Management of CMV Pneumonia, DAH, and BOS Following HSCT in a Child with β-Thalassemia: A Case Report - PubMed
12 hours ago
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- #HSCT
- #CMV pneumonia
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for thalassemia major but carries a high risk of post-transplant complications.
- A pediatric case with β-thalassemia major developed steroid-refractory grade III acute graft-versus-host disease (aGVHD) after HLA-9/10 mismatched unrelated donor allo-HSCT.
- Cytomegalovirus (CMV) reactivation progressed to severe CMV pneumonia complicated by diffuse alveolar hemorrhage (DAH).
- A combination of ganciclovir and letermovir was effective in achieving complete virologic clearance and marked respiratory improvement after failure of first-line antiviral therapy.
- Bronchiolitis obliterans syndrome (BOS) was diagnosed on day +154, treated with repeated infusions of umbilical cord-derived mesenchymal stromal cells (UC-MSCs) and the FAM regimen (fluticasone, azithromycin, montelukast), leading to full clinical recovery.
- Key management insights include the effectiveness of ganciclovir-letermovir combination in pediatric refractory CMV pneumonia and sequential UC-MSC administration in controlling acute GVHD and late pulmonary complications.
- Multidisciplinary collaboration and individualized strategies are essential in managing complex post-transplant pulmonary syndromes in children.