Figure - available from: Journal of Clinical Medicine
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Flow diagram reporting the results of the search at clinicaltrials.gov (Last accessed 17 October 2022). BOS: bronchiolitis obliterans syndrome; HSCT: hematopoietic stem cell transplantation; SOS: sinusoidal obstruction syndrome; VOD: veno-occlusive disease. * Studies could be excluded for more than one reason, but they were counted only once in this figure.
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Hematopoietic stem cell transplantation (HSCT) is often the only curative treatment option for patients suffering from various types of malignant diseases and some non-cancerous conditions. Nevertheless, it is associated with a high risk of complications leading to transplant-related mortality and long-term morbidity. An increasing number of therap...
Citations
... 33 Another area of interest is related to the use of this drug after HSCT to prevent relapse. 34 Blinatumomab seems a very good candidate for this use, considering its good tolerability, with low risk of infections and low rate of other toxicities such as liver toxicity, which prevents the use of many other drugs after a transplant. An MD Anderson trial, including pediatric patients, tested blinatumomab as a prophylactic treatment in patients at high risk of relapse after HSCT. ...
The treatment of childhood acute lymphoblastic leukemia (ALL) has reached overall survival rates exceeding 90%. The present and future challenges are to cure the remainder of patients still dying from disease, and to reduce morbidity and mortality in those who can be cured with standard-of-care chemotherapy by replacing toxic chemotherapy elements while retaining cure rates. With the novel therapeutic options introduced in the last years, including immunotherapies and targeted antibodies, the treatment of ALL is undergoing major changes. For B-cell precursor ALL, blinatumomab, an anti-CD19 bispecific antibody, has established its role in the consolidation treatment for both high- and standard-risk first relapse of ALL, in the presence of bone marrow involvement, and may also have an impact on the outcome of high-risk subsets such as infant ALL and Philadelphia chromosome-positive ALL. Inotuzumab ozogamicin, an anti-CD22 drug conjugated antibody, has demonstrated high efficacy in inducing complete remission in relapsed ALL, even in the presence of high tumor burden, but randomized phase III trials are still ongoing. For T-ALL the role of CD38-directed treatment, such as daratumumab, is gaining interest, but randomized data are needed to assess its specific benefit. These antibodies are currently being tested in patients with newly diagnosed ALL and may lead to major changes in the present paradigm of treatment of pediatric ALL. Unlike the past, lessons may be learned from innovations in adult ALL, in which more drastic changes are piloted that may need to be translated to pediatrics.
As the field of pediatric transplant infectious diseases continues to grow, new challenges are constantly arising. Advances in immunosuppressive drugs, antimicrobial development, and novel diagnostic tests add new wrinkles to the care of pediatric transplant recipients. This progress in clinical care serves as a call to direct energy toward pediatric transplant infectious diseases research, to better understand how to use these interventions in pediatric practice.
