Children’s Stem Cell Treatment Tied to Readmissions

Close to two-thirds of children who received stem cell transplants returned to the hospital within six months for treatment of unexplained fevers, infections or other problems, according to a study at Dana-Farber/Children’s Hospital Cancer Center in Boston. Children who received their own cells were half as likely to be readmitted as were children who received donor cells.

“No one had ever looked at these data in children, ” said Leslie E. Lehmann, M.D., clinical director of pediatric stem cell transplantation at Dana-Farber. “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 review of the records of 129 children from 2008 to 2011 revealed that 64% had at least one hospital readmission within 180 days of receiving a stem cell transplant. The source of the donor cells was a key predictor. Seventy-nine percent of patients receiving transplants from a related or unrelated donor were readmitted compared to 38% who received their own cells (autologous transplant).

Fever without a documented source of infection accounted for 39% of the readmissions, 24% were for infections and 15% were for gastrointestinal problems. “Most of the patients went on to be successfully treated and ultimately did very well, ” said Lehmann. He hopes the findings can 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.