Home platelet transfusion in pediatric oncology terminal care

✍ Scribed by Brook, Lynda ;Vickers, Jan ;Pizer, Barry

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 70 KB
• Volume: 40
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/mpo.10147

✦ Synopsis

The best therapeutic approach for these patients also remains unclear. In patients with secondary HS, different treatment modalities are used including intravenous immunoglobulins [9], etoposide, and corticosteroids [10], and various immunosuppressive agents [11], whereas patients with primary HS or severe forms of secondary HS can only be cured by allogeneic bone marrow transplantation (BMT) [12]. Recently, successful correction of HS with unrelated BMT [13], unrelated umbilical cord blood transplantation [14], and allogeneic peripheral blood stem cell transplantation [15] has also been reported. In our patient, different treatment approaches including etoposide, corticosteroids, cyclosporine A, and daclizumab, a monoclonal antibody against the IL-2 receptor [4], were initiated without success. Aggressive chemotherapy for treatment of the germ cell tumor could not be initiated because of severe pancytopenia and bleeding coagulopathy. The patient deteriorated rapidly within weeks and died before a suitable stem cell donor could be found, the rationale being such an emergency transplant might eradicate the HS together with the malignant germ cell tumor.

In conclusion, HS associated with malignant germ cell tumor is a rare and evidently fatal constellation. No effective treatment is known. Allogeneic stem cell transplantation might therefore be considered as immediate initial treatment.