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Most children readmitted after stem cell transplant

Wednesday April 24, 2013
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Nearly two-thirds of children receiving stem cell transplants returned to the hospital within six months for treatment of unexplained fevers, infections or other problems, according to a study.

Children who received donor cells were twice as likely to be readmitted as children who received their own stem cells, reported researchers with Dana-Farber/Children’s Hospital Cancer Center in Boston.

"No one had ever looked at these data in children," Leslie E. Lehmann, MD, clinical director of pediatric stem cell transplantation at Dana-Farber, said in a news release. "This is very important information and will allow us to counsel families appropriately, as well as try to devise interventions that reduce the rate of readmissions."

A records review of 129 children from 2008 to 2011 revealed that 64% had at least one hospital readmission within 180 days of transplant. The source of the donor cells was a key predictor: 79% of patients receiving transplants from a related or unrelated donor were readmitted, compared with 38% who underwent an autologous transplant.

The average number of readmissions was 2.4, indicating that for some children, discharge after transplant is only the beginning of a long process characterized by repeated hospital stays.

Fever without a documented source of infection accounted for 39% of the readmissions, while 24% were for infections and 15% for gastrointestinal problems.

"Most of the patients went on to be successfully treated and ultimately did very well," Lehmann said. "We hope these findings can eventually lead to identifying a group of low-risk children who could be managed at local hospitals rather than transplant centers, reducing costs and inconvenience to families."

Lehmann said the goal is to identify which patients could be safely treated without requiring an admission to the hospital.

Lehmann and Harvard Medical School student David Shulman were scheduled to present the study at the annual meeting of the American Society of Pediatric Hematology/Oncology, which takes place April 24-27 in Miami.


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