Umbilical Cord Blood Banking: Consensus Statement of the Indian Academy of Pediatrics

Justification: Practitioners and people need information about the therapeutic potential of umbilical cord blood stem cells and pros andcons of storing cord blood in public versus private banks.Process: Indian Academy of Pediatrics conducted a consultative meeting on umbilical cord blood banking on 25th June 2016 in Pune,attended by experts in the field of hematopoietic stem cell transplantation working across India. Review of scientific literature was alsoperformed. All expert committee members reviewed the final manuscript.Objective: To bring out consensus guidelines for umbilical cord banking in India.Recommendations: Umbilical cord blood stem cell transplantation has been used to cure many malignant disorders, hematologicalconditions, immune deficiency disorders and inherited metabolic disorders, even when it’s partially HLA mismatched. Collectionprocedure is safe for mother and baby in an otherwise uncomplicated delivery. Public cord blood banking should be promoted over privatebanking. Private cord blood banking is highly recommended when an existing family member (sibling or biological parent) is sufferingfrom diseases approved to be cured by allogenic stem cell transplantation. Otherwise, private cord blood banking is not a ‘biologicalinsurance’, and should be discouraged. At present, autologous cord stem cells cannot be used for treating diseases of genetic origin,metabolic disorders and hematological cancers. Advertisements for private banking are often misleading. Legislative measures arerequired to regularize the marketing strategies of cord blood banking.

Langerhans Cell Histiocytosis Presenting as Isolated Mediastinal Mass in an Infant.

Background: Isolated mediastinal involvement in Langerhans cell histiocytosis (LCH) has been rarely reported. Case characteristics: A 3-month-old boy presented with history of low grade intermittent fever, cough and noisy breathing for 2 weeks. Observation: A chest X-ray showed massive mediastinal widening. Biopsy of the mass confirmed LCH. Outcome: Patient is doing well after one year of treatment with LCH III protocol. Message: Langerhans cell histiocytosis should be considered in differential diagnosis of mediastinal mass in infants.

Serum Vascular Endothelial Growth Factor-A Levels During Induction Therapy in Children with Acute Lymphoblastic Leukemia.

Objective: To evaluate serum vascular endothelial growth factor (VEGF) levels in children with acute lymphoblastic leukemia (ALL) during the induction phase of chemotherapy. Design: Prospective sudy. Setting: Hospital-based study over 18 months. Patients: 30 children with ALL and 17 healthy age- and sexmatched controls. Intervention: Serum concentration of VEGF-A–165 isoform (s- VEGF) was measured by enzyme-linked immunoabsorbant assay at diagnosis and at the end of induction chemotherapy. Main outcome measures: s-VEGF was compared with markers of tumor burden. Kinetics of s-VEGF was assessed in response to induction chemotherapy. Results: Median VEGF was significantly lower in untreated patients than in controls (17.0 vs. 42.6 pg/mL, P=0.004). s-VEGF levels were fairly correlated with WBC count (r=-0.56, P=0.004) and LDH (r=-0.52, P=0.02) at diagnosis. All patients but one were in morphologic remission at the end of induction. Median s-VEGF concentration on day 29/33 was significantly higher than on day 1 (44.2 pg/mL, P=0.009). Conclusion: Untreated children with ALL have significantly lower s-VEGF concentration than controls. At the end of the induction therapy, s-VEGF increased to levels similar to controls. The role of ligand-receptor interaction between VEGF and VEGF receptors on leukemia cells needs to be further delineated.