Novel human astrovirus (HAstV) strains have been recently shown to cause fatal encephalitis in immunocompromised patients. We report two cases from our institution. A 2-year old female undergoing treatment for acute lymphoblastic leukemia and a 9-year old male with refractory acute myeloid leukemia. Both were found to have HAstV-VA1 in the cerebrospinal fluid (CSF) by metagenomics next generation sequencing (m-NGS) after the initial evaluation did not reveal any etiology. Patient 1 remains alive, in remission, showing gradual neurological improvement after treatment with steroids, intravenous immunoglobulin, ribavirin, nitazoxanide and Peg-INF-alpha 2b. Patient 2 died 7 weeks later while receiving palliative care.

Calcineurin inhibitors (CNI), cyclosporine and tacrolimus, are commonly used for pharmacotherapeutic prophylaxis of Graft-vs.-Host disease after hematopoietic cell transplantation (HCT). Unfortunately, their use is associated with significant toxicities. While intolerance to CNI is well defined, there is very little data on how they impact outcomes after HCT in children. Our retrospective study in a cohort of 82 children, shows a high intolerance rate of 39% in this population associated with lower event free survival and a higher transplant-related mortality.