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1.  The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit 
Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in mortality are accompanied by an increase in complications, such as respiratory and cardiovascular insufficiencies as well as neurological problems that may require an admission to the pediatric intensive care unit where most supportive therapies can be provided. It has been shown that ventilatory and cardiovascular support along with renal replacement therapy can benefit pediatric hemato-oncology patients if promptly established. Even if admissions of these patients are not considered futile anymore, they still raise sensitive questions, including ethical issues. To support the discussion and potentially facilitate the decision-making process, we propose an algorithm that takes into account the reason for admission (surgical versus medical) and the hemato-oncological prognosis. The algorithm then leads to different types of admission: full-support admission, “pediatric intensive care unit trial” admission, intensive care with adapted level of support, and palliative intensive care. Throughout the process, maintaining a dialogue between the treating physicians, the paramedical staff, the child, and his parents is of paramount importance to optimize the care of these children with complex disease and evolving medical status.
doi:10.1186/2110-5820-2-14
PMCID: PMC3423066  PMID: 22691690
Oncology; Hematology; Cancer; Stem cell; Transplantation; Graft; Child; Pediatrics; Critical care; Intensive care
2.  Analysis of risk factors influencing outcome in children with myelodysplastic syndrome after unrelated cord blood transplantation 
Leukemia  2010;25(3):449-454.
We describe 70 children with myelodysplastic syndrome [refractory cytopenia (n=31) and refractory anemia with excess blasts (n=30) or blasts in transformation (n=9)] who received umbilical cord blood (UCB) transplantation with a single UCB unit and a myeloablative conditioning regimen. Approximately 20% of children had secondary myelodysplastic syndrome. Median age at transplantation was 7 years and the median follow-up, 3 years. The day-60 probability of neutrophil recovery was 76%; recovery was faster after transplantation of matched or 1-locus mismatched UCB, irradiation-containing conditioning regimen, cell dose >6 × 107/kg and monosomy 7. Risks of treatment failure (recurrent disease or death) were lower in patients with monosomy 7 and transplantations after 2001. The 3-year disease-free survival (DFS) was 50% for transplantations after 2001 compared to 27% for the earlier period (p=0.018). Transplantations after 2001 occurred within 6 months after diagnosis and used UCB units with higher cell dose. DFS was highest in patients with monosomy 7 (61%) compared to other karyotypes (30%), p=0.017. These data suggest transplantation of mismatched UCB graft is an acceptable alternative for children without a matched sibling or suitably matched unrelated adult donor.
doi:10.1038/leu.2010.285
PMCID: PMC3365546  PMID: 21135856
myelodysplastic syndrome; cord blood transplantation; monosomy 7

Results 1-2 (2)