We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽−2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score −2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3–99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.

Coronary artery disease after bone marrow transplantation is rare in children and young adults. We report the case of a 21-year-old who developed coronary artery disease and acute myocardial infarction secondary to graft versus host disease following bone marrow transplantation. Physicians caring for young patients after bone marrow transplantation should be aware of the potential for coronary artery disease and evaluate appropriately.

Purpose: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant.

Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up.

Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3%. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.

Objective: Although success rates for bone marrow transplantation (BMT) continue to improve, there is still a high level of morbidity and physical and emotional distress associated with BMT. To date, limited research has focused on the assessment of and screening for specific psychiatric disorders of patients facing BMT. This is especially true with regard to identifying adjustment disorder (AD), despite the fact that AD is the most prevalent psychiatric diagnosis in cancer patients.

Methods: A sample of 95 BMT patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID) and completed several commonly used self-report instruments to determine if these tools could be used to identify patients with adjustment disorder in need of further assessment and intervention.

Results: Of these patients, 34.7% were diagnosed with adjustment disorder, 11.6% with major depression, and 5.3% with generalized anxiety disorder. The instruments were not found to be predictive of AD. However, the results of a regression analysis showed that the Social Subscale of the Functional Assessment of Cancer Therapy–General (R2 Δ = 0.04, F = 4.30, p < 0.05) was a significant predictor of adjustment disorder.

Significance of results: We conclude that there is little efficacy in using existing scales for detecting adjustment disorders in cancer patients undergoing bone marrow transplantation, and that other tools for identifying patients with adjustment disorder who might benefit from counseling are needed.

Objectives: To compare outcome attributes of three available technologies for stem cell transplantation—bone marrow transplantation (BM), peripheral blood cell transplantation (PB), and cord blood transplantation (CB). To compare the cost per recipient for the three technologies, incorporating all donor and antigen matching functions, as well as the transplantation procedures.

Methods: Review of relevant literature using the CancerLit and HealthSTAR databases (plus earlier searches of MEDLINE and Embase) to summarize outcome differences. Estimations of cost per transplant using models drawing on Canadian experience.

Results: The literature review indicated that PB may have a modest advantage over BM in terms of outcomes. The literature indicated that CB has longer engraftment times (although this may be due to inadequate controls). Our modeling exercise indicated that costs for PB and BM are similar. CB has a higher cost per recipient, due in large part to the higher testing costs for every donated unit.

Conclusions: Current literature is inadequate to provide an outcomes comparison of CB, PB, and BM. Viewed from a system-wide perspective, CB is a higher cost technique. However, PB and CB are emerging as technologies, and so our results should be viewed alongside the notion that there may be a steep learning curve in these technologies.