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Bone marrow transplantation in childhood leukemia using reverse isolation techniques
A K Ogden1, C P Steuber, D H Mahoney
1Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Abstract:
Between 1979 and 1986, 29 pediatric patients underwent bone marrow transplantation at Texas Children's Hospital using routine reverse isolation. Laminar air flow rooms, prophylactic antibiotics, and gut sterilization were not utilized. The diagnoses included acute lymphocytic leukemia (ALL) (16 patients), acute nonlymphocytic leukemia (ANLL) (10 patients), and chronic myelogenous leukemia (CML) (three patients). All patients had fever during hospitalization. There were 11 episodes of bacteremia in seven patients giving a bacteremia rate of 37.9%. Moderate-to-severe (grade II-IV) acute graft-versus-host disease (GVHD) was seen in eight patients (27.6%). The incidence of infection and GVHD during the first 100 days post-transplantation is comparable to published reports from centers utilizing rigid isolation and sterilization of the gut. It is suggested that bone marrow transplantation may be done using standard reverse isolation techniques without increasing the morbidity or mortality of the procedure.
Insights
Pediatric bone marrow transplants using standard reverse isolation showed infection and graft-versus-host disease rates comparable to strict protocols. This suggests bone marrow transplantation can be performed safely without intensive isolation measures.
Area of Science:
- Hematology
- Oncology
- Infectious Disease
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric hematologic malignancies.
- Historically, intensive isolation techniques were employed to minimize infection and graft-versus-host disease (GVHD) risks.
- The necessity of stringent protocols versus standard isolation in BMT remains an area of investigation.
Purpose of the Study:
- To evaluate the outcomes of pediatric BMT performed with routine reverse isolation.
- To compare infection and GVHD rates in patients not utilizing laminar air flow, prophylactic antibiotics, or gut sterilization.
- To determine if standard isolation is sufficient for safe pediatric BMT.
Main Methods:
- Retrospective analysis of 29 pediatric patients undergoing BMT between 1979 and 1986.
- Patients received care under routine reverse isolation protocols.
- Exclusion of laminar air flow rooms, prophylactic antibiotics, and gut sterilization.
Main Results:
- 16 patients with acute lymphocytic leukemia (ALL), 10 with acute nonlymphocytic leukemia (ANLL), and 3 with chronic myelogenous leukemia (CML) were included.
- A bacteremia rate of 37.9% (11 episodes in 7 patients) was observed.
- Moderate-to-severe acute graft-versus-host disease (GVHD) occurred in 27.6% (8 patients).
Conclusions:
- The incidence of infection and GVHD within 100 days post-BMT was comparable to published data from centers using rigid isolation.
- Pediatric bone marrow transplantation can potentially be performed safely using standard reverse isolation.
- These findings suggest that intensive isolation and gut sterilization may not be essential for all BMT procedures, potentially reducing patient burden and resource utilization.