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The role of end of induction minimal residual disease (MRD) as determined by flow cytometry for treatment assignment in pediatric T-cell acute lymphoblastic leukemia (T-ALL) is not well defined. We studied 33 children with newly diagnosed T-ALL. Thirty-two of 33 patients remain in continuous complete remission at a median of 4 years. Nineteen patients were MRD positive at the end of induction and all remain in remission with augmented Berlin Frankfurt Münster-based therapy. One patient underwent hematopoietic stem cell transplant for rising MRD. Persistent end of induction MRD alone is not an indication to alter therapy in pediatric T-ALL., (© 2015 Wiley Periodicals, Inc.)

Marrow ablative chemotherapy (MAC) with autologous hematopoietic stem cell transplantation (HSCT) is limited by poor bone marrow reserve after chemotherapy and/or radiotherapy, and the extent of bone/bone marrow disease. We report a child with recurrent metastatic medulloblastoma who received an allogeneic HSCT while in relapse and subsequently achieved radiological resolution of disease and favorable marrow minimal residual disease (MRD) response. Disease recurred intra-cranially at 304 days post-HSCT. Tumor biopsy 488 days post-HSCT showed infiltration with donor lymphocytes demonstrating graft-versus-tumor (GVT) effect. The patient remained alive >2 years post-HSCT. Allogeneic HSCT may be a consideration for high-risk recurrent medulloblastoma., (© 2015 Wiley Periodicals, Inc.)

We assessed clinical practice standards for infectious complications among pediatric blood and marrow transplant (PBMT) recipients. An anonymous online survey was sent to all 64 pediatric program directors (PD) of PBMT centers in the United States, which are accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). The overall response rate was 56% (CI: 44-68%); variations in clinical practices were noted regarding (i) surveillance for late onset cytomegalovirus (CMV) infection and (ii) pharmacokinetic/therapeutic drug monitoring of antimicrobials. Prospective studies among PBMT recipients to address infectious complications among this population and variations in clinical practice may be required., (© 2015 Wiley Periodicals, Inc.)

Hemophagocytic lymphohistiocytosis (HLH) is a rare autosomal recessive disorder of infancy and childhood that is invariably fatal if not treated. We report on the first patient to receive post-natal HSCT for HLH after receiving in utero chemotherapy for disease stabilization.