Post-Transplant Education Group Increases Patient Knowledge and Confidence.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3325-3325
Author(s):  
Jane Dabney ◽  
Laura Bernhard ◽  
Kelly Cherni ◽  
Jennifer Kosar ◽  
Mary Serafin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cleveland Clinic ◽  
Marrow Transplant ◽  
Post Discharge ◽  
Face To Face ◽  
Post Transplant ◽  
Education Group ◽  
Nurse Coordinator ◽  
Number Of Patients ◽  
The Face

Abstract Purpose: An overwhelming amount of information is given to patients/caregivers undergoing Bone Marrow Transplantation at all phases of the treatment. It is difficult for many to comprehend the information and retain it. We observed that patients, while eager to be discharged home, often become apprehensive about leaving the 24 hour care given in the hospital. Based on the experience of other BMT centers, we developed a post-transplant education group for the 17 bed inpatient unit, to increase patient and family/caregiver knowledge of care and precautions that are required post-discharge as well as coping with life after transplant. Methods: The Cleveland Clinic BMT team recently designed a Bone Marrow Transplant Education Binder specific to our BMT program. Although this is used to supplement the face to face contact with the patient/caregiver, the information can still be overwhelming. The post-transplant group was designed to increase knowledge and confidence while reinforcing the information in the education binder. The information presented was designed by nursing and social work. The initial group session took place in May 2005 and has been repeated monthly since. The post-transplant information was initially presented by an outpatient BMT nurse coordinator and a BMT social worker. After 7 months the program was improved by having an inpatient BMT nurse also assist in presenting the information. All participants sign an attendance form indicating if they are the patient, family member or caregiver. The group covers topics such as coping with life after transplant, preventing infections, resuming physical and sexual activity, nutrition guidelines and graft vs. host disease. At the conclusion of the group, participants evaluate the session. The evaluation includes overall rating of the session, whether information was helpful, if participants feel better prepared for discharge, and suggestions to improve the program. Results: The post-transplant education session has been well attended by patients/caregivers with an average monthly attendance of 10 (range 6–15). The number of patients versus family members or caregivers was nearly equal. The evaluations have shown that patients/caregivers feel they are better prepared for discharge and have increased knowledge of what is required after transplant. A total of 138 evaluations were completed and 99.3% of the participants rated the session as good or excellent. Suggestions offered to improve the session included providing more detailed information about nutrition after transplant and inclusion of the dietician in the sessions. Conclusion/Recommendations: The post-transplant education group has enhanced the education of our patients/caregivers, increased their confidence and knowledge, and has become a helpful tool in new team member orientation. The recommendation of patients and caregivers to include a dietician will be implemented to improve the nutrition information provided. The benefits of this group may encourage other centers to implement similar programs. Based on the success of our post-transplant education group the possibility of a pre-transplant education group will be explored.

Utility of WT1 as a Reliable Tool for the Detection of Minimal Residual Disease in Children with Leukemia

2002 ◽  
Vol 5 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Morris Kletzel ◽  
Marie Olzewski ◽  
Wei Huang ◽  
Pauline M. Chou
Keyword(s):  
Bone Marrow ◽  
Minimal Residual Disease ◽  
Bone Marrow Transplant ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Blast Crisis ◽  
Marrow Transplant ◽  
Post Transplant ◽  
High Level ◽  
Minimal Residual

WT1 encodes a transcription factor involved in the pathogenesis of Wilms' tumor. A high level of expression has been reported in blasts from patients with various hematological malignancies. The study was performed to evaluate the utility of monitoring WT1 expression in children with leukemia at diagnosis, during therapy, and following bone marrow transplant. We tested a total of 204 samples prospectively. These included samples from patients with the following diagnoses: acute lymphoblastic leukemia (ALL) at diagnosis ( n = 45), at relapse ( n = 14), and in remission ( n = 45); acute non-lymphoblastic leukemia (ANLL) at diagnosis ( n = 14), at relapse ( n = 5), and in remission ( n = 12); and chronic myelogenous leukemia (CML) in blast crisis ( n = 1) and in chronic phase ( n = 1). A total of 33 of these patients were transplanted: 19 ALL, 12 ANLL, and 2 CML. In addition, samples from 5 patients with aplastic anemia and 28 controls were obtained from peripheral blood ( n = 17), cord blood ( n = 3), and bone marrow ( n = 8). Primer pairs were designed to locate specific nucleotide sequences for mRNA of WT1. RT-PCR was performed in all samples and compared with K562 cells from ATCC (defined as 1.0) as positive control. A positive test was arbitrarily defined as WT1/K562 > 0.5. Samples at diagnosis and relapse, including 56 out of 59 ALL (95%), 26 ANLL (100%), and 1 CML in blast crisis, demonstrated high levels of WT1 expression. In contrast, only 5 of 90 samples obtained in remission or post-transplant showed high levels of WT1 expression ( P < 0.0001; 95% CI = 0.66–0.94). The five patients with high WT1 expression during follow-up relapsed within 2 to 6 months. In conclusion, we have found that WT1 is consistently elevated in children with leukemia. Significant differences in the level of WT1 expression were noted between these patients during diagnosis and at relapse, and those during remission. More importantly, following bone marrow transplant, a significant high level of WT1 expression preceded clinical relapse by 2 to 6 months. Therefore, WT1 is a reliable marker for monitoring minimal residual disease during therapy as well as in the post-transplant period.

scholarly journals Graves’ Disease After Hematopoietic Allogeneic Bone Marrow Transplant in a Patient With Sickle Cell Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A930-A931
Author(s):  
Majid Alameri
Keyword(s):  
Bone Marrow ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Marrow Transplant ◽  
Graves Disease ◽  
Allogeneic Bone ◽  
Cell Disease ◽  
Free T4 ◽  
Post Transplant

Abstract Endocrinopathies are among the most recognized late complications post hematopoietic stem cell transplant (HSCT). Dysfunctions of hormonal axes including the hypothalamus, pituitary, gonads, thyroid and adrenals reported. Moreover, thyroid dysfunctions including thyroiditis, hypothyroidism and hyperthyroidism has been reported to develop 8-32 months after HSCT. We report a 27-year-old male with sickle cell disease diagnosed at age of 5. He had multiple painful vasoocclusive sickle crises treated with blood transfusions, folic acid and rituximab. At age of 21, he presented with sudden right sided weakness and slurred speech. Further investigations, including magnetic resonance imaging of brain revealed occlusion of the left middle cerebral artery resulting in ischemic infarction. Subsequently, he had multiple red blood cell exchange transfusions on regular basis. He remained with residual weakness and slurred speech after rehabilitation. Bone marrow transplant was recommended as a curative treatment for his sickle cell disease by haematology team. A year later, he underwent a geno-identical allogeneic bone marrow transplantation harvested from his brother. He remained well for 22 months post-transplant without any evidence of graft versus host disease. 23 months post-transplant, he presented with loose motions, 2 kg wight loss and fine tremors. He was referred to endocrine department for further workup. Physical examination revealed a small smooth goitre. He had discrete exophthalmos of his left eye without any signs of active inflammation. Thyroid function tests confirmed diagnosis of Graves’ disease with TSH&lt;0.01 milli IU/L, Free T4=23.9 pmol/L, and TSH receptor antibodies of 3.79 IU/ml. Ophthalmological consultation suggested 6 months of selenium supplementation (200 mcg/day) with regular follow up. There has been no family history of autoimmune diseases or thyroid disorders. He started carbimazole (CMZ) 30 mg daily. His symptoms improved within 8 weeks, with normalization of Free T4 and Free T3 (TSH remained suppressed). 18 months later, he remained asymptomatic on carbimazole. He had recurrence of hyperthyroidism symptoms after 4 weeks trail of stopping carbimazole with elevation of Free T4 and Free T3. Carbimazole was restarted and he has been offered other treatment modalities of Graves’ disease. He elected to undergo total thyroidectomy. His sickle cell and blood counts remained stable during follow up period. Conclusion: Transplanted patients carries a life-long risk for developing endocrinopathies post initial transplant therapy. Acknowledging the wide spectrum of post-transplant endocrinopathies, an individualized case based periodic screening can be helpful to improve health outcomes of such patients. Because of the usual late presentation of such endocrine complications, transplanted patients might need life-long endocrine follow-up.

scholarly journals Extracellular Microvesicle Cytokines Secreted from Bone Marrow Mesenchymal Cells Mediate Proliferative and Survival Advantage in Acute Myeloid Leukaemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2744-2744
Author(s):  
Michelle Lazenby ◽  
Oliver G. Ottmann ◽  
Keith Wilson ◽  
Caroline Alvares ◽  
Joanna Zabkiewicz
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Research Funding ◽  
Significant Proportion ◽  
Haematopoietic Stem Cell ◽  
Allogeneic Bone ◽  
Term Survival ◽  
Post Transplant ◽  
Proliferative Effect ◽  
Number Of Patients

Abstract Background Haematopoietic stem cell transplantation is still the most effective anti-leukaemic therapy for AML treatment for a large number of patients, but a significant proportion of these will relapse post-transplant and the probability of long term survival is low. The bone marrow microenvironment has been implicated as a major contributor to chemotherapy resistance and relapse through mediating interactions between residual haematopoietic stem cells (HSC), leukaemic stem cells (LSC) and mesenchymal stem cells (MSC) which have been shown to support and maintain the leukaemic niche. Interactions within this malignant niche can be facilitated by exosomes, microvesicles secreted by multiple cell types that function as delivery vehicles of cargo consisting of mRNA, DNA, miRNA, enzymes and cytokines. Exosomes have become the focus of much interest in recent years as there is increasing evidence that they are involved in cancer progression and resistance to therapy, however the role of secreted exosomes in mediating cell communication in the post-transplant microenvironment is relatively unknown. Results Stromal MSC cultures were derived from diagnostic, post-allogeneic bone marrow transplant (BMT) AML patients (AML-MSC, n=20) and normal bone marrow donors (NBM-MSC, n=5). MSC supernatants were collected from monolayers at passage 3 and exosome preparations were extracted and quantified using NanoSight analysis and western blotting for CD81 and CD63 exosome membrane proteins. Results show that exosome particle number and protein content was significantly increased in diagnostic AML-MSCs samples compared to normal and post-BMT samples (p=0.0028). miRNA yield was also found to be significantly higher in diagnostic samples compared to normal and post-BMT marrow MSC production (p=0.0017). Ex vivo co-culture assays using sucrose cushion derived functional exosome preparations from primary AML-MSCs revealed an exosome induced proliferative effect when cultured with primary AML blasts (p<0.05) and a significant protection against TKI treated co-cultures (n=7, p<0.001) confirming the pro-leukaemic effects of AML-MSC derived exosomes, these effects were absent in NBM-MSC derived exosome preparations. Within stromal co-cultures the addition of exosomes exerted a significantly increased proliferative effect compared to stroma alone demonstrating the additional support exosomes provide (p=0.0079) Secreted cytokine profiling was undertaken using a Luminex bead capture array panel of more than 100 secreted targets in paired AML-MSC exosome and total supernatants. AML-MSC exosome profiles were compared to NBM-MSC fractions and contained significantly higher levels of several inflammatory/angiogenic chemokines including MMP-1 (p=0.0286), CXCL2 (p= 0.0497) and CXCL8 IL-8 (p=0.0284) all of which have been previously associated with poor prognosis in AML. This observation was also reflected in the total supernatant cytokine profile. Within the exosomal fractions the following targets showed increased levels compared to their corresponding supernatant; MMP-3 involved in chemokine signalling, IL-1ra and TRAIL both involved in immunological response and implicated in AML blast proliferation. Profiles of the post-BMT exosomal fraction followed the signature of diagnostic-MSC fractions, indicating the persistence of a diseased phenotype. These results demonstrate significant differences in the exosome production and content of AML-MSC compared to NBM-MSC and whilst both NBM and AML derived MSC exosomes are capable of protecting against drug resistance in co-culture, AML-MSC exosomes produce a considerably stronger proliferative drive and this in part may be mediated through a leukaemic specific MMP/pro-angiogenic signalling axis which has the potential to remodel the surrounding microenvironment. Targeting these pathways warrants further investigation to determine whether suppression of the leukaemic microenvironment may influence transplant outcome for these patients. Disclosures Ottmann: Amgen: Consultancy; Celgene: Consultancy, Research Funding; Fusion Pharma: Consultancy, Research Funding; Pfizer: Consultancy; Incyte: Consultancy, Research Funding; Takeda: Consultancy; Novartis: Consultancy.

scholarly journals Assessment of Iron Overload in the Pediatric Allogeneic HSCT Recipient

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5735-5735
Author(s):  
Brittany Paige DePriest ◽  
Mikey Huang
Keyword(s):  
Bone Marrow ◽  
Iron Overload ◽  
Iron Concentration ◽  
Marrow Transplant ◽  
Moderate Correlation ◽  
Liver Iron Concentration ◽  
Liver Iron ◽  
Post Transplant ◽  
Transplant Patients ◽  
T2 Mri

Abstract Background: Owing to improved strategies in pediatric bone marrow transplantation, a larger number of transplanted children are now becoming long term survivors. These post-transplant patients remain at risk for late complications including iron overload, which has the potential to impair quality of life and adversely affect later outcomes. While literature has previously focused on iron overload in the adult sickle cell patient, there has been minimal research into its effect on the pediatric bone marrow transplant recipient. Thus, no current guidelines exist for screening, management or treatment of iron overload in this patient population. Our study focuses specifically on this population and reports the relationship between number of PRBC transfusions and current diagnostic tools. Objectives: To identify the presence or absence of correlation between the number of red blood cell transfusions and indicators of iron overload via two different modalities: ferritin values and the T2* MRI liver iron concentration (Ferriscan). Methods: A retrospective chart review of the allogeneic pediatric bone marrow transplant patients over the past 5 years at a single center (n = 32). Quantitative data obtained which included number of PRBC transfusions, ferritin, and T2* MRI LIC. Correlation analysis subsequently performed between pre-and post-transplant values. Results: There was significant (p < 0.001) moderate correlation (r = 0.62) between the number of pre-transplant PRBC transfusions and the pre-transplant ferritin value. No significant (p >0.1) correlation between the number of pre-transplant PRBC transfusions and the pre-transplant T2* LIC. Also, no significant (p > 0.1) correlation between pre-transplant ferritin and T2* LIC. The total number of PRBC transfusions up to 100 days post-transplant did have significant (p = 0.008) moderate correlation (r= 0.62) with post-transplant ferritin values. There was significant (p = 0.01) strong correlation (r= 0.87) between the total number of PRBC transfusions up to 100 days post-transplant with post-transplant T2*LIC values. No significant correlation (p > 0.1) between post-transplant ferritin and T2* MRI LIC values. Conclusions: In terms of modalities utilized for evaluation of iron overload in the pediatric allogeneic BMT population, no significant correlation exists between ferritin values and T2* MRI liver iron concentration values. While ferritin is an acceptable screening tool the post-transplant T2*MRI LIC is a more accurate diagnostic indicator of transfusion burden. Future studies will be used to explore associated adverse outcomes of patients diagnosed with iron overload. Disclosures No relevant conflicts of interest to declare.

scholarly journals Identification of an anti-A and anti-B blood group glycosyltransferase antibody after incompatible bone marrow transplant

Blood ◽  
1989 ◽  
Vol 74 (3) ◽  
pp. 1134-1138
Author(s):  
M Mojena ◽  
L Bosca
Keyword(s):  
Bone Marrow ◽  
Blood Group ◽  
Polyacrylamide Gel Electrophoresis ◽  
Protein A ◽  
Sodium Dodecyl ◽  
Marrow Transplant ◽  
Post Transplant ◽  
Sds Page ◽  
Electrophoretic Transfer ◽  
B Blood Group

The occurrence of a potent antibody against plasmatic A and B glycosyltransferase activities has been characterized in a patient (blood group A1) transplanted with a bone marrow from a blood group O donor. A and B glycosyltransferases were purified to near homogeneity from plasma of A1 and B blood-group individuals. The half-maximal inhibition of both enzymes was obtained at 1 to 2 micrograms/mL of the post-transplant IgG fraction, prepared by protein A-sepharose chromatography. A and B glycosyltransferases were also recognized by the post-transplant IgG fraction after sodium dodecyl sulfate- polyacrylamide gel electrophoresis (SDS-PAGE) followed by electrophoretic transfer to nitrocellulose membranes.

Trafficking and Expansion of NK Cells in Murine Models of Bone Marrow Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2389-2389
Author(s):  
Janelle A. Olson ◽  
Robert Negrin
Keyword(s):  
Bone Marrow ◽  
Nk Cells ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Nk Cell ◽  
Marrow Transplant ◽  
Cell Trafficking ◽  
Post Transplant ◽  
Bioluminescent Signal

Abstract Allogeneic hematopoietic cell transplantation has proven to be an effective treatment for hematologic malignancies and some solid tumors. However, the high incidence of graft versus host disease (GVHD) as a complication of this treatment has limited the overall effectiveness of HCT. In addition, disease relapse also limits overall success. Novel strategies are needed which can suppress the development of GVHD but still maintain an effective immune response to provide a GVT effect. It has been shown that NK cells have the capability of suppressing the development of GVHD while inducing an anti-tumor response. The trafficking of cells to specific organs and tissue sites after transplant can be a major factor in determining whether or not they contribute to GVT and GVHD reactions. Little is known about the trafficking patterns of NK cells following hematopoietic cell transplantation, their proliferation or how long they persist in vivo. We investigated the trafficking patterns of NK cells in vivo in an allogeneic and syngeneic bone marrow transplant setting using a novel in vivo bioluminescence imaging (BLI) technique. Freshly isolated NK cells from FVB L2G85 transgenic mice, which constitutively express the luciferase gene and can be imaged by BLI, were transplanted along with T-cell depleted bone marrow into lethally irradiated BALB/c (allogeneic) or FVB (syngeneic) mice. BLI of the irradiated mice on successive days post-transplant indicated that in the allogeneic setting, NK cells traffic to distinct lymphoid organs, such as the cervical lymph nodes and spleen. The bioluminescent signal was 2.75-fold greater on Day 6 post-transplant than on Day 2 post-transplant, indicating a significant in vivo expansion of the NK cells in an allogeneic recipient in the first week post-transplant. In the syngeneic setting, NK cell trafficking to distinct lymphoid organs was not observed, and the bioluminescent signal intensity emitted from the transplanted mice remained constant. Thus, we anticipate that the in vivo expansion of NK cells seen in the allogeneic bone marrow transplant setting is not due to homeostatic proliferation alone. Continuing studies will address whether the in vivo expansion is driven by NK cell receptor-ligand interactions or MHC Class I differences. Understanding NK cell trafficking and proliferation could provide novel insights into enhancing function of both innate and adoptively transferred NK cells.

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