Journal of Pediatric Critical Care · Published 2025-11-01 · DOI 10.4103/jpcc.jpcc_137_25
Cellular therapies represent a major breakthrough in pediatric onco-critical care and transplantation, using living immune or stem cells to restore or enhance immune function, fight malignancy, and promote tissue repair. These therapies have transformed outcomes in both solid organ transplantation (SOT) and Hematopoietic Stem Cell Transplantation (HSCT) by reducing dependence on broad immunosuppressive drugs. Chimeric Antigen Receptor (CAR- T) therapy has revolutionized the management of refractory B-cell malignancies, with India’s NexCAR19 marking an affordable, indigenous advancement. However, immune toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) require expert critical care support. Mesenchymal stem cells (MSCs) promote engraftment, prevent graft-versus-host disease (GVHD), and enhance immune recovery through potent immunomodulatory effects. Memory T-cell Add-Back therapy (CD45RO+) accelerates immune reconstitution and controls viral infections post-HSCT, while virus-specific T cells (VSTs) target persistent viral infections in immunocompromised hosts. Natural killer (NK) cell therapy offers tumour and infection control through antibody-dependent and death receptor-mediated cytotoxicity. Collectively, these evolving cellular therapies are reshaping the landscape of pediatric oncology and transplantation by providing targeted, immune-based interventions that improve survival and long-term recovery while minimizing treatment-related toxicity.
Abstract from DOAJ. Public domain (CC0 1.0).
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