Acute Complications in Hematopoietic Stem Cell Transplantation and Cellular Immunotherapy

Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many pediatric diseases. Cellular immunotherapy, such as the use of chimeric antigen receptor T cells, has emerged recently as a highly effective modality to treat refractory lymphoid malignancies. Although HSCT and cellular immunotherapy are now considered essential parts of the current therapeutic armamentarium, both are associated with a wide range of acute complications, many of which are unique to these treatment modalities. These acute complications are seen not only in hospitalized patients but also in patients in the ambulatory setting, including the emergency department. Emergency care providers will need to be able to recognize these complications and provide appropriate initial assessment and management. In this review, we describe the acute complications associated with HSCT and cellular immunotherapy, with the emphasis on their recognition, workup, and treatment.