Pediatric hematopoietic stem cell transplantation (HSCT) is a specialized field with its own unique terminology, timelines, and range of complications. Many issues arise at specific stages of transplantation and often present with similar clinical features, while the underlying pathophysiology and management can differ significantly. Every intensivist caring for these patients must understand these nuances. These challenges are thoroughly addressed in this issue, especially in the chapters “Introduction to HSCT” and “Timeline of Complications,” which together form the core of this edition. This issue of the Journal of Pediatric Critical Care (JPCC) features review articles on Onco–Critical Care and Transplant Emergencies, with a special focus on hematopoietic stem cell transplantation (HSCT). HSCT is a complex and fast-changing field that pediatric intensivists are encountering more often in their daily practice. Our previous issue of JPCC was concentrated on oncology and major oncologic emergencies. However, the scope of this subject is extensive, making it impossible to cover every critical aspect in a single edition. Therefore, this issue continues that exploration, with a sharper focus on transplant-related critical care. Cytokine release syndrome (CRS) represents one of the most dramatic and life-threatening complications encountered during transplantation and cellular therapies. Occurring at distinct phases and sometimes triggered by therapeutic agents, CRS demands early anticipation, prompt recognition, and timely intervention. Optimal management hinges on meticulous cardiorespiratory supportive care and judicious use of targeted therapies, such as monoclonal antibodies, which can significantly reduce mortality. Febrile neutropenia, a familiar yet formidable condition, remains a medical emergency. Unlike community-acquired infections, it requires early, broad-spectrum antimicrobial coverage, targeting Gram-negative organisms, identifying the source (such as mucositis, gut, perianal area, long-term indwelling lines, and sinuses), and close monitoring, as delays can be catastrophic. Nonrelapse mortality after cancer therapy and transplantation is primarily caused by infections, many of which are specific to certain phases and pathogens. These complexities are thoroughly explained by infectious disease experts in the chapters on the timeline of infections in HSCT and solid organ transplantation. Finally, when a cure is no longer possible, care and comfort must take precedence. Palliative and end-of-life care are essential responsibilities for every intensivist. Pain management, nutrition, emotional well-being, respiratory support, and compassionate communication form the foundation of this care. Above all, dignity in life and dignity in death are fundamental human rights. It is our collective duty, as caring intensivists, to ensure that our critically ill and terminally ill children receive this care with empathy, respect, and compassion. We hope this issue provides you with the knowledge, insight, and perspective necessary to better care for this vulnerable population.
Jaykumar Indira (Thu,) studied this question.