scholarly journals Haplo-Identical Bone Marrow Transplant Protocol using Reduced Intensity Conditioning for Fundeni Clinical Institute

2015 ◽  
Vol 34 (1-2) ◽  
pp. 32-38
Author(s):  
Varady Zsofia ◽  
Coriu Daniel ◽  
Ghiaur Gabriel ◽  
Richard J. Jones
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Conditioning Regimen ◽  
Marrow Transplant ◽  
Disease Assessment ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Donor Pool ◽  
Factors Affecting ◽  
Parents And Children

Abstract Purpose: Even if the romanian population is ethnically compact caucasian-type population, many of the patients referred for bone marrow transplantation lack a suitable donor. In order to expand the donor pool and the accesibility to transplant for those who have indications it is necessary to perform haplo-identical bone marrow transplant procedure in Fundeni Clinical Institute. Since 2009 Romania established a National Volunteer Stem Cell Donor Registry (RNDVCSH), the goal was to enlarge the possibility to find HLA-matched unrelated donors (MUD) for patients. This approach offered transplant for only up to 60%patients referred for transplantation in 2014, even we chose one HLA-mismatch donors. The haploidentical transplant protocol proposed for our institution is based on Sidney Kimmel Comprehensive Cancer Center protocol from Johns Hopkins University School of Medicine. The major milestones of this protocol include: patient eligibility, donor selection criterias, evaluation of the haplo donor, the conditioning regimen plan and additional supportive care, the bone marrow harvest, prophylaxis of graft versus host disease, assessment during and after the transplant. Donor must be HLA-haploidentical first-degree relatives of the patient with signed consent. The patient, parents and children are typed at the allelic level for HLA-A, -B,-C,-DRB1 and -DQB1. They will perform also de HLA-antibody search using cross-match test in complement-dependent cytotoxicity. The conditioning regimen is composed by Fludarabine 30 mg/m2/day (from day -6 to day -2) combined with Cyclophosphamide 14,5 mg/kgIBW/day (from day -6 to day-5) and TBI at 2 Gyîn day -1. In case of lacking TBI procedure at 2 Gy dose in day -1, it could be replaced by two dose of Busulfan iv in day -3 and day-2 (dose=3,2 mg/kgIBW/day) for those with acute and chronic leukemias. The donor will have general anesthesia,the target yield of marrow is 4 x 10^8 total nucleated cells/kg recipient using his IBW. The GVHD prophylaxis consisted of post-transplant Cyclophosphamide (PTCy) of 50mg/kgIBW/day in IV administration in day +3 and +4, followed by tacrolimus and mycophenolatemofetil (MMF) beginning day +5. The MMF will be stopped at day+35, the tacrolimus will continue till 6 months after the transplantation. Conclusion: One of the most important factors affecting transplantation outcome is proper timing.Therefore, donor availability is an crucial issue. Haploidentical related donors are available for almost all patients, so the use of those donors is a viable alternative.

scholarly journals False-positive residual disease assessment after bone marrow transplant in acute lymphoblastic leukemia [letter]

Blood ◽  
1994 ◽  
Vol 84 (4) ◽  
pp. 1352-1353 ◽  
Author(s):  
K Langlands ◽  
NJ Goulden ◽  
CG Steward ◽  
MN Potter ◽  
JM Cornish ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Transplant ◽  
False Positive ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Marrow Transplant ◽  
Disease Assessment

A Successful Syngeneic Bone Marrow Transplant after an Ortotopic Liver Transplantation for Fulminant Hepatitis - Case Report.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5442-5442
Author(s):  
Lucia Silla ◽  
Alessandra Paz ◽  
Claudia Astigarraga ◽  
Alethea Zago ◽  
Caroline Brum ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Fulminant Hepatitis ◽  
Conditioning Regimen ◽  
Acute Hepatic Failure ◽  
Marrow Transplant ◽  
Drug Dose ◽  
Screening Tests ◽  
Clinical Recovery ◽  
Hepatitis Case

Abstract We report the case of a 12 year old girl admitted to the hospital in August 2004 presenting acute hepatic failure with grade IV encephalopathy without stigmatic of chronic liver disease. Investigation for A, B and C hepatitis was negative as well as the tests for HIV, Toxoplasmosis, EBV, B19 parvovirus and CMV. Diagnosed as fulminant hepatitis she received an ortotopic hepatic transplant 25 days after admission. She had an excellent clinical recovery on tracolimus for immunossupression, except for an asymptomatic pancytopenia unresponsive to drug dose reduction, which progressed to severe bone marrow aplasia in a four months period. A second round of virus screening tests was still negative. She was then submitted to bone marrow transplantation from her twin identical sister utilizing 50mg/kg/day of cyclophosphamide for two days as conditioning regimen. She received 6.6 x 106 CD34+ cells/kg and engrafted at D+22. She was discharged at D+ 33 on tracolimus without any sign of liver or bone marrow rejection. She is presently in complete clinical recovery after 7 months of BMT. This is, from our knowledge, the first report of a successful hepatic transplant followed by an equally successful syngeneic bone marrow transplant.

Delirium documentation in hospitalized pediatric patients with cancer

2021 ◽  
pp. 1-4
Author(s):  
Kelly Lastrapes ◽  
Malisa Dang ◽  
J. Brian Cassel ◽  
Tamara Orr ◽  
Tracye Proffitt ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Pediatric Oncology ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Marrow Transplant ◽  
Screening Tools ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Transplant Patients

Abstract Objective Screening tools for delirium are being used more consistently in pediatric critical care. However, screening is not universal, and delirium may be underdiagnosed, misdiagnosed, or undocumented in hospitalized patients. We evaluated the identification and documentation of delirium in pediatric oncology and bone marrow transplant patients. Method A retrospective chart review on all hospitalized pediatric oncology and bone marrow transplant patients admitted to an Academic Cancer center between 2013 and 2016. Patients aged less than 21 years of age with active cancer were included. Patients with major psychiatric conditions, developmental delays, or autism were excluded. Data were collected to characterize documentation concerning the identification and diagnosis of delirium. Results Of 201 hospitalization records, 54 (26.9%) admissions from 109 unique patients had documentation of delirium. The overall documented incidence of delirium was 3.2% of hospitalizations or 8.2% of unique patients. Patients prescribed opioids and benzodiazepines were more likely to have documentation of delirium. ICD coding under-reported delirium while physician documentation was inaccurate in 26% (53/201) when compared with the chart review. Significance of results Delirium was frequently undocumented or miscoded. Implementing a validated, universal screening tool for delirium may improve identification and clinical outcomes.

QIM19-134: Improving Access to Bone Marrow Transplant in the Community: The Memorial Sloan Kettering Cancer Alliance Shared Care Program

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-134
Author(s):  
Craig Sauter ◽  
W. Jeffrey Baker ◽  
Elizabeth Rodriguez ◽  
Silvia Willumsen ◽  
Barbara Morcerf ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Care Program ◽  
Marrow Transplant ◽  
Shared Care ◽  
Cancer Center ◽  
Post Transplant ◽  
Management Of Complications ◽  
Tumor Boards ◽  
Definitive Therapy

Background: Memorial Sloan Kettering Cancer Center (MSK) created the MSK Cancer Alliance in 2014, a dynamic and bidirectional collaboration with high-quality community providers to enhance access to state-of-the-art cancer care close to home. Hartford HealthCare Cancer Institute (HHC), joined the MSK Cancer Alliance as the first member in 2014. Research suggests that bone marrow transplant (BMT) is an underutilized definitive therapy (Yao et al, Biol Blood Bone Marrow Transplant 2013) for patients with hematologic malignancies and the timing of a referral for transplant has significant impact on patient outcomes (National Marrow Donor Program, available at: https://bethematchclinical.org/transplant-indications-and-outcomes/additional-outcomes/timing-impact-on-outcomes/). MSK and HHC developed the BMT Shared Care program to improve access to transplant, ensure BMT specialist consults for appropriate candidates occur during initial treatment planning, reduce burdensome travel for patients by facilitating care locally, and enhance seamless coordination between local oncologists and BMT providers from initial consult through post-transplant care. Methods: To achieve these goals, MSK and HHC physicians, nurses, and staff created a program that includes: HHC hiring a BMT nurse, who trained for 4 weeks at MSK, and works with MSK counterparts to create a streamlined referral process, pretransplant care at HHC, and travel logistics to MSK; MSK and HHC physicians hold virtual tumor boards to jointly evaluate patients and provide BMT consults at the optimal time; onsite lectures and observer-ships focused on advances in BMT, supportive care, and management of complications like graft versus host disease, leading to the integration of additional clinical services like infectious disease and dermatology; and research, including an MSK clinical trial open at HHC to identify and understand barriers to transplant in the community for patients with newly diagnosed or relapsed acute leukemia. Results: Since November 2015, HHC has referred 86 patients for BMT consult through this Shared Care program, with 35 patients transplanted or receiving immune effector cells (IEC) to date. Conclusions: The BMT Shared Care program effectively facilitates the referral and transplant of appropriate patients while allowing them to receive much of their pre- and post-transplant care in their local communities. Collaboration between BMT nurse coordinators and robust physician engagement are essential to this program. Future opportunities include expanding the use of telemedicine, enhancing electronic data sharing, quantifying and analyzing patient satisfaction, and expanding BMT research at HHC.

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