scholarly journals Audit of Psychosocial and Palliative Care Support for Children Having Allogeneic Stem Cell Transplants at the New Zealand National Allogeneic Transplant Centre

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 356
Author(s):  
Amanda M. Evans ◽  
Hiran Thabrew ◽  
Bruce Arroll ◽  
Nyree Cole ◽  
Ross Drake
Keyword(s):  
Palliative Care ◽  
Stem Cell ◽  
Social Work ◽  
New Zealand ◽  
Psychological Assessment ◽  
Cell Transplant ◽  
Sibling Support ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Care Support

Psychosocial and palliative care support during stem cell transplants (SCT) is known to improve outcomes. Aim: evaluate the support provided to children and families at the New Zealand National Allogeneic Stem Cell Transplant unit (NATC). Method: the psychosocial and palliative care support for children who received SCT between December 2012 and April 2018 was audited. Results: of the 101 children who received SCT, 97% were reviewed by the social work team (SW) and 82% by the psychiatric consult liaison team (CLT) at least once during their illness. However, pre-transplant psychological assessment only occurred in 16%, and during the SCT admission, only 55% received SW support, and 67% received CLT support. Eight out of eighty-five families (9%) were offered support for siblings. Eight of the sixteen children who died were referred for pediatric palliative care (PPC) with all supported and half the families who experienced a death (n = 8; 50%) received bereavement follow up. Conclusion: although the majority received some social work and psychological support, auditing against the standards suggests the consistency of involvement could be improved. Referrals for PPC were inadequate and largely for end-of-life phase. Sibling support, in particular donor siblings, had insufficient psychological assessment and support. Key recommendations are provided to address this underperformance.

scholarly journals Increasing Rates of Fluoroquinolone Resistance in Escherichia coli Blood and Urinary Isolates in Stem Cell Transplant and Hematologic Malignancy Populations

2016 ◽  
Vol 1 (2) ◽  
pp. 234 ◽  
Author(s):  
Christopher G. Hauck ◽  
Pearlie P. Chong ◽  
Melissa B. Miller ◽  
Katarzyna Jamieson ◽  
Jason P. Fine ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Stem Cell ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Fluoroquinolone Resistance ◽  
Cell Transplant ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Febrile Episodes ◽  
Urinary Isolates

Fluoroquinolone (FQ) antibiotics have been shown to reduce mortality and the number of febrile episodes when used as prophylaxis during neutropenia. Prior studies suggest that prophylaxis may result in increasing rates of FQ resistance. Fluoroquinolone non-susceptibility trends in Escherichia coli isolated from blood and urine cultures were evaluated over a 16-year period during which prophylaxis was initiated in patients with hematologic malignancies and stem cell transplants. Non-susceptibility rates increased after the introduction of prophylaxis, with yearly non-susceptibility rates rising from 30%­–33% to 40%–88% in blood isolates. The high rates of non-susceptibility now observed raise concerns about the continued efficacy of FQ prophylaxis. This concern exists particularly in those patients undergoing stem cell transplants where the total FQ non-susceptibility rates over the study period were 82.3%. Further evaluation of the effect of FQ prophylaxis on antibiotic resistance and its efficacy in the setting of increased rates of resistance is warranted.

scholarly journals Better Transplant Outcomes with Umbilical Cord Stem Cells in Patients with Dyskeratosis Congenita

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3592-3592 ◽  
Author(s):  
Ashish O. Gupta ◽  
Steven L Shein ◽  
Jignesh D Dalal
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Umbilical Cord ◽  
Patient Population ◽  
Stem Cell Transplant ◽  
Unknown Etiology ◽  
Cell Transplant ◽  
Transplant Outcomes ◽  
Cell Transplants ◽  
Stem Cell Transplants

Abstract Background:Dyskeratosis congenita (DKC) is a rare genetic bone marrow failure (BMF) syndrome of unknown etiology with a multisystem involvement and predisposition for cancer. It presents as a classic triad of dystrophic nails, oral leukoplakia and skin hyperpigmentation. Hematopoietic stem cell transplant (HSCT) has been tried as a treatment option but there is limited data on outcomes in these patients. Methods:As the disease is rare with high mortality, there have been no prospective studies. Retrospective database analysis is an effective means to evaluate outcomes in this patient population. Our study utilized Pediatric Health Information Systems (PHIS) database, which is an administrative quality-controlled database from 43 not-for-profit children's hospital, to analyze healthcare outcomes in pediatric patients with DKC. ICD-9 code 757.39 was used to identify the disease classification and as the only condition with an indication for stem cell transplant, we isolated the cases that underwent HSCT with that diagnostic code. Results: A total of 40 patients with DKC were identified who underwent transplant. A higher incidence was noted in Caucasian males with no significant difference in mortality across gender and ethnicity. The median length of hospitalization was 48 days (range 8.5 to 160.5 days) with a mean age of hospital admission at 93 months (95% CI: 70, 117). All the transplants were allogeneic with almost 20% umbilical cord (UCT) stem cell transplants. There was 15% mortality noted in this patient population, with all of deaths occurring prior to 2012. The complication rate (including acute and chronic GVHD as well as graft failure) was noted to be 37.5%, with acute GVHD being most common (20%). Fludarabine, Alemtuzumab, Cyclophosphamide, and Melphalan based conditioning regimen were most commonly used. Cyclosporine (65%), steroids (80%), Mycophenolate mofetil (50%) and Tacrolimus (40%) were commonly used for GVHD prophylaxis. Despite small numbers, significantly lower mortality was noted in UCT as compared to the other allogeneic stem cell transplants (p<0.01). Conclusion: Limited literature is available on pediatric transplant outcome data in DKC. UCT has better transplant outcomes in DKC patients due to longer telomere lengths of donor stem cells. Larger studies are needed for to compare transplant outcomes from different sources. Disclosures No relevant conflicts of interest to declare.

scholarly journals Nursing diagnosis after hematopoietic stem cell transplant due to Fanconi anemia

2022 ◽  
Vol 75 (3) ◽  
Author(s):  
Lara Cássia Silva Sandri ◽  
Letícia Pontes ◽  
Carmem Maria Sales Bonfim ◽  
Solena Ziemer Kusma
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Fanconi Anemia ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Nursing Diagnosis ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
South Of Brazil ◽  
Hematopoietic Stem Cell Transplants

ABSTRACT Objectives: to identify nursing diagnoses in patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, according to the NANDA-I taxonomy. Methods: exploratory study using a retrospective analysis of 85 records from patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, developed in a specialize transplant center in the South of Brazil. The results were analyzed using descriptive statistics. Results: 73 different diagnoses were found in 9 out of the 13 domains from the NANDA-I taxonomy. From these, 22 were in 50% or more of the patients investigated, and most of them are related to the domain Safety/Protection. Conclusions: it was possible to identify the nursing diagnosis in the patients who underwent hematopoietic stem cell transplants due to Fanconi anemia, contributing to design a plan for the care of these patients. The same was true for those with other syndromes of chromosomal instability that need to undergo this transplant.

The Utility Of Monitoring Chimerism: More Predictive For Nonablative Regimens?

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5490-5490
Author(s):  
Lyndsey Runaas ◽  
Walter L. Longo ◽  
Mark Juckett ◽  
Wayne Borcherding ◽  
Peiman Hematti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Early Intervention ◽  
Conflicts Of Interest ◽  
Cell Transplant ◽  
Donor Chimerism ◽  
Significant Difference ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Disease Specific

Abstract Introduction Treatment related mortality and overall survival of allogeneic stem cell transplants have improved over the past 30 years but disease relapse remains the primary cause of death. New tools are sought to detect a window for early intervention. Chimerism studies are one tool that may allow clinicians to recognize impending graft failure or disease recurrence. Use of chimerism data varies in terms of frequency of monitoring and decision-making based on results. In this single-center study we evaluated the use and utility of chimerism studies in patients undergoing ablative and nonablative stem cell transplants for hematologic malignancies. Methods Following IRB approval, a retrospective chart review of 133 patients undergoing allogeneic stem cell transplant for leukemia or MDS at our institution during the period from 2007-2012 was performed. Of this group, 90 had chimerism studies performed using the Promega PowerPlex 16 System. Full donor chimerism (FDC) was defined as donor hematopoeisis of greater than or equal to 95% in both CD3 and CD33 lineages. Mixed donor chimerism (MDC) was defined as donor hematopoeisis of less than 95%. Patients with FDC at all assessments were categorized as complete chimerism (CC). Patients with MDC initially that improved on subsequent evaluation were categorized as improving chimerism (IC). Patients with FDC that devolved into stable MDC or worsening MDC were categorized as worsening chimerism (WC). Fifteen patients were unclassifiable due to incomplete data and were excluded. A univariate statistical analysis was performed on the remaining 75 patients and overall survival (OS), disease specific survival (DSS), and relapse free survival (RFS) determined. A sub-analysis using Chi-Square and Fisher's Exact Test was performed on individuals in the nonablative cohort with WC or IC to investigate whether there were higher rates of intervention in the IC group. Results Demographic data for the ablative cohort and nonablative cohort, and among patients with CC, IC and WC were similar. There was no statistically significant difference in OSS or DSS between patients with CC, IC and WC. There was a statistically significant hazard ratio favoring both CC and IC versus WC in terms of RFS in the nonablative cohort and in the combined cohort but this was not seen in the ablative cohort (Table 1). Within the nonablative group, there was not a higher rate of withdrawal of immunosuppression (p=0.98), donor lymphocyte infusion (p=0.43), or additional disease-specific therapy (p=0.43) in the IC versus the WC group to explain the improving chimerism, suggesting that interventions based on chimerism results are either too late or are inadequate. Discussion This study suggests that chimerism studies have utility in the setting of nonablative transplant where WC predicts worse RFS. Despite this additional prognostic information, the window for early intervention is narrow and we were unable to demonstrate that improvements in chimerism studies were related to clinician initiated interventions in this small study. The risk of developing GVHD must be weighed in deciding to withdraw immunosuppression or administer DLI given the relatively low success rate of changing MDC into FDC. Finally, despite our institutions' recommendation of monitoring chimerism studies serially, 32% of the charts we reviewed had not had these studies performed. Given the complexity and heterogeneity of patients with hematological malignancies, more evaluation of chimerism studies is needed to fully establish or discredit the potential utility of this test. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Donor-Specific Isoagglutinin Clearance in ABO Mismatched Stem Cell Transplant Recipients: How Long Should It Normally Take?

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1260-1260 ◽  
Author(s):  
John Chinawaeze Aneke ◽  
Nayana Sondi ◽  
Santhosh Thyagu ◽  
Christine M. Cserti-Gazdewich ◽  
Jacob Pendergrast
Keyword(s):  
Stem Cell ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Pure Red Cell Aplasia ◽  
Cell Transplant ◽  
Post Transplant ◽  
Expected Time ◽  
Significant Difference ◽  
Cell Transplants ◽  
Stem Cell Transplants

Abstract Introduction: In patients undergoing ABO-incompatible stem cell transplants, recipient isoagglutinins with specificity for donor antigens are expected to slowly become undetectable during the post-transplant period, presumably secondary to the loss of recipient plasma cells via either conditioning chemotherapy or graft-versus-host-disease. Conversely, the persistence or return of these anti-donor isoagglutinins may induce hemolytic anemia or pure red cell aplasia, and may even signify disease relapse. In order to define the expected time to clearance of these donor isoagglutinins at our institution, a retrospective study was performed Methods: The transfusion records of all major-side or bidirectionally ABO-incompatible stem cell transplants performed at an academic cancer hospital between May 2009 and July 2018 were reviewed. Patients without detectable anti-donor isoagglutinins at time of transplant were excluded. Isoagglutinin clearance was defined as non-reactivity of patient plasma against donor-type reverse grouping cells occurring during the post-transplant period; relapse was defined as a 2+ or stronger reaction after one or more non-reactive results Results: A total of 280 patients were included in analysis, of which 44 were native group A, 42 group B and 194 group O. Average age was 52 (±13) years and 130 (46%) were female. Compatibility samples were sent to the UHN blood bank during the post-transplant period for a median of 156 days (IQR 74-370 days). During this time period, donor-targeting/host-derived isoagglutinin clearance was documented in 192 (69%) patients at a median of 48 days (IQR 23-116.5) post-transplant. Of these, 52 (30%) experienced a subsequent return of reactivity at a median 98 days post-transplant (IQR 54-216). Amongst the 128 patients with at least 28 days of post-transplant monitoring and no return of previously cleared isoagglutinins, the median time to clearance was 60 days (IQR 26.5 - 127.5 days). There was no statistically significant difference in time to isoagglutinin clearance between those with and without a subsequent return of reactivity, and time to durable clearance did not correlate with patient age, sex or native ABO group. Conclusions: Amongst patients undergoing major-side or bidirectionally ABO incompatible stem cell transplants, the majority will have cleared their donor-specific isoagglutinins within 120 days of stem cell infusion, although this does not guarantee against later return of reactivity. Thus, the persistence of donor-specific isoagglutinins beyond 120 days post-transplant, or the subsequent return of previously cleared isoagglutinins, may be considered abnormal results which warrant notification of the clinical team by the hospital transfusion service. Disclosures No relevant conflicts of interest to declare.

Hematopoietic Stem cell transplant in National Oncology Cancer Institute of Panama. Ten Years of Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4524-4524
Author(s):  
Jose Luis Franceschi Diaz
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Cell Transplants ◽  
Stem Cell Transplants ◽  
Hematopoietic Stem Cell Transplants

Abstract Abstract 4524 Panama has a population of 3.5 million inhabitants. Between 2,000 and 2,010 there were 123 hematopoietic stem cell transplants at the INSTITUTO NACIONAL DE ONCOLOGIA (ION). Even though, there are two other specialized centers doing the same procedures that we do, the ION has the greatest experience in the whole country. The objective of this document is to show you our experience and the results of a third level cancer center in an undeveloped country with limited financial resources however with pathologies and diseases that request bone marrow transplant programs installed and developed. The bone marrow transplant program (BMT) of ION initiated at the beginning of 2,000 and since then, it has been doing approximately 10–12 HSCT annually. Material and Methods: We did a review of the data during this first decade and the most important epidemiological and statistics data are presented next. Results: There were 85 autologous and 28 allogeneic hematopoietic stem cell transplants. In the allo group there were 4 reduced intensity included. In every single auto hematopoietic stem cell transplants the source of progenitor stem cells were peripheral blood and in the case of allo, hematopoietic stem cell transplants the source was the bone marrow in 18 cases and the peripheral blood in 20 cases. The mean of CD34 + progenitor cell infused was 3.23×106 (range 2.12–9.93). The peripheral blood progenitor cells were cryopreserved in liquid nitrogen until −136° celsius degrees using controlled rate temperature computerized freezers. The cells were protected from damages during the cryopreservation with cryoprotectant, in this case dimethil sulphoxide 10% was used. The age range was from 17 to 65 years old with a mean of 39 years old with a median of 40 years old. There were 66 males and 57 females. The main indication for Hematopoietic stem cell transplant was Hodgkin disease in 20 cases; follicular lymphoma in 13 cases; large cell lymphoma in 12; chronic myeloid leukemia in 21; adult acute lymphoblastic leukemia 17; adult acute myeloid leukemia in 10; multiple myeloma in 22 (2 pts. were transplanted twice upfront); severe aplastic anemia in 1; myelodisplastic syndrome in 1; lymphoblastic lymphoma in 4, and gray zone lymphoma in 1. The day 100, mortality rate for all patients was 16.3 per 100 with a range between 5–21.1 per 100 according to different diseases and types of transplants. The overall survival for all patients has a median of 59 months but when it is analyzed according to the transplant type with log rank test, there was no significative difference in the overall survival (p = 0.063). However, when all the population is grouped in categories according to diseases in Hodgkin disease; lymphomas; multiple myeloma and leukemias there is a clear difference in plot overall survival, in all four groups statistically significative with the most desfavorably outcome in the leukemia group. Indeed, if all the group is divided in two groups leukemia vs. others, there would be a clear difference in overall survival with a median overall survival of 12 months in the leukemia group that hasn’t been reached in the other group after more than 5 years of follow up (log rank p = 0.014). In all the groups there have been 55 deaths; 20 in the allo hematopoietic stem cell transplant group; and in these patients the main causes were relapse in 12 patients; graft vs. host disease in 3; infection in 4, organ toxicity in 1. There were 35 deaths in were in the auto hematopoietic stem cell transplant group, and in these patients the main group of deaths were relapse in 25 patients; infections in 3; organ toxicity in 2. Acute graft vs host disease (aGVHD). in allo hematopoietic stem cell transplant did affected desfavorably the outcome as we can see in the overall survival plot in comparison to patients without aGVHD (log rank test, p = 0.014). Chronic graft versus host disease (cGVHD) also affected desfavorably the outcome in allo hematopoietic stem cell transplant in comparison to patients with cGVHD (log rank p = 0.002). Conclusion: these results show that a BMT program can be performed in an undeveloped country with efficiency and efficacy. Disclosures: No relevant conflicts of interest to declare.

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