IntroductionHematopoietic stem cell transplant (HSCT) is an important treatment modality for patients with both benign and malignant hematological diseases [1].Tremendous advances have occurred in the field of stem cell transplant with the use of mismatched and haploidentical donors and improved supportive care to prevent graft versus host disease enabling more patients to undergo transplant safely. Patients undergoing stem cell transplant are at an increased risk of bacterial, viral and fungal infections [2]. Patients have severe neutropenia in the immediate peri-transplant period and are at highest risk of bacterial infections [3, 4]. Infection is the most common cause of morbidity and mortality in patients undergoing transplants [5,6]. There can be several reasons for high rates of infections in these patients [7]. Bacteremia occurs in as high as 20% of patients [8].Multiorgan dysfunction and mortality ensues in complicated cases. Some studies have reported that gram-positive cocci (GPC) blood stream infections (most commonly coagulase negative staphylococcus) occur more commonly than gram-negative bacilli (GNB) infections. However, gram-negative infections contributed to as high as 45% mortality in these patients [9].Measures to decrease the incidence of infections like isolation, HEPA filter fitted rooms [10] and gut decontamination have been used in transplant patients. Antibiotic prophylaxis with fluoroquinolone has been recommended by the IDSA and ASCO for patients who are expected to have a profound (< 100 neutrophils/uL) and prolonged neutropenia (> 7 days) [11]. In a recent meta-analysis antibiotic prophylaxis significantly reduced the all-cause mortality in neutropenic patients [8]. However, it has been shown to alter the gut microbiome increasing chance of clostridium difficile infections [12]. There are concerns regarding subsequent emergence of fluroquinolone resistance increasing need for therapy with carbapenem antibiotics. Many authors have argued against using prophylactic antibiotics and advocate well-structured sepsis care bundles that focuses on timely identification and treatment of neutropenic sepsis [13]. There is also a concern around rising carbapenem resistant enterobacteracae (CRE) around the world [14]. In this study we evaluate the role of antibiotic prophylaxis in patients undergoing stem cell transplant at our center.

Daratumumab induced Minimal Residual Disease Negative Remission in CD 38 (dim) Positive Pediatric Acute Myeloid LeukemiaPronamee Borah1, Dinah Ng1, Nitin Dayal2, Sangeeta Pathak3, Rahul Naithani11Hematology and Bone Marrow Transplant Division, Max Superspecialty Hospital, Delhi, India2Department of Lab Medicine, Max Superspecialty Hospital, Delhi, India3Department of Transfusion medicine, Max Superspecialty Hospital, Delhi, IndiaConflicts of interest: None to declare.No financial support was obtained in this study.Text word count 815Brief running title: Daratumumab in Pediatric AMLKey Words: Daratumumab, AML, ChildrenTables: 0; Figures: 0

Rahul Naithani, MD, DM1; Nitin Dayal, MD21Division of Hematology & Bone Marrow Transplantation, 2Lab MedicineMax Superspeciality Hospital, DelhiWord Count: 182Figure: 1Dr Rahul Naithani declares that he has no conflict of interest. Dr Nitin Dayal declares that he has no conflict of interest.

Children with congenital neutropenia frequently require hospitalization due to febrile neutropenia. Deficiency of Adenosine DeAminase -2(DADA-2) an autosomal recessive disorder caused by a mutation in CECR1 gene. It is an autoinflammatory disease presenting with autoimmunity and features of immunodeficiency. It usually presents in early childhood with recurrent stroke and vasculitis features. Here, we report a young male with CECR1 mutation presenting predominantly with neutropenia.

Early T cell precursor acute lymphoblastic leukemia is a relatively new, high risk subgroup of acute lymphoblastic leukemia characterized by unique immune-phenotype and disease biology. ETP ALL cells share similarities with hematopoietic stem cells and myeloid progenitor cells. These patients have lower rates of complete remission overall survival. Venetoclax is an orally bioavailable BCL 2 inhibitor. We report the treatment outcomes of 2 patients with ETP ALL who achieved MRD negative remission with short course of venetoclax.