„Ми з Вами” (We Stand with You) – saving child war refugees from Ukraine by haematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy in Poland

Introduction
The devastation of hospitals and the severing of international links has made paediatric haematopoietic stem cell transplantation (HSCT) in Ukraine impossible. The aim of our study was to present the activity of Polish paediatric bone marrow transplant units in saving the lives of child war refugees.

Material and methods
The data collected from 6 units on the treatment of child war refugees from Ukraine with HSCT were analysed.

Results
From 24 February 2022 up to the end of 2022, 18 children from Ukraine underwent HSCT and one received chimeric antigen receptor T-cell (CAR-T) therapy. This project was possible due to great organisational support from non-governmental organisations (NGOs), international cooperation (“SAFER Ukraine” enterprise), and financial coverage by the Polish national insurance system. Twelve patients were treated in Wrocław, 3 in Lublin, 2 in Bydgoszcz, one in Poznań, and one in Kraków. The group consisted of 10 boys and 9 girls, aged 1.3–17.9 years, 16 of whom suffered from haematological malignancy (acute lymphoblastic leukaemia n = 9, acute myeloblastic leukaemia n = 5, juvenile myelomonocytic leukaemia n = 2) and 3 from non-neoplastic disease (severe aplastic anaemia n = 2 and severe combined immunodeficiency syndrome n = 1). Despite poor preparation, numerous pre-existing comorbidities, a high rate of acute complications, and long hospital stays, the overall results were satisfactory. Only 2 patients (10%) died during the first 100 days after transplantation, both due to severe infection. The total number of allogeneic-HSCTs performed in Poland on Ukrainian children during wartime was not substantially lower than in previous years in their home country. Moreover, this specific war situation allowed the prescribing of CAR-T therapy to one of the first paediatric patients from this country.

Conclusions
Saving the lives of seriously ill child war refugees with the use of HSCT and CAR-T therapy is effective provided that all entities responsible for it cooperate in a coordinated manner and support the activities of NGOs.