Variation in supportive care for pediatric HSCT recipients

  • TCT 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • The recent Transplantation & Cellular Therapy annual meeting hosted a discussion concerning diet, optimal return-to-school timing, and revaccination in children who have undergone a hematopoietic stem cell transplant (HSCT).
  • The session moderated by Christopher E. Dandoy, MD, concluded that there were significant variations across treatment centers in supportive care for children who have undergone HSCTs, some of which could adversely affect outcomes.

Key points

Neutropenic diet

  • The age-old neutropenic diet is still being offered to transplant recipients at some centers.
  • Cynthia Taggart, RD, from the Cincinnati Children's Hospital Medical Center in Ohio, said: "The history of the neutropenic diet is based on logic, prudent practice, and reasonable theoretical rationale, but there's no evidence to support this idea."
  • She highlighted evidence from comparative studies that found either no advantage or even potential detriments to a neutropenic diet.

Return to school

  • There is no clear consensus regarding the ideal timing for transplant recipients to resume school.
  • The National Marrow Donor Program and the Pediatric Blood and Marrow Transplant Consortium have differing views.
  • A survey showed that only 28 of 45 pediatric transplant centers had a standard operating procedure (SOP) for the return-to-school process.
    • Even for those with an SOP, the timings varied from 3 to 12 months.
  • Neel S. Bhatt, MD, from the Fred Hutchinson Cancer Research Center in Seattle, said: "This process of returning to school is complex, and support from all stakeholders is essential for successful transition."

Revaccination

  • With respect to revaccination of children who have undergone HSCT, Donna J. Curtis, MD, from the University of Colorado School of Medicine and Children's Hospital Colorado in Aurora, said: "variability is the norm."
  • Even with vaccination guidelines in place, providers often deviate in terms of when to vaccinate, which vaccines to administer, and the rationale behind their decisions.
  • Dr. Curtis noted that except for minor variations regarding timing, guidelines issued by major international organizations are very similar, and transplant centers should adhere to them whenever possible.