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C-reactive protein (CRP) is an acute phase reactant that is a reliable marker of systemic inflammation and has been associated with increased morbidity and mortality following hematopoietic stem cell transplantation (HSCT) in adults. In this study, we evaluated whether early elevations of CRP were associated with various complications and nonrelapse mortality following HSCT in pediatric patients. Seventy pediatric patients had CRP levels drawn at regular time points during the first week following their transplants. Patients were followed for 100 days following transplant, and transplant-related complications were documented. Patients who subsequently developed severe infections had higher median CRP values than those without severe infections (median 8.03 mg/dL versus 1.64 mg/dL, P = .0008) as did those who suffered nonrelapse mortality compared with those who did not (12.6 mg/dL versus 2.44 mg/dL, P = .02). These findings suggest that elevated CRP values may be useful as a marker of individual pediatric patients with a higher risk for treatment-related morbidity and mortality. [Copyright &y& Elsevier]

Aim: Chimerism analysis post HPCT has become an essential tool for the surveillance of engraftment, graft rejection or relapse. MDC is a dynamic process reflecting the competition of multiple coexisting cell populations. In the setting of a second HPCT it may be difficult to assess the percentage of donor chimerism or the risk of relapse. A retrospective study on chimerism within the framework of MDC was demonstrated in the recipient’s graft. Methods: We studied 13 patients (9 males, 4 females), median age of 9 (1-16) years, who received a 2nd HPCT for acute leukemias (ALL n=9, AML n=3, Infant Leukemia n=1) who relapsed after the 1st HPCT. All patients achieved complete remission with full donor chimerism (FDC) of the 1st donor prior to the 2nd HPCT. AlleleSEQR™ qPCR (RUO) was used in this analysis. The technology follows the comparative ΔΔ CT method for relative PCR quantification with the known DNA quantity in a reference sample. Our stepwise approach to MDC analysis began with identifying the correct reference sample for pre transplant evaluation. Assessment of individual possible informative markers for: recipient, 1st donor and 2nd donor were performed. There were two combinations to be measured: recipient vs. 2nd donor and 1st donor vs. 2nd donor. Results: All cases engrafted and recovered their counts of ANC>500 /μl in a median of 18.5 (10-25) days and un-sustained platelets >20.0 /μl in 19 (0-54) days. Chimerism was evaluated weekly for the first 100 days. Three patterns were observed: a) FDC + 2nd donor (n=8) (62%), b) MDC without recipient (n=3) (23%) and c) MDC + recipient (n=2) (15%). Of 13 patients, three relapsed 2 with pattern C and 1 in pattern A. Conclusions: It is imperative to identify the informative assays for all 3 genotypes in order to assess MDC and its outcome properly. This study provided a novel approach in the interpretation of MDC. Presence of recipient cells post second HPCT illustrated a higher chance of relapse. [Copyright &y& Elsevier]

ADV has emerged as an important pathogen in children undergoing allogeneic HPCT. A prospective study of the epidemiology of ADV infection and preemptive therapy of high risk ADV infections in children undergoing HPCT was undertaken. Cultures of throat, urine, and stool for viral pathogens and plasma for ADV PCR were obtained prior to transplantation, weekly for the first 100 days, and then monthly for one yr. Children developing high-risk ADV infections were treated preemptively with cidofovir 1 mg/kg/day given three times weekly for three wk. A case-controlled study was performed to identify risk factors for high-risk ADV infections. Seven (18%) of the 38 subjects developed high-risk ADV infections usually within 100 days of HPCT and were preemptively treated with i.v. cidofovir at a dose of 1 mg/kg/dose three times weekly for nine doses. High-risk ADV infections resolved in all seven patients without renal toxicity. CMV viremia occurred in two of seven patients during or shortly after therapy with cidofovir. A case–control study did not identify any risk factors that achieved statistical significance. Treatment with a modified dosing regimen of cidofovir was well-tolerated and high-risk ADV infections resolved in all patients. [ABSTRACT FROM AUTHOR]