Autologous hematopoietic stem cell transplantation(AHSCT) is an increasingly used curative treatment for some solid tumors in children. Instead of allogeneic transplantation, the risk of developing graft versus host disease (GvHD) is much lower after AHSCT. Although the clinical findings of auto-GVHD are mild and self-limited in most cases, rare cases may be severe and need intensive immunosuppressive treatment. Here, we present a case who underwent autologous HSCT due to relapsed neuroblastoma, developed steroid-refractory GvHD after AHSCT, and achieved remission using ruxolitinib. A 12 years old female patient was diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine treatment, AHSCT was performed, and the status of the disease was a very good partial response at the time of transplantation. Our patient was diagnosed with severe and steroid-refractory GvHD with skin involvement after AHSCT. We used ruxolitinib with extracorporeal photopheresis because of the essential side effects of the other drugs and got a very good response. Over the following five months, there was no recurrence of GvHD. She was in complete remission of neuroblastoma after two years of AHSCT. It is crucial to keep in mind that GvHD may develop after AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT.

Wilms’ tumor is one of the most common childhood solid malignancies, which accounts for almost 95% of renal malignancies in pediatrics, and classically arises from primitive metanephric cells. Exceptionally it may occur at places other than kidneys. The estimated rate of nephroblastoma outside the kidneys is almost 0.5 to 1% of Wilms’ tumor cases. Extrarenal Wilms’ tumor occurs mostly in childhood. In this article, we report a 3-year-old girl who first presented with spinal dysraphism and a mass in the lumbar spinal cord with a histopathological diagnosis of nephrogenic rest, and after one year, a Wilms tumor arose in this location. When extrarenal wilms tumor located in the spine is unlikely to be suspected preoperatively because it is embryologically less intuitive. Thus, we report this case of a congenital Wilms tumor associated with spinal dysraphism to increase awareness and describe this malignant tumor’s clinical outcome.

Abstract: Immune thrombocytopenic purpura (ITP) is an autoimmune disease presents with isolated thrombocytopenia (thrombocyte count < 100.000/mm3) and develops due to increased thrombocyte destruction by autoantibodies. ITP is the most common cause of pediatric thrombocytopenia. Usually a self-limiting disease with an acute course of 70% - 80%. However, 20% - 25% cases are chronical. These cases are follow-up and management difficult and expensive. It is important to distinguish events that may become chronic at the time of initial diagnosis. In this study, we sought clues to be able to choose, which the patient will be chronicle?