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Pancreatitis associated with bone marrow transplantation in children
S L Werlin1, J Casper, D Antonson
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53226.
Insights
Gastrointestinal symptoms like vomiting and pain in children undergoing bone marrow transplants (BMT) may indicate pancreatitis, not just standard treatment side effects. Early pancreatitis testing is crucial for BMT patients experiencing these common symptoms.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Hematology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various pediatric conditions.
- Commonly observed gastrointestinal (GI) symptoms post-BMT include vomiting, abdominal pain, and distension.
- These symptoms are often presumed to be side effects of chemo-irradiation and mucositis.
Observation:
- Seven pediatric BMT patients (3.5%) presented with significant GI symptoms.
- Diagnostic evaluation revealed mild to severe pancreatitis in these children.
- Pancreatitis occurred during conditioning or after BMT administration.
Findings:
- All affected patients received medications with known pancreatitis risks, including corticosteroids, sulfonamides, cyclosporine A, and cytosine arabinoside.
- Five of the seven patients had a history of graft-versus-host disease.
- The study identified a potential link between specific BMT conditioning regimens/medications and pancreatitis.
Implications:
- Upper GI symptoms in BMT patients warrant investigation beyond presumed mucositis or chemo-irradiation.
- Pancreatitis should be considered in the differential diagnosis for GI distress in pediatric BMT recipients.
- This finding may prompt revised diagnostic protocols and treatment strategies for BMT patients.
Abstract:
Vomiting, abdominal pain and distension, common findings in children who receive bone marrow transplants (BMT), are usually attributed to chemo-irradiation and mucositis, universally found in these patients. We report seven children, 3.5% of BMT patients at our institutions, with these symptoms who were found to have mild to severe pancreatitis during conditioning for or after receiving BMT. All patients were receiving drugs known to cause pancreatitis, such as adrenocorticosteroids and sulfonamides as well as numerous putative pancreatotoxins such as cyclosporin A and cytosine arabinoside. Five of the seven patients had suffered from graft-versus-host disease. In patients who have received BMT, upper gastrointestinal symptoms should not be attributed to mucositis or chemo-irradiation without first testing for pancreatitis.