Immunological Challenges Following Pediatric Hematopoietic Transplantation

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Background

The utilization of hematopoietic stem cell transplantation (HSCT) to treat childhood diseases continues to increase with every passing year. Originally a treatment modality primarily confined to malignant conditions, HSCT is now often considered for a wide variety of non-malignant, genetic conditions which include immunodeficiencies, hemoglobinopathies, and metabolic diseases. This expanded use of HSCT is due to: 1) improvements in transplantation medicine reducing the risk of transplant-related morbidity and mortality, 2) expansion in the use of alternative donors increasing the availability of the procedure, and 3) improvements in diagnostic testing, particularly newborn screening programs leading to the early detection of conditions amenable to transplantation increasing the number of viable HSCT candidates. Despite these many advances, achieving a successful transplant outcome with normal immune reconstitution remains a challenge. A wide variety of conditions can impact normal host defense, auto/alloreactivity, and disrupt sustained engraftment, and these issues must be managed by the transplant physician. Decades of research has improved our understanding of these issues but there remain many unresolved questions:

1) How can we optimize host defenses against opportunistic infections and unwanted lymphoproliferation?
2) How do we minimize immune-mediated attack on the host?
3) How do we maintain stable donor hematopoiesis to ensure correction of the underlying disease?

This Research Topic will explore our current understanding of how the transplanted graft and the emerging donor immune system interface with the host leading to the scope of challenges we experience in the clinical transplant arena. We will review the current state of transplant medicine within this scope and highlight the obstacles that currently impede the broader use of this technology to treat human disease. As advances move forward with regard to gene therapy, conventional HSCT may lose its attractiveness as a therapeutic option. Further enhancements in transplant medicine to address the topics discussed in this issue will be needed to retain this treatment modality as a viable option for patients with life threatening hematopoietic-based disease.

We welcome the submission of Review, Mini-Review, Original Research, and Perspective articles covering the following topics:

1. Immune reconstitution.
2. Cgvhd.
3. Mesenchymal stem cells.
4. Late infections and adoptive immunotherapy strategies.
5. Autoimmune disease.
6. Post-Transplant Lymphoproliferative Disease.
7. Chimerism.
8. Graft rejection, late rejection.

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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