Adverse reactions during stem cell infusion in children treated with autologous and allogeneic stem cell transplantation

Area of Science:

• Pediatric Hematology
• Cellular Therapy
• Transplantation Immunology

Background:

• Adverse reactions (ARs) are frequent during cellular therapy product (CTP) infusions in hematopoietic stem cell transplantation (HSCT).
• Predictors of ARs in pediatric HSCT are not well-defined, particularly regarding CTP characteristics.

Purpose of the Study:

• To determine the incidence and grade of ARs during CTP infusion in pediatric patients undergoing autologous and allogeneic HSCT.
• To identify independent risk factors associated with serious ARs during CTP infusion in this population.

Main Methods:

• Retrospective analysis of 213 pediatric patients (120 allogeneic, 93 autologous) undergoing HSCT.
• Data from 361 CTP infusion episodes were analyzed for AR incidence, grade, and potential predictors.
• Statistical analysis identified independent risk factors using odds ratios (OR) and confidence intervals (CI).

Main Results:

• Serious ARs (grade 2-3) occurred in 25% and 11% of infusions, respectively; no grade 4-5 ARs were observed.
• Stem cell source was a significant predictor: cord blood vs. marrow (OR 7.3) and PBSC vs. marrow (OR 1.8) increased risk.
• Manipulated CTPs were protective (OR 0.4), and unlike adult studies, white blood cell (WBC) and granulocyte content were not risk factors in children.

Conclusions:

• Pediatric patients undergoing HSCT exhibit distinct AR profiles compared to adults.
• Manipulated CTPs may reduce the risk of adverse infusion reactions in pediatric HSCT.
• Children appear to tolerate higher WBC content during CTP infusion, suggesting potential for modified infusion parameters.