Supportive care
Before and after transplantation, all children receivedPneumocystis pneumonia and antifungal prophylaxis according to
institutional guidelines. Irradiated blood products were used for
transfusion support. Together with the CloEC, all patients received
dexamethasone, both as antiemetic prophylaxis and as prophylaxis for
cytokine release syndrome. No antibacterial prophylaxis was given,
although an aggressive empirical treatment of febrile neutropenia
episodes was mandatory. After transplantation, the patients were
screened at least weekly for CMV, AdV, and EBV. If viral DNA was
detected, the number virus copies was monitored, and appropriate
antiviral treatment was started when indicated. All patients with IgG
specific for varicella-zoster or herpes simplex viruses received
prophylactic acyclovir according to institutional guidelines.
Defibrotide was not used as VOD prophylaxis. Human granulocyte
colony-stimulating factor was not used to enhance neutrophil recovery
after transplantation.