Complications of hematopoietic stem cell transplantation in children

Abstract

In 2023, hematopoietic stem cell transplantation remains the ultimate hope of cure for children suffering from malignant or non-malignant diseases. It is a complex procedure based on the administration of high-dose chemotherapy, with or without radiotherapy, followed by the injection of an autologous or allogeneic graft. The occurrence of complications, responsible for a transplant-related mortality of about 15%, is observed essentially after allogeneic transplantation. These complications, which occur in children weakened by their previous treatments, prolonged neutropenia, and immune deficiency, may be infectious (bacterial sepsis, invasive fungal infection, viral infection), result from endothelial pathology (veno-occlusive disease of the liver), or from immune conflict (graft versus host disease). The occurrence of organ dysfunction requires early transfer to an intensive care unit where joint management by pediatric resuscitators and graft specialists can improve the prognosis.