How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

Matt S Zinter; Christopher C Dvorak; Jeffery J Auletta

doi:10.3389/fonc.2020.581447

How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

Front Oncol. 2020 Sep 16:10:581447. doi: 10.3389/fonc.2020.581447. eCollection 2020.

Authors

Matt S Zinter¹, Christopher C Dvorak², Jeffery J Auletta^{3

4}

Affiliations

¹ Division of Critical Care Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States.
² Division of Allergy, Immunology, and Blood and Marrow Transplantation, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States.
³ Division of Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, United States.
⁴ Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, United States.

Abstract

Pediatric allogeneic hematopoietic cell transplant (HCT) survival is limited by the development of post-transplant infections. In this overview, we discuss a clinical approach to the prompt recognition and treatment of fever and hypotension in pediatric HCT patients. Special attention is paid to individualized hemodynamic resuscitation, thorough diagnostic testing, novel anti-pathogen therapies, and the multimodal support required for recovery. We present three case vignettes that illustrate the complexities of post-HCT sepsis and highlight best practices that contribute to optimal transplant survival in children.

Keywords: bone marrow transplant; fever; hypotension; infection; sepsis.

Publication types

Review