Malnutrition during the peri-transplantation period is known to result in negative outcomes after allogeneic hematopoietic cell transplantation (allo-HCT). The nutritional risk index (NRI) which is a simple index calculated using serum albumin levels and body weight (BW) ratio (current BW/ideal BW) has been reported be to a prognostic factor in adult HCT. However, its usefulness in pediatric HCT setting remain unclear. Therefore, we retrospectively analyzed the impact of the NRI before allo-HCT on outcomes in pediatric patients. We found that poor nutritional status before pediatric HCT led to a worse prognosis, including NRM.

Poor graft function (PGF) is a major obstacle to successful allogeneic stem cell transplantation after achieving normal bone marrow function. We report a successful treatment of domino DLI for poor graft function in younger brother with hyper IgM syndrome from HLA-identical elder brother with the same disorder with a history of HLA-mismatched unrelated bone marrow transplantation using same donor. Immunological profiling revealed that DLI-induced T-regulatory cells could correct skewed immune responses in the BM microenvironment due to secondary PGF pathogenesis. Immunological tolerized domino DLI can be a new therapeutic option for secondary PGF in HLA-identical sibling pairs with congenital immunodeficiency.