Frontiers in Anesthesiology · Published 2026-07-14 · DOI 10.3389/fanes.2026.1879861
Shaikha Alqahtani, Fabiana Cacace, Beiyu Liu, Hwanhee Hong, Erika Summers, Lauren Stafford, Brittany Paige DePriest, Carmem Bonfim, Timothy A. Driscoll, Jennifer Jaroscak, Shatha Yousef, Joanne Kurtzberg, Kris M. Mahadeo
Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative therapy for infants with certain non-malignant inherited disorders and high-risk hematologic malignancies. Infants undergoing HCT differ from older pediatric cohorts as they may present with (i) different indications for HCT (ii) increased sensitivity of developing organs to treatment-related morbidities(iii) rapid clinical deterioration with more subtle early hemodynamic changes and (iv) limited data to predict those who require critical care support (CC). This single center retrospective report included 107 infants who consecutively underwent HCT between 2003 and 2023. Median age at HCT was 5.81 (Q1: 3.45, Q3: 10.55) months, predominantly for non-malignant indications (90.7%) with myeloablative conditioning (87.9%) and unrelated cord blood donors (88.8%). Within 100 days post-HCT, 41% required CC primarily for respiratory distress (77.3%), of which 56.8% (n = 25) required invasive mechanical ventilation (IMV). Infants who required CC had significantly greater risk of mortality as compared to those who didn't (HR: 3.59). Among patients requiring CC, mortality was further associated with longer time to neutrophil engraftment (HR 4.8), need for IMV (HR 10.04), and longer duration of IMV (HR 1.03). Overall survival (OS) among all patients was 85.9% and 73.5% at 100 days and 1-year post-HCT respectively. Among patients who required CC, those who underwent HCT after 2013- had a significantly (59%) lower risk of mortality compared to those transplanted before 2013. While infants undergoing HCT have a disproportionately higher risk of requiring CC, OS is high and continues to improve likely due to advancements in HCT techniques, CC and supportive care.
Abstract from DOAJ. Public domain (CC0 1.0).
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Alqahtani, S., Cacace, F., Liu, B., et al. (2026). Infants show improving survival after hematopoietic cell transplantation despite high rates of critical care admission. Frontiers in Anesthesiology. https://doi.org/10.3389/fanes.2026.1879861