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The letter to the editor discusses the impact of CD34+ cell doses on outcomes in pediatric patients undergoing autologous hematopoietic stem cell transplant for central nervous system tumors (CNSTs) and high-risk neuroblastoma. The study found that higher CD34+ cell doses were associated with improved overall survival and progression-free survival in CNST patients but not in neuroblastoma patients. Possible explanations for these differences include tumor cell contamination, differences in the marrow microenvironment, and variations in chemosensitivity between the two conditions. Further research is needed to understand these outcome differences and optimize transplant outcomes for children with CNSTs and neuroblastoma. [Extracted from the article]

However, 80% of pediatric physicians who responded to our survey reported using the HCT-CI <50% of the time, noting that they do not feel that the HCT-CI is applicable to their patient population or impactful in their clinical practice. Hematopoietic cell transplantation-comorbidity index (HCT-CI) was developed to evaluate comorbidity burden before HCT and to provide prognostic information about transplant outcomes [[1]]. Interestingly, only 5% of adult transplant physicians versus 44.2% of pediatric transplant physicians reported never using the HCT-CI B ( b Figure 1(A)). [Extracted from the article]

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal illness characterized by impaired natural killer (NK) cell and cytotoxic T-cell function. Patients develop systemic inflammation, multisystem organ dysfunction, and if untreated, death. Patients who present in the neonatal period often have atypical presentations with evidence of liver dysfunction and cholestasis; this has a broad differential diagnosis including neonatal infection, congenital liver defects, or other causes of liver dysfunction, such as neonatal hemochromatosis. Here, we present an infant whose diagnosis of familial HLH was confounded by the history of a stillborn sibling with suspected neonatal hemochromatosis, ultimately delaying diagnosis and initiation of curative treatment. This highlights the need to maintain a low threshold for sending HLH work-up concurrently with evaluation of liver diseases in infants with liver dysfunction, to ensure timely diagnosis and initiation of treatment. Clinicians should maintain a high index of suspicion for HLH and be aware that HLH may mimic the findings on liver biopsy seen in neonatal hemochromatosis. [ABSTRACT FROM AUTHOR]

Hematopoietic stem cell transplantation (HCT) offers a potential cure for patients with high-risk malignancies but carries a risk of death from transplant-related complications. Extracorporeal membrane oxygenation (ECMO) is often considered a contraindication to transplant with the assumption that lung injury puts the patient at risk for pulmonary complications post-HCT. Although patients who have required prolonged intubation show gradual improvement in pulmonary function over time, there is little data on pulmonary functional recovery after ECMO which makes assessment pre-HCT difficult. We present a case series of two patients with high-risk hematologic malignancies, who had previously received ECMO and then underwent reduced-intensity HCT. Although both patients had complications post-HCT, neither patient suffered significant pulmonary toxicity related to their prior ECMO exposure. We conclude that, although patients who have previously been treated with ECMO remain at high risk for complications after transplant, but they should not be excluded from consideration for reduced intensity transplantation. [ABSTRACT FROM AUTHOR]