections in leukemia and stem cell transplant patients. The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007. The third meeting of the group (ECIL 3) was held in September 2009 and the group updated its previous recommendations. The goal of this paper is to summarize the new proposals from ECIL 3, based on the results of studies published after the ECIL 2 meeting: (1) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently, by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole; (2) micafungin was introduced as an alternative drug for empirical antifungal therapy; (3) although several studies were published on preemptive antifungal approaches in neutropenic patients, the group decided not to propose any recommendation, as the only randomized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group. [ABSTRACT FROM AUTHOR]

The International Cellular Therapy Coding and Labeling Advisory Group was established to address the growing need for standardization of terminology and labeling for cellular therapy products as a result of increasing international transfer of these products. This paper presents new standards for terminology and labeling. These standards have been developed through a consultative process and are supported by key professional and accreditation bodies. By using these standards, together with the unique donation identification numbers and international product reference tables provided by the International Society of Blood Transfusion (ISBT) 128 Standard, consistency and traceability can be assured at the global level. A companion paper provides guidance on the implementation of the ISBT 128 system.Bone Marrow Transplantation (2007) 40, 1075–1083; doi:10.1038/sj.bmt.1705858; published online 1 October 2007 [ABSTRACT FROM AUTHOR]

In this paper, we describe modern statistical methods for presentation of the results of studies of bone marrow transplantation. We focus here on ‘univariate’ or unadjusted techniques to describe the outcomes of such studies. In another paper we will discuss multivariate methods. We discuss the type of data one may have available to make inference about outcomes. We explain the differences between the Kaplan–Meier estimator of the survival function and the cumulative incidence curve, how these curves should be interpreted and when each is the appropriate summary statistic. We discuss the weighted log rank statistic and show how different weights can be used to put emphasis on detecting differences between groups in different time periods. We also present a simple estimate of current leukemia-free survival which is useful in summarizing post-transplant events. Bone Marrow Transplantation (2001) 28, 909–915. [ABSTRACT FROM AUTHOR]

The use of blood and/or bone marrow stem cell transplantation (SCT) grew extensively in the last decade as technological advances led to improved outcomes and wider availability. The first study of SCT costs, however, was not published until 1989. This paper summarizes current knowledge about costs and cost-effectiveness of allogeneic and autologous SCT for leukemias and lymphoma. Methodological issues in cost studies such as types of costs, methods of data collection, and time horizons are discussed, and studies are evaluated with regard to these issues. Considerations specific to economic analyses of SCT are considered, including the potential impact of technological changes, learning curve effects, and inter-institutional differences. [ABSTRACT FROM AUTHOR]

In October 1995 the World Marrow Donor Association (WMDA) was restructured in order to facilitate its primary function of establishing guidelines in relation to international bone marrow and blood stem cell transplants - transplants in which the donor is in one country and the patient is in another country. Five new working groups were established - Donor Registries, Ethics, Quality Assurance, Finances, and Stem Cells. This paper, prepared by members of the Donor Registries Working Group, in consultation with the Quality Assurance Working Group, provides recommendations for the 'donor work-up'. This term covers events that start when the definitive donor has been identified, includes the harvesting (collection) and transportation of the stem cell product and ends when the product reaches the transplant centre. The paper includes examples of the documentation intended to ensure compliance with the recommendations at all key points in the sequence. [ABSTRACT FROM AUTHOR]

The success of allogeneic hematopoietic cell transplantation (HCT) has been limited by transplant-associated toxicities related to the conditioning regimens used and to graft-vs-host disease (GVHD). The frequency and severity of GVHD observed when extensive HLA barriers are transgressed has greatly impeded the routine use of extensively HLA-mismatched HCT. Allogeneic HCT also has potential as an approach to organ allograft tolerance induction, but this potential has not been previously realized because of the toxicity associated with traditional conditioning. This paper reviews an approach to HCT involving reduced intensity conditioning that demonstrated sufficient safety in patients with hematologic malignancies, even in the HLA-mismatched transplant setting, to be applied for the induction of kidney allograft tolerance in humans with no other indication for HCT. These studies provided the first successful example of intentional organ allograft tolerance induction across HLA barriers in humans. Current data and hypotheses on the mechanisms of tolerance in these patients are reviewed. [ABSTRACT FROM AUTHOR]

With increasing frequency, allogeneic hematopoietic cell transplantation involving children is being performed in the research setting. Allogeneic hematopoietic cell transplantation, however, cannot be performed without a hematopoietic stem cell (HSC) donor. This donor is often a sibling of the recipient and may also be a child. In such circumstances, it is unclear whether or how the federal regulations for pediatric research apply to the minor donors. This introductory paper reviews the issues to be considered while evaluating studies that use HSCs obtained from minor donors and identifies areas where further research is needed. In the era of increasing applicability for donor-derived cellular therapies, we provide a suggested framework for determining when minor donors qualify as human research subjects and when their participation can be approved under the federal regulations. [ABSTRACT FROM AUTHOR]

In Figures 3 and 4 of the above paper some additional asterisks appeared in the final published copy of the paper. Corrected versions of the figures follow. [ABSTRACT FROM AUTHOR]

The inaugural meeting of 'New Frontiers in Pediatric Allogeneic Stem Cell Transplantation' organized by the Pediatric Blood and Transplant Consortium (PBMTC) was held at the American Society of Pediatric Hematology and Oncology Annual Meeting. This meeting provided an international platform for physicians and investigators active in the research and utilization of pediatric Allo-SCT in children and adolescents with malignant and non-malignant disease (NMD), to share information and develop future collaborative strategies. The primary objectives of the conference included: (1) to present advances in Allo-SCT in pediatric ALL and novel pre and post-transplant immunotherapy; (2) to highlight new strategies in alternative allogeneic stem cell donor sources for children and adolescents with non-malignant hematological disorders; (3) to discuss timing of immune reconstitution after Allo-SCT and methods of facilitating more rapid recovery of immunity; (4) to identify strategies of utilizing Allo-SCT in pediatric myeloproliferative disorders; (5) to develop diagnostic and therapeutic approaches to hematological complications post pediatric Allo-SCT; (6) to enhance the understanding of new novel cellular therapeutic approaches to pediatric malignant and non-malignant hematological disorders; and (7) to discuss optimizing drug therapy in pediatric recipients of Allo-SCT. This paper will provide a brief overview of the conference. [ABSTRACT FROM AUTHOR]

Transplantation of hematopoietic stem cells (HSCs) has been successfully developed as a part of treatment protocols for a large number of clinical indications, and cryopreservation of both autologous and allogeneic sources of HSC grafts is increasingly being used to facilitate logistical challenges in coordinating the collection, processing, preparation, quality control testing and release of the final HSC product with delivery to the patient. Direct infusion of cryopreserved cell products into patients has been associated with the development of adverse reactions, ranging from relatively mild symptoms to much more serious, life-threatening complications, including allergic/gastrointestinal/cardiovascular/neurological complications, renal/hepatic dysfunctions, and so on. In many cases, the cryoprotective agent (CPA) used-which is typically dimethyl sulfoxide (DMSO)-is believed to be the main causal agent of these adverse reactions and thus many studies recommend depletion of DMSO before cell infusion. In this paper, we will briefly review the history of HSC cryopreservation, the side effects reported after transplantation, along with advances in strategies for reducing the adverse reactions, including methods and devices for removal of DMSO. Strategies to minimize adverse effects include medication before and after transplantation, optimizing the infusion procedure, reducing the DMSO concentration or using alternative CPAs for cryopreservation and removing DMSO before infusion. For DMSO removal, besides the traditional and widely applied method of centrifugation, new approaches have been explored in the past decade, such as filtration by spinning membrane, stepwise dilution-centrifugation using rotating syringe, diffusion-based DMSO extraction in microfluidic channels, dialysis and dilution-filtration through hollow-fiber dialyzers and some instruments (CytoMate, Sepax S-100, Cobe 2991, microfluidic channels, dilution-filtration system, etc.) as well. However, challenges still remain: development of the optimal (fast, safe, simple, automated, controllable, effective and low cost) methods and devices for CPA removal with minimum cell loss and damage remains an unfilled need. [ABSTRACT FROM AUTHOR]

Patient/caregiver out-of pocket costs associated with hematopoietic cell transplantation (HCT) are not well known. We conducted a pilot study to evaluate patient/caregiver out-of-pocket costs in the first 3 months after allogeneic HCT. Thirty patients were enrolled at three sites. Before HCT, participants completed a baseline survey regarding household income and insurance coverage. Subsequently, they maintained a paper-based diary to track daily out-of-pocket expenses for the first 3 months after HCT. Telephone interviews were conducted to follow-up on the missing/incomplete diaries and on study completion. Twenty-five patients/caregivers completed the baseline survey. Among these, the median pre-tax household income was $66 500 (range, $30-$375 000) and 48% had to temporarily relocate close to the transplant center. Insurance coverage was managed care plan (56%), Medicaid (20%), Medicare (17%) and other (8%). Twenty-two patients/caregivers completed 4 diaries; the median out-of-pocket expenses were $2440 (range, $199-$13 769). Patients/caregivers who required temporary lodging had higher out-of-pocket expenses compared with those who did not (median, $5247 vs $716). Patients/caregivers can incur substantial out-of-pocket costs over the first 3 months, especially if they need to temporarily relocate close to the transplant center. Our study lays the foundation for future research on the early and long-term financial impact of allogeneic HCT on patients/caregivers. [ABSTRACT FROM AUTHOR]

Reactivation of human herpesvirus-6 (HHV-6) frequently occurs following hematopoietic SCT (HSCT), and has been associated with clinical consequences in many patient populations. HHV-6 reactivation and HHV-6 encephalitis seem to occur more frequently in patients undergoing HSCT with cord blood (CB) as the stem cell source. We have conducted a systematic literature review and meta-analysis to investigate the clinical significance of this correlation. A systematic review of publications indexed in PubMed was performed for HSCT studies published over the past 10 years that fit inclusion criteria. Data on prevalences of HHV-6 reactivation and HHV-6 encephalitis post HSCT were abstracted from 19 papers. Meta-analyses were conducted to calculate combined prevalence estimates. The prevalences of HHV-6 reactivation and encephalitis were compared among CB vs non-CB HSCT. Prevalences of HHV-6 reactivation and HHV-6 encephalitis were significantly higher in patients receiving CB as the stem cell source than in patients receiving another stem cell source (72.0% vs 37.4%, P<0.0001; 8.3% vs 0.50%, P<0.0001, respectively). HHV-6 reactivation and HHV-6 encephalitis are significant complications in the post-HSCT setting, particularly in patients receiving CB as the stem cell source. Thus, patients undergoing umbilical CB transplantation should be closely monitored for HHV-6 reactivation. [ABSTRACT FROM AUTHOR]

Since the introduction of the concept of aplastic anemia (AA) by Paul Ehrlich in 1888 and despite the current better understanding of the underlying mechanisms involved in this disease, a clear delimitation among BM failure syndromes is still a matter of debate. The diagnosis of AA can be difficult basically due to the overlapping morphological characteristics with other BM failure disorders. This paper reviews critical data relevant to the diagnosis of acquired AA and recommends work out steps and main considerations to determine severity and characterization of the disease. The diagnostic challenge in the differentiation between AA and hypoplastic myelodysplastic syndromes is also addressed. The definition of the response criteria to treatment belongs to the diagnostic tasks and it is included in this review as well as an overview of novel tools for the diagnosis of AA. [ABSTRACT FROM AUTHOR]

The demand for unrelated haematopoietic cell (HPC) donors has risen threefold over the last decade, and is likely to continue to rise over the next 10 years. The time taken from diagnosis to transplant is recognised to adversely affect patient outcome, and provision of unrelated donors (UDs) has been identified as a key source of delay. Obstacles to provision of UD include: delays in referral to a transplant centre, awaiting sibling typing, lack of matched donors (particularly for those from ethnic minorities and/or with rare HLA phenotypes), low- or intermediate-resolution donor HLA typing, donor attrition from the registries, donor ineligibility on grounds of health and difficulties encountered transporting HPC across international borders. There are now over 18 million volunteer donors in registries worldwide, and efficiency has improved, at least in part, because of a switch from paper to electronic searches. As a result, the average time from search request to transplant is estimated to be less than half of what it was two decades ago. Furthermore, registries have developed a number of strategies designed to minimise delays and, ultimately, improve patient outcomes. These include: optimisation of donor numbers and ethnic mix through focused and selective recruitment; high-resolution typing at donor recruitment; cord blood banking with aggressive recruitment in ethnic minorities; early identification of those unlikely to find a match so alternative transplant options may be pursued in a timely manner, through use of HLA-based predictive algorithms; reduction of donor attrition; centralised, registry-based, donor identification services; and provision of a back-up donor. [ABSTRACT FROM AUTHOR]

Invasive fungal diseases (IFDs) continue to cause considerable morbidity and mortality in patients with haematological malignancy. Diagnosis of IFD is difficult, with the sensitivity of the gold standard tests (culture and histopathology) often reported to be low, which may at least in part be due to sub-optimal sampling or subsequent handling in the routine microbiological laboratory. Therefore, a working group of the European Conference in Infections in Leukaemia was convened in 2009 with the task of reviewing the classical diagnostic procedures and providing recommendations for their optimal use. The recommendations were presented and approved at the ECIL-3 conference in September 2009. Although new serological and molecular tests are examined in separate papers, this review focuses on sample types, microscopy and culture procedures, antifungal susceptibility testing and imaging. The performance and limitations of these procedures are discussed and recommendations are provided on when and how to use them and how to interpret the results. [ABSTRACT FROM AUTHOR]

Changes in clinical practice should be driven by relevant and reliable evidence. Hence, adoption of a new therapy requires demonstrating that it provides (causes) benefit. Such evidence is generally obtained from intent-to-treat analyses of randomized clinical trials (RCTs). In this paper, we review other approaches to assessing the causal relationship between treatments and outcomes: (1) inference from non-randomized (observational) studies, (2) analysis of randomized studies where patients received treatments other than those to which they were randomized and (3) analysis of studies where the outcome of interest is sometimes unobservable because of a competing event (competing risks). We conclude that for the practice-changing demonstration of a favorable benefit-to-risk ratio, the gold standard is the intent-to-treat analysis of RCTs. At the same time, we illustrate how careful application of special statistical methods for assessment of treatment-outcome causation can be instrumental in complementing existing randomized evidence and guiding design of future research. [ABSTRACT FROM AUTHOR]

In this paper we review evidence concerning the impact of hematopoietic SCT (HSCT) on sexuality. The aims are to determine: (1) the sexual changes experienced by patients following allogeneic or autologous HSCT, and its consequences; (2) changes in the sexual function over time and (3) the impact of physiological changes induced by intensive treatment with radiation and chemotherapy on sexual functioning. Four databases were searched for articles published between January 1995 and May 2011. A total of 14 studies were identified and analyzed. We found that (1) multiple aspects of sexuality were affected, and the impact and etiology of these sexual alterations were different between genders, and (2) recovery of sexual activity and pleasure occurred in the first 2 years after HSCT, although it appears that some survivors are more likely to experience sexual dysfunction even 5-10 years after HSCT as compared with controls; and (3) there was contradictory evidence concerning possible differences between allogeneic and autologous HSCT, although there was a significant relation between the sexual dysfunctions and the type of chemotherapy administrated as conditioning and chronic GVHD. Future prospective research in sexual dysfunction with specific reliable validated instruments and more adequate sample sizes will be required to definitively evaluate the impact of HSCT on sexuality. [ABSTRACT FROM AUTHOR]

The article presents abstracts of papers presented at the European Group for Blood and Marrow Transplantation (EBMT) 2012 meeting including "Ethics in transplant: a phenomenological exploration of nursing and medical perspectives," by C. Evans, J. Hanbury, and J. Derbyshire, "Understanding HSCT patients' late psychosocial concerns," by A. Polomeni and S. Lapusan, and "Stress level assessment and intervention in a bone marrow transplantation inpatient nurse group," by M. Vicini and colleagues.

The article presents abstracts of papers presented at the European Group for Blood and Marrow Transplantation (EBMT) 2012 meeting including "The outcomes of allogeneic stem cell transplantation in AML patients with monosomal karyotypes," by J. H. Moon and colleagues, "Reconstitution of human herpes virus 6 (HHV6)-specific T-cell immunity after paediatric HSCT," by T. Mina and colleagues, and "Examples of the use of stem cells from cord blood in Poland," by T. Oldak and colleagues.

The article presents abstracts of papers presented at the European Group for Blood and Marrow Transplantation (EBMT) 2012 meeting including "Improved survival in AML patients with a high FLT3-ITD mutation rate after allogeneic transplantation," by H. Wandt and colleagues, ""Non-transplant" treatment approaches for AML," by F. Ravandi, and "Rapamycin prevents experimental sclerodermatous chronic graft-versus-host disease in mice," by L. Belle and colleagues.

The EORTC Quality of Life Core Questionnaire QLQ-C30 is widely used, but no reference values are available for patients receiving HSCT. We retrieved data for 38 samples from 33 papers in English and German that provided evaluable information on QLQ-C30 scores (mean, s.d.) covering about 2800 patients. Results are presented as a table that provides reference data that allow QLQ-C30 scores at different points during the disease trajectory to be put in context. With respect to their central tendency and their variance, scores vary over time. Quality of life is lowest during inpatient time. About 1 year after HSCT, the pre-transplant level is reached. Physical functioning is the scale reaching the highest level of all scales. Fatigue, dyspnoea and insomnia are symptoms that remain at an elevated level and should thus be considered as persisting problems after HSCT. For the interpretation of differences between scores, a very conservative recommendation would be to set the s.d. at 30 points. Doing so, one could be quite sure of having found a clinically significant change if the difference of two scores exceeds 15 points. Differences below 5 points should be interpreted with caution. [ABSTRACT FROM AUTHOR]

The article presents abstracts of papers presented at the 2011 congress of the European Group for Blood and Marrow Transplantation (EBMT) including "Educational programme in the paediatric haematopoietic stem cell transplantation unit," by A. Pertlova and colleagues, "Haematology goes digital," by M. Bouwens and M. Goedhart, and "Conservation of central venous devices with tauro lock solution," by A. Grubisic and colleagues.

A nonmyeloablative conditioning regimen consisting of fludarabine (FLU) and 2 Gy TBI has been used extensively and with substantial engraftment success without promoting excessive nonrelapse mortality in medically infirm patients requiring hematopoietic cell transplantation. In this paper, we studied this same low-toxicity regimen as a means of promoting engraftment of unrelated donor hematopoietic cell transplantation in patients with Fanconi anemia (FA). All patients tolerated the regimen well with no mucositis or other severe toxicities. Of six patients transplanted, five achieved stable mixed or full donor chimerism. Acute and chronic GVHD occurred in four and three patients, respectively. Three patients are alive and well at a median of 45.9 (range, 20.9-68.1) months after transplant. In summary, this FLU-based regimen facilitates stable engraftment of unrelated PBSCs, but is associated with significant chronic GVHD. [ABSTRACT FROM AUTHOR]

Severe aplastic anemia (SAA) is a BM failure syndrome in which allo-SCT remains a highly effective curative option. Its application remains limited by donor availability and by the potential for treatment-related morbidity and mortality. The improved outcomes with unrelated transplantation are a result of the advent of molecular donor-recipient matching, generation of effective novel conditioning regimens, improvement of supportive care and expansion of the donor registry. Decision making regarding the earlier use of unrelated transplant procedures is rapidly evolving. This paper reviews critical data relevant to these treatment options and recommends early consideration of related SCT for patients with SAA who show failure of immune suppressive therapy. [ABSTRACT FROM AUTHOR]

The international exchange of cord blood units (CBUs) for transplantation has brought new challenges to the stem cell donor registries involved in the exchange of BM and PBSCs. The unique properties of cord blood cells and differences in the search processes between CBUs and adult unrelated donors has required registries responsible for cord blood bank (CBB) networks to review their current practices and to develop new processes to accommodate for the provision of CBUs. This paper describes the aims and activities of the World Marrow Donor Association (WMDA) Cord Blood Working Group (CBWG) which was established in 2007 to gather and exchange information about cord blood registry needs and activities, and to develop guidelines to support and promote safe effective international exchange of unrelated CBUs for transplantation. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at panel sessions on neuroimmunology is presented. Topics include multiple sclerosis (MS), systemic lupus erythematosus and the effectiveness of haematopoietic stem cell transplantation (HSCT) in treating Crohn's disease. Other reports discussed during the sessions include one on autoimmune cytopenias, another on statistical considerations for clinical trials in autoimmune diseases and one on surrogate markers in MS clinical trials.

Efforts are needed to enhance the efficacy of cord blood (CB) transplantation. Laboratory information set the stage for the first and subsequent CB transplants, and will be instrumental in continuing to advance the field. This paper offers a brief understanding of the current state of hematopoietic stem cell (HSC) and hematopoietic progenitor cell (HPC) biology, a look back at laboratory studies leading to the first CB transplants, and a discussion of the possible means to enhance CB transplantation. Results show that physical recovery of greater numbers of HPCs is possible after CB is collected by perfusing the placenta, but how realistic this procedure is for collection of CB to be banked is open to question. We also show that the chemokine stromal cell-derived factor-1/CXCL12 can enhance the ex vivo expansion of CB HPCs beyond that of the combination of SCF, Flt3-ligand and TPO. Advances in cytokine and stromal cell biology, and in intracellular signals mediating the effects of cytokines/stromal cells should be considered in the context of future efforts to enhance functional activities of donor CB HSCs and HPCs and the microenvironmental niche of the recipient, which is required for acceptance and nurturing these HSCs/HPCs. [ABSTRACT FROM AUTHOR]

The article presents abstracts of papers on nursing which include "I can do needles," by P. Askew, "Mouth care procedure for children undergoing stem cell transplantation ― An every day challenge," by P. Kettler, M. Hansen, and S. Berthelsen, and "The challenges of accessing overseas treatment for the critically ill BMT patient," by M. Trnkova, J. Peacock, W. Larmouth and S. Dodd.

The field of high-dose therapy and SCT has made many advances in the past several years and the success rates have been steadily increasing as newer therapies emerge and improvements in supportive care continue to improve patient survival and cure rates. There still remains a mortality risk for high-dose therapy and the need for palliative care becomes more apparent as the focus also incorporates quality of life in all facets of cancer treatment and care. This paper reports on the lack of literature available on palliative care into the BMT and explores areas of future research in the integration of these two fields of medicine.Bone Marrow Transplantation (2009) 43, 265–273; doi:10.1038/bmt.2008.436; published online 19 January 2009 [ABSTRACT FROM AUTHOR]

Currently, 50% of adolescents with ALL are treated by adult teams and 50% by paediatric teams (following either adult or paediatric protocols). The aim of this paper is to review the results obtained with first-line chemotherapy and with haematopoietic SCT (HSCT) in adolescents with ALL. Disease biology and host factors are responsible for the differences observed between adolescents and other age categories. The outcome of adolescents with ALL after first-line chemotherapy is poorer as compared with children, although better as compared with adults. Recent studies have shown that adolescents who were enrolled in paediatric trials achieved better results than those who were enrolled in adult trials. This is most likely because of several differences, including protocol design, dose intensity and use of HSCTs, as well as better compliance to treatment and better supportive care. Disparities in the attitude towards treatment between paediatric and adult wards might also contribute to the better outcome that is observed in paediatric institutions. Indications for HSCT in children with ALL are well defined by international protocols. Only very high-risk paediatric patients are eligible for HSCT in CR1, whereas in adult trials, allogeneic or autologous HSCT are frequently offered, even to standard-risk patients in CR1. The outcome of adolescents given HSCT is poorer than in children, though better than in adults. Improving both psychosocial support during therapy and physical exercise habits represent further challenges for teams involved in the treatment of adolescents. Cooperation between paediatric and adult haematologists would surely improve the ability to recruit as many patients as possible and would promote progress in the research on adolescents. In conclusion, redefining age limits according to risk-based strategies, as well as encouraging multi-centre cooperation, should be taken into consideration to improve the outcome of this age category. Adolescents should be referred to research treatment teams that have experience in the management of paediatric ALL and they should be enrolled in international cooperative studies.Bone Marrow Transplantation (2008) 42, S35–S39; doi:10.1038/bmt.2008.281 [ABSTRACT FROM AUTHOR]

Infectious complications constitute a major cause of morbidity and mortality in pediatric and adult patients undergoing hematopoietic SCT (HSCT). Current guidelines and recommendations for prevention of infections in children after HSCT are presented in this mini review. The paper is based on evidence-based recommendations rated by the strength of the recommendation and the quality of the supporting evidence. Prophylaxis strategy based on risk stratification includes: (1) general infection control in hospital environment, (2) pharmacological approach related to antibacterial, antifungal and antiviral agents and (3) vaccination. Although most studies were carried out on adults only, some included both pediatric and adult patients. No differences in prophylaxis strategy and efficacy among age groups are reported. With changing practices, transplant teams are encouraged to review local patterns of prophylaxis strategy.Bone Marrow Transplantation (2008) 42, S77–S81; doi:10.1038/bmt.2008.289 [ABSTRACT FROM AUTHOR]

This paper outlines the BMT activity in India and describes in some detail the transplant program at the Christian Medical College, Vellore. In September 2005, data from six transplant centers in India were collected and a total of 1540 transplants have been performed in a country of over one billion population. At the center in Vellore, from October 1986 to December 2006, a total of 626 transplants have been performed in 595 patients, with 28 patients having more than one transplant. Thalassemia accounted for a third of these transplants: the country has over 20 million carriers and 10 000 children are born each year with thalassemia major. The average cost of allogeneic BMT in India is around $15 000–20 000, and this is considerably lower than the cost in the West. India needs to develop more transplant centers with adequately trained personnel, as there is great need for them. Improvements in the economy mean that more patients can afford this treatment.Bone Marrow Transplantation (2008) 42, S81–S84; doi:10.1038/bmt.2008.124 [ABSTRACT FROM AUTHOR]