{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:25:57Z","timestamp":1783463157443,"version":"3.55.0"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aim was to enhance access to autologous stem cell transplant (ASCT) for high\u2010risk neuroblastoma in a public hospital in a lower\u2010middle\u2010income country, while ensuring safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from a single center were analyzed in this ambispective, observational study spanning 12\u00a0years (2012\u20132023). The adaptations included performing ASCT in isolation rooms within the general ward, storing stem cells at 2\u00b0C\u20136\u00b0C without cryopreservation for 7\u00a0days, utilizing plerixafor for stem cell mobilization, no central lines, minimizing venipunctures for sampling, no antibacterial\/antifungal\/antiviral prophylaxis, administering pegylated\u2010G\u2010CSF on Day +4, avoiding platelet transfusion for asymptomatic thrombocytopenia, prednisolone for preventing engraftment syndrome, and early discharge upon rising white cell count and monocytosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010three patients were treated on the backbone of the high\u2010risk neuroblastoma study\u20101 of SIOP\u2010Europe (SIOPEN). The median age was 38\u00a0months. Sixty\u2010six (90.4%) patients had Stage 4 disease. A regimen of busulfan+melphalan was administered to 62 (84.9%) patients. Median CD34 cell count and stem cell viability were 5.2 \u00d7 10\n                      <jats:sup>6<\/jats:sup>\n                      \/kg and 91.5%. The median hospital stay was 20\u00a0days. At discharge, the median absolute neutrophil and platelet counts were 0.60 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L and 19 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L. After 2017, there was a reduction in the number of aphereses (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), blood transfusions (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), amphotericin (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.012), and venipunctures (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.045). Forty (54.8%) patients died; relapse: 33 (82.5%); progressive disease: five (12.5%); and treatment\u2010related mortality: two (5%). There was no case of engraftment failure. The median follow\u2010up for surviving patients was 55.3\u00a0months. Five\u2010year overall survival (OS) and event\u2010free survival (EFS) were 34.6% \u00b1 6.6% and 27% \u00b1 5.8%. Survival was comparable to our historical cohort of 28 patients treated without ASCT (4\u2010year EFS: 29.3%; 4\u2010year OS: 29.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our cohort, the incorporation of ASCT into multimodality therapy was feasible with resource\u2010adapted strategies; however, this did not translate into a meaningful improvement in survival outcomes when compared with our historical non\u2010transplant cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70388","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T07:42:46Z","timestamp":1778571766000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simple Interventions Can Improve Access to Autologous Stem Cell Transplant in Low\u2010 and Lower\u2010Middle\u2010Income Countries by Reducing Complexity, Lowering Costs, and Minimizing Infectious Risks"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-7649","authenticated-orcid":false,"given":"Deepak","family":"Bansal","sequence":"first","affiliation":[{"name":"Pediatric Hematology\u2010Oncology Unit Department of Pediatrics, Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Chandel","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\u2010Oncology Unit Department of Pediatrics, Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rekha","family":"Hans","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Postgraduate Institute of Medical 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