Blood transfusions at end of life for stem cell transplant patients.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 115-115
Author(s):  
Winnie S Wang ◽  
Joseph D. Ma ◽  
Sandahl H Nelson ◽  
Carolyn Revta ◽  
Gary T Buckholz ◽  
...  
Keyword(s):  
Stem Cell ◽  
Blood Transfusion ◽  
End Of Life ◽  
Stem Cell Transplant ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Objective ◽  
Cell Transplant ◽  
Hospice Patients ◽  
The Mean

115 Background: Transfusions are an essential palliative tool in the stem cell transplant (SCT) population. Limited data exist regarding transfusion practices at end-of-life for SCT patients and whether these practices may limit enrollment in hospice. Methods: A retrospective chart review was conducted of deceased patients with hematologic malignancies who underwent SCT at an academic medical center from 2011 to 2015. The primary objective was to determine the difference between the dates of last transfusion and death in patients enrolled and not enrolled in hospice. A secondary objective was evaluation of the number of transfusions between groups. Data were compiled from a single electronic medical record. Descriptive analyses were performed. Days to last transfusion were analyzed using the Wilcoxon-Mann-Whitney test. Number of packed red blood cell (PRBC) transfusions and platelets transfusions on the last day were analyzed using Fisher and chi-squared tests, respectively. Results: A total of 633 SCT were performed from 2011 to 2015 including 39% (n = 245) allogeneic and 61% (n = 388) autologous transplants (n = 29 patients had 2 transplants). Mean ± SD age of SCT patients was 55 ± 13 years. As of January 2016, 20% (n = 119) of these SCT patients have died. Of those that died, 15% (n = 18) were enrolled in hospice. For SCT patients enrolled in hospice, the mean ± SD time of last blood transfusion from death was 42.3 ± 63.4 days, with mean ± SD 0.67 ± 0.77 units of PRBC’s and 0.72 ± 0.75 units of platelets administered. For SCT patients not enrolled in hospice, the mean ± SD time of last blood transfusion from death was 14.2 ± 47.9 days, with mean±SD total 0.69 ± 1.03 units of PRBC’s and 1.14 ± 1 units of platelets administered. Hospice patients had a statistically significant longer number of days until last blood transfusion compared to non-hospice patients (p < 0.001). There was no difference between SCT patients enrolled in hospice and not enrolled in PRBC transfusions (p = 0.069), but there was a significantly higher amount of platelet transfusions in patients not enrolled in hospice (p < 0.005). Conclusions: This data suggests that time to last transfusion may be a significant obstacle for SCT patients when enrolling in hospice, but requires further validation.

scholarly journals End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center

2018 ◽  
Vol 54 (5) ◽  
pp. 700-706 ◽  
Author(s):  
Richard J. Lin ◽  
Theresa A. Elko ◽  
Miguel-Angel Perales ◽  
Koshy Alexander ◽  
Ann A. Jakubowski ◽  
...  
Keyword(s):  
Stem Cell ◽  
End Of Life ◽  
End Of Life Care ◽  
Stem Cell Transplant ◽  
Cancer Center ◽  
Cell Transplant ◽  
Life Care ◽  
Allogeneic Stem Cell Transplant

Efficacy of a conversion from filgrastim to filgrastim-sndz in stem cell transplant patients undergoing mobilization

2020 ◽  
pp. 107815522094158
Author(s):  
Lauren D Curry ◽  
Brandi Anders ◽  
Emily V Dressler ◽  
LeAnne Kennedy
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Medical Center ◽  
Hematopoietic Cells ◽  
The United States ◽  
Similar Efficacy ◽  
Median Number ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Biosimilar Product

During autologous stem cell transplant, granulocyte colony-stimulating factors (G-CSF) serve the integral role of mobilizing hematopoietic cells into the peripheral blood for subsequent collection by leukapheresis. Filgrastim (Neupogen®) is a G-CSF and affects hematopoietic cells by stimulating growth and differentiation of neutrophils. Filgrastim-sndz (Zarxio®), a biosimilar of filgrastim, received landmark approval as the first biosimilar product approved by the FDA in the United States. As a result of the recent FDA approval, our medical center made the conversion in August 2016 from using filgrastim to filgrastim-sndz to provide patients the same benefits of the filgrastim injection at a reduced cost. This retrospective, observational cohort study evaluated the comparative efficacy of the filgrastim-sndz biosimilar in 147 patients who underwent mobilization prior to stem cell transplant with filgrastim between 1 August 2015 and 31 July 2016 or filgrastim-sndz between 1 September 2016 and 30 November 2017. The mean number of CD34 cells collected during apheresis was 7.38 × 106 in the filgrastim group and 8.86 × 106 in the filgrastim-sndz group. Filgrastim-sndz was significantly non-inferior, as the difference between filgrastim and filgrastim-sndz was −1.48 × 106 with an upper 95% confidence bound equal to −0.24 × 106 that did not include the non-inferiority margin of 1 × 106 ( p = 0.0006). The median number of days of apheresis was 2 in both groups ( p= 0.3273). In conclusion, the biosimilar product was non-inferior for mobilization and the conversion from filgrastim to filgrastim-sndz afforded patients similar efficacy for mobilization in stem cell transplant at a reduced cost.

Allogenic stem cell transplant in patients over the age of 70, including octogenarians, with hematologic malignancies: A single institution experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18538-e18538
Author(s):  
Robert E. Gaudet ◽  
Jan Cerny ◽  
Muthalagu Ramanathan ◽  
Glen Raffel ◽  
Zheng Zhou ◽  
...  
Keyword(s):  
Stem Cell ◽  
Treatment Modality ◽  
Stem Cell Transplant ◽  
Medical Center ◽  
Hematologic Malignancies ◽  
Cell Transplant ◽  
Single Institution ◽  
Allogenic Stem Cell Transplant ◽  
Unrelated Donors ◽  
Grade Ii

e18538 Background: Patient age is an important factor when considering allogenic stem cell transplant (aSCT) as a treatment modality for hematologic malignancies. Previous series exploring older age and outcome in aSCT have generally not included fit, older adults beyond the age of 80: a group typically considered ineligible for aSCT. This report describes our single-institution experience with aSCT in patients age 70 and older, including octogenarians, from March 2010 through April 2016. Methods: Retrospective analysis was performed on all patients older than 70 years undergoing aSCT at UMass Memorial Medical Center (UMMMC) between March 2010 and April 2016. The study was approved by the UMMMC IRB. Results: 32 patients were identified: 19 men and 13 women. 1 patient underwent a second aSCT in the study period. Median age at time of aSCT was 73 years (range 70-83). 4 patients were age >80. Diseases treated were AML (19 pts.), MDS (12 pts.), and CLL (1 pt.). 24 transplants were performed with unrelated donors: 17 with 10/10 match, 3 with 11/12 match, 3 with 10/12 match, and 1 with 9/12 match. 9 were performed with umbilical cord blood units. Grade II-IV acute GVHD developed in 9 patients (27%). Day 100 survival by age following the transplant were 11/18 (61%) for patients aged 70-75, 6/10 (60%) for patients aged 75-80 and 4/4 (100%) for patients aged 80-85. Conclusions: Allogenic Stem Cell Transplant is a viable treatment modality in highly-selected elderly patients with hematologic malignancies. Further studies are warranted in a prospective fashion. [Table: see text]

Ability of individual patient health parameters to predict malnutrition among elderly stem cell transplant patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21521-e21521
Author(s):  
Nizar Bhulani ◽  
Holly Michelle Holmes ◽  
Robert Morgan
Keyword(s):  
Weight Loss ◽  
Stem Cell ◽  
Cancer Patients ◽  
Stem Cell Transplant ◽  
Patient Characteristics ◽  
Cell Transplant ◽  
Transplant Patients ◽  
Patient Health ◽  
The Mean ◽  
Study Participants

e21521 Background: Increasing number of geriatric patients are now being considered as suitable candidates for allogeneic hematopoietic cell transplantation (HCT). Malnutrition being a common comorbidity in older cancer patients with no gold standard in malnutrition screening tools, it warrants for a better understanding of the health of geriatric cancer patients from a nutrition stand point. This study was pursued to evaluate individual patient parameters to predict malnutrition among elderly stem cell transplant patients. Methods: A retrospective cohort analysis was conducted on patients eligible for allogeneic HCT at the MD Anderson Cancer Center. Nutrition was assessed using the Mini Nutritional Assessment tool. Individual parameters to predict malnutrition included body mass index of less than 24 and weight loss of more than 3 kgs in the past 3 months. Statistical analysis was conducted using SPSS, version 23. Results: Mean age of the study participants was 65 years. Majority of the study population had the diagnosis of acute myelogenous leukemia (AML) at the time evaluation. The mean BMI of the study participants was 28.91 +- 4.77 while the mean MNA score was 24.95 +- 3.39. There was no association found between patient characteristics and history of weight loss or abnormal BMI. There was a significant association (p < 0.001) found between loss of more than 3 kg weight and an abnormal MNA score. There was no association found between any of the patient characteristics and abnormal BMI with abnormal MNA. The sensitivity of weight loss in comparison with MNA score was 62.5% and the specificity was 91%, thus, having a positive and negative predictive value of 77% and 84% respectively. Given that 86% of our patients were either overweight or obese at the time of evaluation, from those who were under weight, 100% had an abnormal MNA and 50% of normal weight patients had an abnormal MNA. Conclusions: The significant association between weight loss and poor MNA status shows that we are moving in the right direction to provide answers to nutrition status using individual patient health parameters.

scholarly journals Is There a Higher Incidence of Graft Failure or Delayed Time to Engraftment in Patients Undergoing Autologous Stem Cell Transplantation Who Receive Olanzapine for Anti-Emetic Prophylaxis?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4905-4905
Author(s):  
Hannah McNally ◽  
Luke Mountjoy ◽  
Alison Collings
Keyword(s):  
Stem Cell ◽  
Graft Failure ◽  
Stem Cell Transplant ◽  
Controlled Trial ◽  
Autologous Stem Cell Transplant ◽  
Nausea And Vomiting ◽  
Cell Transplant ◽  
Transplant Patients ◽  
The Mean ◽  
Delayed Time

Abstract Olanzapine has been shown to significantly decrease nausea and emetic episodes associated with chemotherapy in patients undergoing hematopoietic stem cell transplant (Monson, Greer, Kreikemeier, & Liewer, 2020). Additionally, Olanzapine has been shown to improve clinical outcomes in autologous stem cell transplant patients when added to triplet anti-emetic therapy of ondansetron, fosaprepitant and dexamethasone without any negative effects on time to engraftment (Clemmons, et al., 2018). Although this study did not show any delay in time to engraftment, there is only a small amount of data looking at this question, including Clemmons et al. (2016) and Trifilio et al. (2017). Other studies (Navari et al., 2016) demonstrated a decrease in chemotherapy related nausea and vomiting in patients receiving Olanzapine, but did not provide data on engraftment times as this was in standard chemotherapy recipients. At Colorado Blood Cancer Institute (CBCI), Olanzapine was used for a period of time for anti-emetic prophylaxis both pre and post autologous stem cell transplant. There was concern regarding whether or not Olanzapine was causing delays in time to engraftment or even potentially graft failure and use of the drug in transplant anti-emetic regimens was discontinued. We hypothesized that Olanzapine does not cause higher incidence of graft failure, as compared to patients who do not receive Olanzapine as part of their anti-emetic regimen during the pre and post autologous stem cell transplant period. A retrospective analysis (n = 272) was conducted on patients who underwent autologous stem cell transplant between 2019 and 2020. 134 of these patients received Olanzapine during conditioning and up until time of engraftment, and 138 patients had no Olanzapine exposure throughout their conditioning and transplant. Conditioning regimens were equal between the two groups (Table 1). The average number of days on Olanzapine was 10.7, and the average dose was 7.5mg daily. For the purposes of this study engraftment was defined as the first day post stem cell infusion that the patient had an absolute neutrophil count (ANC) of greater than or equal to 500. Findings showed that the mean day of engraftment in the patients with Olanzapine exposure was 14.69; in the non-Olanzapine group, the mean day of engraftment was 12.64 (Table 2). Using the two-sample t-test, this difference (2.05 days, 95% CI (1.60-2.51)) is significant (p&lt;.0001). Based on our findings, there is evidence to support Olanzapine causing a slightly delayed time to engraftment in autologous stem cell transplant patients, but not a higher incidence of graft failure, although a randomized controlled trial would be needed to fully investigate. There is clear data showing increased ability to manage chemo therapy induced nausea and vomiting. While a randomized controlled trial would be needed to fully investigate, given there is not a proven increase in graft failure, Olanzapine should be considered as a desirable option to treat and prevent chemotherapy induced nausea and vomiting in autologous stem cell transplant patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Olanzapine (Zyprexa) - Used off-label for the treatment and prevention of chemotherapy induced nausea and vomiting

The impact of initiating posaconazole on tacrolimus pharmacokinetics in allogeneic stem cell transplantation

2019 ◽  
Vol 26 (1) ◽  
pp. 5-12
Author(s):  
Jennifer Collins ◽  
Katherine Shea ◽  
Sandeep Parsad ◽  
Kelly Plach ◽  
Pauline Lee
Keyword(s):  
Stem Cell ◽  
Dose Reduction ◽  
Stem Cell Transplant ◽  
Academic Medical Center ◽  
Tacrolimus Concentration ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Transplant Patients ◽  
The Impact ◽  
Tacrolimus Pharmacokinetics

Background Posaconazole reduces the risk of invasive Aspergillus in transplant patients, but significantly inhibits tacrolimus metabolism. One study demonstrated that a three-fold dose reduction of tacrolimus was required to obtain therapeutic concentrations when used with posaconazole. However, with empiric dose reduction, there is a risk of subtherapeutic tacrolimus levels and subsequent graft failure or graft-versus-host disease. Overall, the existing data on the impact of posaconazole on tacrolimus pharmacokinetics is limited. Objective The purpose of this study is to determine whether tacrolimus doses should be decreased upon initiation of posaconazole in patients receiving an allogeneic stem cell transplant. Methods This is a retrospective chart review at an academic medical center. All allogeneic stem cell transplant adults who received concomitant posaconazole and tacrolimus from February 2016 through December 2017 were included. Results Seventy-nine patients identified using an internal electronic database were analyzed. The median time to therapeutic tacrolimus concentration was significantly longer in patients who did not receive an empiric dose reduction (0% DR, 10d; 1–30% DR, 4d; 31–65% DR, 5d; >65% DR, 4d; p = 0.0395). The rate of supratherapeutic levels was highest amongst patients who did not receive an empiric DR, and was noted to be significant compared to the group that had 31–65% DR ( p < 0.001). Conclusion This study validates our current practice of instituting an empiric 50% dose reduction of oral tacrolimus to 0.03 mg/kg/day when used concomitantly with posaconazole to achieve therapeutic levels in allogeneic stem cell transplant patients.

Characterizing advance care planning, palliative care utilization, and location of end-of-life for adult allogeneic hematopoietic stem cell transplant recipients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7034-7034
Author(s):  
Stephanie Hoffman ◽  
Pavan Reddy ◽  
John Martin Magenau ◽  
Attaphol Pawarode ◽  
Brian Parkin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Stem Cell ◽  
End Of Life ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Patient Characteristics ◽  
Cell Transplant ◽  
Care Planning ◽  
Hematopoietic Stem ◽  
Advance Care

7034 Background: The impacts of advance care planning (ACP) on end-of-life (EOL) outcomes in allogeneic hematopoietic stem cell transplant (allo HCT) recipients are not well known. ACP includes advance directive (AD) completion, and palliative care (PC) consultation. Using these two components, we aimed to explore the current state of ACP and its impact on EOL outcomes in allo HCT recipients to provide the groundwork for future prospective studies. Methods: We performed a retrospective study of deceased adult patients who underwent allo HCT between December 2015-December 2019. We summarized patient characteristics, the rate of AD completion, PC consultation, and location of end-of-life (EOL). Univariate and multivariate analyses were performed to evaluate patient characteristics that may be associated with AD completion, PC consultation and assess the impact of these two factors on location of EOL. Results: See Table for summary of patient characteristics. Of the 125 patients included, we found that 66% (n = 82) completed ADs. All patients with ADs completed them prior to undergoing transplant and never modified them. The majority of patients (84%) with an AD expressed the desire to avoid life-sustaining treatment in the event of terminal illness or irreversible coma. PC was consulted for 46% (n = 58) of patients within 6 months prior to time of death (TOD). Regarding location of EOL, 30% of all patients died in the hospital (non-ICU), 20% in the ICU, 38% at home with hospice, and 10% in a hospice facility. Patients with ADs appeared more likely to die outside of the hospital compared to those without (53% vs. 44%, p = 0.4506). By multivariate analysis, there were no significant patient characteristics associated with the presence of an AD or PC consultation. After adjusting for age and comorbidity index, we found that patients with an AD were significantly more likely to die outside of the ICU (OR 3.0, 95% CI 1.2-7.5, p = 0.02), an effect that was further amplified in patients who both had an AD and received PC consultation at any point (n = 30, p = 0.0077). Conclusions: Our findings highlight the importance of ACP for EOL outcomes in the allo HCT population. While the rate of AD completion in our study population is higher than that of prior studies, future prospective studies aimed to improve the rate of ACP are needed.[Table: see text]

Olanzapine as a rescue antiemetic in hematopoietic stem cell transplant

2019 ◽  
Vol 26 (4) ◽  
pp. 918-922
Author(s):  
Taylor Monson ◽  
Devon Greer ◽  
Emily Kreikemeier ◽  
Susanne Liewer
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Oral Intake ◽  
Primary Objective ◽  
Nausea And Vomiting ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Rescue Antiemetic

Background Chemotherapy-induced nausea and vomiting occurs in up to 80% of patients undergoing chemotherapy treatment and is associated with a deterioration in quality of life. Olanzapine is an atypical antipsychotic antagonist blocking a variety of neurotransmitters in the nausea and vomiting pathophysiology. Objectives The primary objective of this study is to determine whether olanzapine is associated with improved breakthrough nausea and vomiting in patients undergoing hematopoietic stem cell transplant. Secondary outcomes include number of documented emesis episodes, an evaluation of patient oral intake, and number of rescue antiemetic agents administered after olanzapine initiation. Methods This is a retrospective cohort review examining the effects of olanzapine for the treatment of breakthrough nausea and vomiting following hematopoietic stem cell transplant. Patients undergoing autologous or allogeneic hematopoietic stem cell transplant between January 2014 and October 2017 were included. Results A total of 150 patients were included in the study. Olanzapine use was associated with a complete response in 30% of patients for breakthrough chemotherapy-induced nausea and vomiting (p < 0.0001). An improvement in nausea (p < 0.0001) and vomiting (p = 0.02) was also observed in patients. Olanzapine administration was associated with lower as needed antiemetic usage (p < 0.0001) as well as fewer emesis episodes (p < 0.0001) but had no effect on oral intake (p = 0.13). Conclusions Olanzapine was associated with significant improvements in breakthrough nausea and vomiting control while reducing the number of emesis episodes and required antiemetic doses in the hematopoietic stem cell transplant population. Olanzapine may be beneficial in optimizing antiemetic regimens for breakthrough chemotherapy-induced nausea and vomiting control in patients undergoing hematopoietic stem cell transplant.

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