Hematopoietic Stem Cell Transplant and Cellular Therapy
Hematopoietic cell transplantation (HCT) and cellular therapy (CT) are potentially lifesaving treatments for children with malignant and nonmalignant diseases. Advancements in care have led to expanding patient eligibility, with overall reduced morbidity and improved survival. Survival for HCT patients requiring pediatric intensive care unit (PICU) admission have improved. While almost half of pediatric patients receiving CAR-T therapy may require intensive care support, overall survival remains promising. However, patients undergoing HCT remain at risk for debilitating and life-threatening complications such as sinusoidal obstructive syndrome (S0S), infection, and graft-versus-host disease (GVHD); patients receiving chimeric antigen receptor (CAR) and other T-cell therapies are at risk for unique toxicities such as cytokine release syndrome (CRS) and CAR-T-related encephalopathy syndrome (CRES). Judicious patient and treatment selection, vigilant monitoring, and prompt interventions may reduce the need for PICU admission among HCT and CAR-T recipients. When PICU intervention is required, early intervention, excellent interdisciplinary communication, prognostication, and intensive support may improve outcomes.
