Evaluation of malgylcemia in the pediatric hematopoietic stem cell transplant population
Jenna Sopfe, MD
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is an integral component of therapy for many pediatric hematologic disorders, and can provide definitive cure that is not otherwise achievable. Unfortunately, children who undergo HSCT remain at high risk of complications such as infections, graft versus host disease (GVHD), graft failure, and death. In adults, abnormal glucose homeostasis (malglycemia), defined by hypoglycemia, hyperglycemia, or glycemic variability, is associated with worse outcomes including increased infection, length of hospital stay, organ dysfunction, GVHD, rate of hematopoietic recovery and rate of mortality.
GAP: All published studies of this subject have been retrospective and focused on adult populations. The incidence and impact of malglycemia on pediatric/AYA patients with hematologic diseases who undergo HSCT has not yet been defined.
HYPOTHESIS: We hypothesize that malglycemia is common in the hematologic pediatric HSCT population and that it is associated with higher rates of post-transplant complications.
METHODS: In this observational prospective cohort study, CGM devices will be used in 23-30 subjects, age 2-30, undergoing hematopoietic stem cell transplant for hematologic conditions. Glucose levels will be measured by CGM from the time of admission for HSCT until discharge. In addition to glucose data collected by CGM, we will prospectively collect outcomes data, including: safety related to CGM use, infection rate, length of hospital stay, days requiring intensive care, and survival.
IMPACT: Once we have identified the incidence of malglycemia its relationship with pediatric HSCT outcomes, we can then work to improve HSCT outcomes by improved glucose control to mitigate the association between malglycemia and outcomes.
Malglycemia is Associated with Increased Morbidity and Mortality in Pediatric Hematopoietic Stem Cell Recipients.