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Browsing Department of Pediatrics by Author "Abdel-Azim, Hisham"
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Item Candidacy for Extracorporeal Life Support in Children After Hematopoietic Cell Transplantation: A Position Paper From the Pediatric Acute Lung Injury and Sepsis Investigators Network's Hematopoietic Cell Transplant and Cancer Immunotherapy Subgroup(Wolters Kluwer, 2022) Zinter, Matt S.; McArthur, Jennifer; Duncan, Christine; Adams, Roberta; Kreml, Erin; Dalton, Heidi; Abdel-Azim, Hisham; Rowan, Courtney M.; Gertz, Shira J.; Mahadeo, Kris M.; Randolph, Adrienne G.; Rajapreyar, Prakadeshwari; Steiner, Marie E.; Lehmann, Leslie; Hematopoietic Cell Transplant and Cancer Immunotherapy Subgroup of the PALISI Network; Pediatrics, School of MedicineObjectives: The last decade has seen improved outcomes for children requiring extracorporeal life support as well as for children undergoing hematopoietic cell transplantation. Thus, given the historically poor survival of hematopoietic cell transplantation patients using extracorporeal life support, the Pediatric Acute Lung Injury and Sepsis Investigators' hematopoietic cell transplantation and cancer immunotherapy subgroup aimed to characterize the utility of extracorporeal life support in facilitating recovery from critical cardiorespiratory illnesses in pediatric hematopoietic cell transplantation patients. Data sources: All available published data were identified using a set of PubMed search terms for pediatric extracorporeal life support and hematopoietic cell transplantation. Study selection: All articles that provided original reports of pediatric hematopoietic cell transplantation patients who underwent extracorporeal life support were included. Sixty-four manuscripts met search criteria. Twenty-four were included as primary reports of pediatric hematopoietic cell transplantation patients who underwent extracorporeal life support (11 were single case reports, four single institution case series, two multi-institution case series, and seven registry reports from Extracorporeal Life Support Organization, Pediatric Heath Information System, and Virtual Pediatric Systems). Data extraction: All 24 articles were reviewed by first and last authors and a spread sheet was constructed including sample size, potential biases, and conclusions. Data synthesis: Discussions regarding incorporation of available evidence into our clinical practice were held at biannual meetings, as well as through email and virtual meetings. An expert consensus was determined through these discussions and confirmed through a modified Delphi process. Conclusions: Extracorporeal life support in hematopoietic cell transplantation patients is being used with increasing frequency and potentially improving survival. The Pediatric Acute Lung Injury and Sepsis Investigators hematopoietic cell transplantation-cancer immunotherapy subgroup has developed a framework to guide physicians in decision-making surrounding extracorporeal life support candidacy in pediatric hematopoietic cell transplantation patients. In addition to standard extracorporeal life support considerations, candidacy in the hematopoietic cell transplantation population should consider the following six factors in order of consensus agreement: 1) patient comorbidities; 2) underlying disease necessitating hematopoietic cell transplantation; 3) hematopoietic cell transplantation toxicities, 4) family and patient desires for goals of care; 5) hematopoietic cell transplantation preparatory regimen; and 6) graft characteristics. Although risk assessment may be individualized, data are currently insufficient to clearly delineate ideal candidacy. Therefore, we urge the onco-critical care community to collaborate and capture data to provide better evidence to guide physicians' decision-making in the future.Item Diagnosis, grading and management of toxicities from immunotherapies in children, adolescents and young adults with cancer(Springer Nature, 2021) Ragoonanan, Dristhi; Khazal, Sajad J.; Abdel-Azim, Hisham; McCall, David; Cuglievan, Branko; Tambaro, Francesco Paolo; Ahmad, Ali Haider; Rowan, Courtney M.; Gutierrez, Cristina; Schadler, Keri; Li, Shulin; Di Nardo, Matteo; Chi, Linda; Gulbis, Alison; Shoberu, Basirate; Mireles, Maria E.; McArthur, Jennifer; Kapoor, Neena; Miller, Jeffrey; Fitzgerald, Julie C.; Tewari, Priti; Petropoulos, Demetrios; Gill, Jonathan B.; Duncan, Christine N.; Lehmann, Leslie E.; Hingorani, Sangeeta; Angelo, Joseph R.; Swinford, Rita D.; Steiner, Marie E.; Hernandez Tejada, Fiorela N.; Martin, Paul L.; Auletta, Jeffery; Choi, Sung Won; Bajwa, Rajinder; Garnes, Natalie Dailey; Kebriaei, Partow; Rezvani, Katavoun; Wierda, Willian G.; Neelapu, Sattva S.; Shpall, Elizabeth J.; Corbacioglu, Selim; Mahadeo, Kris M.; Pediatrics, School of MedicineCancer immunotherapies are associated with remarkable therapeutic response rates but also with unique and severe toxicities, which potentially result in rapid deterioration in health. The number of clinical applications for novel immune effector-cell therapies, including chimeric antigen receptor (CAR)-expressing cells, and other immunotherapies, such as immune-checkpoint inhibitors, is increasing. In this Consensus Statement, members of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Hematopoietic Cell Transplantation-Cancer Immunotherapy (HCT-CI) Subgroup, Paediatric Diseases Working Party (PDWP) of the European Society of Blood and Marrow Transplantation (EBMT), Supportive Care Committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC) and MD Anderson Cancer Center CAR T Cell Therapy-Associated Toxicity (CARTOX) Program collaborated to provide updated comprehensive recommendations for the care of children, adolescents and young adults receiving cancer immunotherapies. With these recommendations, we address emerging toxicity mitigation strategies, we advocate for the characterization of baseline organ function according to age and discipline-specific criteria, we recommend early critical care assessment when indicated, with consideration of reversibility of underlying pathology (instead of organ failure scores) to guide critical care interventions, and we call for researchers, regulatory agencies and sponsors to support and facilitate early inclusion of young patients with cancer in well-designed clinical trials.Item Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement(Elsevier, 2022) Di Nardo, Matteo; Ahmad, Ali H.; Merli, Pietro; Zinter, Matthew S.; Lehman, Leslie E.; Rowan, Courtney M.; Steiner, Marie E.; Hingorani, Sangeeta; Angelo, Joseph R.; Abdel-Azim, Hisham; Khazal, Sajad J.; Shoberu, Basirat; McArthur, Jennifer; Bajwa, Rajinder; Ghafoor, Saad; Shah, Samir H.; Sandhu, Hitesh; Moody, Karen; Brown, Brandon D.; Mireles, Maria E.; Steppan, Diana; Olson, Taylor; Raman, Lakshmi; Bridges, Brian; Duncan, Christine N.; Choi, Sung Won; Swinford, Rita; Paden, Matt; Fortenberry, James D.; Peek, Giles; Tissieres, Pierre; De Luca, Daniele; Locatelli, Franco; Corbacioglu, Selim; Kneyber, Martin; Franceschini, Alessio; Nadel, Simon; Kumpf, Matthias; Loreti, Alessandra; Wösten-Van Asperen, Roelie; Gawronski, Orsola; Brierley, Joe; MacLaren, Graeme; Mahadeo, Kris M.; Pediatrics, School of MedicineUse of extracorporeal membrane oxygenation (ECMO) in children receiving hematopoietic cell transplantation (HCT) and/or Immune Effector Cells (IEC) remains controversial and evidence-based guidelines are lacking. Remarkable advancements in HCT and IEC therapies have changed expectations around reversibility of organ dysfunction and life-expectancy for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network- (HCT and Cancer Immunotherapy Subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC) and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT-IEC. These are the first international, multi-disciplinary consensus-based recommendations on the use of ECMO in HCT-IEC pediatric patients. This manuscript may serve as a clinical decision support tool for pediatric hematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations may represent a base for future research studies focused on ECMO selection criteria and bedside management.