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Martínez-Roca A, Jiménez-Vicente C, Merchán B, Castaño-Diez S, Zugasti I, Brillembourg H, Bataller Á, Guijarro F, Cortés-Bullich A, Trigueros A, Pérez-Valencia AI, Gallego C, Ballestar N, Rodríguez-Lobato LG, Carcelero E, Díaz-Beyá M, Esteve J, Fernández-Avilés F. At-Home Care Program for Acute Myeloid Leukemia Induction Phase in Patients Treated with Venetoclax-Based Low-Intensity Regimens. Cancers (Basel) 2024; 16:4274. [PMID: 39766173 PMCID: PMC11674946 DOI: 10.3390/cancers16244274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/16/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025] Open
Abstract
Background: Even though venetoclax in combination with azacitidine (VenAza) is considered a low-intensity regimen, its patients present a high incidence of cytopenia and infections during the first courses, making the initial management a challenging phase. Methods: This difficulty in our center led to the establishment of an At-Home (AH) program for ramp-up and follow-up patients during the VenAza combination induction phase focused on therapy administration, patient and caregiver education, and management of adverse events (AEs). A total of 70 patients with newly diagnosed acute myeloid leukemia (ND-AML) or relapsed/refractory AML (R/R AML) were treated with VenAza from March 2019 to May 2022. We compared outcomes between patients managed with a hospital-based (inpatient) approach and those managed through the AH program. Results: Despite most patients experiencing grade 3-4 cytopenias (96.9%), the incidence of serious infections and other AEs was comparable between both groups, with no significant difference in febrile neutropenia (42.3% vs. 27.8%, p = 0.38). Overall, the AH cohort demonstrated a significantly lower hospital readmission rate after ramp-up (29.5% vs. 84.6%, p = 0.001). Moreover, the inpatient cohort's admission days were longer than in the AH cohort (13 vs. 8, p = 0.28). Conclusions: AH management was feasible and safe, leading to better resource use, enhanced patient comfort, and improved treatment compliance. The potential of AH programs for managing low-intensity chemotherapy regimens can reduce hospital admissions and subsequently improve patient and caregiver well-being.
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Affiliation(s)
- Alexandra Martínez-Roca
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Carlos Jiménez-Vicente
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Beatriz Merchán
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Sandra Castaño-Diez
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Inés Zugasti
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Helena Brillembourg
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Álex Bataller
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Francesca Guijarro
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
- Hemopathology Unit, Pathology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Albert Cortés-Bullich
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Ana Trigueros
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Amanda Isabel Pérez-Valencia
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
| | - Cristina Gallego
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Nuria Ballestar
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Esther Carcelero
- Pharmacy Service, Division of Medicine, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Marina Díaz-Beyá
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Jordi Esteve
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
| | - Francesc Fernández-Avilés
- Department of Hematology, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (A.M.-R.); (C.J.-V.); (B.M.); (I.Z.); (H.B.); (Á.B.); (A.C.-B.); (A.T.); (A.I.P.-V.); (C.G.); (N.B.); (L.G.R.-L.); (M.D.-B.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.C.-D.); (F.G.)
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Escribano-Serrat S, Pedraza A, Suárez-Lledó M, Charry P, De Moner B, Martinez-Sanchez J, Ramos A, Ventosa-Capell H, Moreno C, Guardia L, Monge-Escartín I, Riu G, Carcelero E, Cid J, Lozano M, Gómez P, García E, Martín L, Carreras E, Fernández-Avilés F, Martínez C, Rovira M, Salas MQ, Díaz-Ricart M. Safety and efficacy of G-CSF after allogeneic hematopoietic cell transplantation using post-transplant cyclophosphamide: clinical and in vitro examination of endothelial activation. Bone Marrow Transplant 2024; 59:1466-1476. [PMID: 39117736 DOI: 10.1038/s41409-024-02388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
Since 2021 the use of G-CSF was implemented in allo-HCT with PTCY-based prophylaxis with the aim of shortening the aplastic phase and reducing infectious complications. This study investigates the effectiveness of this change in protocol performed at our institution. One-hundred forty-six adults undergoing allo-HCT with PTCY-based prophylaxis were included, and among them, 58 (40%) received G-CSF. The median of days to neutrophil engraftment was shorter in the G-CSF group (15 vs. 20 days, p < 0.001). Patients receiving G-CSF had a lower incidence of day +30 bacterial bloodstream infections (BSI) than the rest (20.7% vs. 47.7%, p < 0.001). GVHD, SOS, and TA-TMA incidences were comparable between groups, and using G-CSF did not impact on survival. Endothelial activation was investigated using EASIX and by the measurement of soluble biomarkers in cryopreserved plasma samples obtained on days 0, +7, +14 and +21 of 39 consecutive patients (10 received G-CSF) included in the study. EASIX, VWF:Ag, sVCAM-1, sTNFRI, ST2, REG3α, TM and NETs medians values were comparable in patients receiving G-CSF and those who did not. Compared with allo-HCT performed without G-CSF, the addition of G-CSF to PTCY-based allo-HCT accelerated neutrophil engraftment contributing on decreasing BSI incidence, and without inducing additional endothelial activation.
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Affiliation(s)
- Silvia Escribano-Serrat
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Pedraza
- Blood Bank Department, Biomedical Diagnostic Center, Banc de Sang i Teixits, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paola Charry
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, (ICAMS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Blanca De Moner
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
- Fundacio i Institut de Recerca Josep Carreras Contra la Leucemia (Campus Clínic), Barcelona, Spain
| | - Julia Martinez-Sanchez
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Ramos
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Cristina Moreno
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laia Guardia
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Gisela Riu
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esther Carcelero
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, (ICAMS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, (ICAMS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Pilar Gómez
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estefanía García
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lidia Martín
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundacio i Institut de Recerca Josep Carreras Contra la Leucemia (Campus Clínic), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Queralt Salas
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Hematopoietic Transplantation Unit, Hematology Department, (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Maribel Díaz-Ricart
- Hemostasis and Erythropathology Laboratory, Hematopathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
- Research Biomedical Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Hernández-Aliaga M, Carretero-Márquez C, Peña CJ, Santacatalina-Roig E, Navarro-Martínez R. At-Home Care Versus Total Hospital Care Model for Autologous Stem Cell Transplantation in Adult Lymphoma Patients: A Pilot Case-Control Study. Cancer Nurs 2024:00002820-990000000-00294. [PMID: 39329506 DOI: 10.1097/ncc.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Lymphoma is the second most prevalent cancer treated with autologous stem cell transplantation (ASCT). Additional resources are required to enhance the provision of care for these patients. OBJECTIVE To explore the complications and economic costs of home versus hospital care models for ASCT in patients diagnosed with lymphoma and to describe the experience of home care patients. METHODS This was an observational pilot case-control study with 1:1 matching, in which all patients assisted at home were included. Data were obtained by reviewing medical records and data from the hospital's financial and resource management service. The IEXPAC scale version 11 + 4 was used to assess the care process experience as perceived by home care patients. RESULTS The study included 34 patients, in which there was a significant decrease in neutropenic fever, both in frequency and duration (P = .001 and P < .001, respectively), in mucositis days (P = .038), and the rate of red cell concentrate transfusion (P < .001); however, there was a longer neutrophil recovery time (P = .044) in home care versus hospitalized patients. The overall cost was higher in the hospital care model (P = .001). Home care patients obtained high scores on the perceived experience of the care process scale. CONCLUSIONS The home ASCT model is associated with fewer complications, shorter hospital stays, and more significant cost savings. The experience of the home care process was rated satisfactorily. IMPLICATIONS FOR PRACTICE This study provides evidence for a model that offers high-quality care and a comfortable experience for ASCT patients. Preparing more nurses for this home care model is imperative.
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Affiliation(s)
- Marina Hernández-Aliaga
- Author Affiliations: Hematology and Hemotherapy Department, Hospital Clínico Universitario de Valencia (Ms Hernández-Aliaga, Dr Carretero-Márquez, and Mr Santacatalina-Roig); Nursing Department, Nursing and Podiatry Faculty, University of Valencia (Ms Hernández-Aliaga and Dr Navarro-Martínez); and Haematopoietic Transplantation Research Group (INCLIVA) (Ms Hernández-Aliaga and Mr Peña) and Care Research Group (INCLIVA) (Dr Navarro-Martínez), Hospital Clínico Universitario de Valencia, Spain
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Prieto del Prado MÁ, Fernández Avilés F. Ambulatory models for autologous stem-cell transplantation: a systematic review of the health impact. Front Immunol 2024; 15:1419186. [PMID: 39081323 PMCID: PMC11287121 DOI: 10.3389/fimmu.2024.1419186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Autologous stem-cell transplantation (ASCT) is the standard of care for the management of multiple myeloma and has a well-established role in the treatment of some types of lymphoma. Over the last decades, the number of ASCT performed has increased significantly, leading to elevated pressure and cost for healthcare services. Conventional model of ASCT includes the admission of patients to a specialized Transplant Unit at any stage of the procedure. To optimize healthcare provision, ambulatory (outpatient/at-home) setting should be the focus moving forward. Thus, ambulatory ASCT model permits reducing average hospital stays and pressures on healthcare services, with significant cost-saving benefits and high degree of patient and caregiver satisfaction. In addition, it facilitates the bed resource for other complex procedures such as allografts or CAR-T cell therapy. The aim of this systematic review is to document the health impact, feasibility and safety of the outpatient/at-home ASCT models, which are increasingly being applied around the world.
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Affiliation(s)
| | - Francesc Fernández Avilés
- Hematology Department, Bone Marrow Transplantation Unit, Instituto del Cáncer y Enfermedades de la Sangre (ICAMS), Hospital Clínic, Barcelona, Spain
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Palomo M, Moreno-Castaño AB, Salas MQ, Escribano-Serrat S, Rovira M, Guillen-Olmos E, Fernandez S, Ventosa-Capell H, Youssef L, Crispi F, Nomdedeu M, Martinez-Sanchez J, De Moner B, Diaz-Ricart M. Endothelial activation and damage as a common pathological substrate in different pathologies and cell therapy complications. Front Med (Lausanne) 2023; 10:1285898. [PMID: 38034541 PMCID: PMC10682735 DOI: 10.3389/fmed.2023.1285898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
The endothelium is a biologically active interface with multiple functions, some of them common throughout the vascular tree, and others that depend on its anatomical location. Endothelial cells are continually exposed to cellular and humoral factors, and to all those elements (biological, chemical, or hemodynamic) that circulate in blood at a certain time. It can adapt to different stimuli but this capability may be lost if the stimuli are strong enough and/or persistent in time. If the endothelium loses its adaptability it may become dysfunctional, becoming a potential real danger to the host. Endothelial dysfunction is present in multiple clinical conditions, such as chronic kidney disease, obesity, major depression, pregnancy-related complications, septic syndromes, COVID-19, and thrombotic microangiopathies, among other pathologies, but also in association with cell therapies, such as hematopoietic stem cell transplantation and treatment with chimeric antigen receptor T cells. In these diverse conditions, evidence suggests that the presence and severity of endothelial dysfunction correlate with the severity of the associated disease. More importantly, endothelial dysfunction has a strong diagnostic and prognostic value for the development of critical complications that, although may differ according to the underlying disease, have a vascular background in common. Our multidisciplinary team of women has devoted many years to exploring the role of the endothelium in association with the mentioned diseases and conditions. Our research group has characterized some of the mechanisms and also proposed biomarkers of endothelial damage. A better knowledge would provide therapeutic strategies either to prevent or to treat endothelial dysfunction.
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Affiliation(s)
- Marta Palomo
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
- Hematology External Quality Assessment Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, Barcelona, Spain
| | - Silvia Escribano-Serrat
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, Barcelona, Spain
| | - Elena Guillen-Olmos
- Department of Nephrology and Kidney Transplantation, Hospital Clínic de Barcelona, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), University of Barcelona, Barcelona, Spain
| | - Sara Fernandez
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Lina Youssef
- BCNatal – Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de Barcelona and Hospital Sant Joan de Déu, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fatima Crispi
- BCNatal – Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de Barcelona and Hospital Sant Joan de Déu, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Meritxell Nomdedeu
- Hemostasis and Hemotherapy Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Julia Martinez-Sanchez
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
| | - Blanca De Moner
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Hemostasis and Erythropathology Laboratory, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Institut de Recerca August Pi Sunyer, University of Barcelona, Barcelona, Spain
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Feasibility of a Hospital-at-Home Program for Autologous Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:111.e1-111.e7. [PMID: 36436783 DOI: 10.1016/j.jtct.2022.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The Hospital at Home (HaH) model has been positioned as an appropriate therapeutic strategy for selected patients undergoing autologous hematopoietic stem cell transplantation (ASCT). This care model provides hospital-equivalent care, in terms of both quality and quantity, with medical and nursing staff that go to the patient's home. Here we describe our experience with a full HaH model for patients undergoing ASCT during the phase of aplasia. The patients met the eligibility criteria between January 1997 and December 2019 and were discharged from the hospital and admitted into the HaH-ASCT program on the same day they in which hematopoietic stem cells were infused. A total of 84 patients were included. The median patient age was 54 years (range, 16 to 74 years), and the median duration of participation in the HaH program was 17 days (range, 3 to 86 days). Only 10 of these patients (12%) required hospital readmission to the hematology department, 9 of them due to sepsis and 1 because of family care support claudication. Seventy-two patients (86%) experienced an episode of neutropenic fever during the HAH admission, with a median duration of 2 days (interquartile range [IQR], 1 to 11 days); all were treated with empiric i.v. antimicrobial therapy. Most patients (88%) presented with mucositis (44% with grade 3-4). Parenteral nutrition was administered in 26% of patients for a median of 6 days (IQR, 1 to 12 days). Most patients (94%) required at least 1 blood product transfusion at home. There was no transplantation-related mortality during the HaH-ASCT program or in the patients who were readmitted. With careful selection of patients and a comprehensive and well- experienced multidisciplinary team (doctors, nurses, and auxiliary nurses) in the HaH department and in close collaboration with the hematology department, complete at-home management of ASCT recipients immediately after transplantation is possible. This allows patients undergoing an aggressive procedure such as ASCT to remain in their own familiar environment, providing a better quality of life with a program that has demonstrated to be effective and safe, with a low incidence of complications and no associated mortality.
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Grosso D, Leiby B, Wilde L, Carabasi M, Filicko-O'Hara J, O'Hara W, Wagner JL, Mateja G, Alpdogan O, Binder A, Kasner M, Keiffer G, Klumpp T, Martinez UO, Palmisiano N, Porcu P, Gergis U, Flomenberg N. A Prospective, Randomized Trial Examining the Use of G-CSF Versus No G-CSF in Patients Post-Autologous Transplantation. Transplant Cell Ther 2022; 28:831.e1-831.e7. [PMID: 36167307 DOI: 10.1016/j.jtct.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Contemporary, prospective data regarding the impact of granulocyte-colony stimulating factor (G-CSF) on outcomes after autologous hematopoietic stem cell transplantation (Auto-HSCT) in an era when stem cell grafts are more qualitatively robust are limited. Recent retrospective analyses have not supported a beneficial effect of post-transplantation G-CSF use on major outcomes after Auto-HSCT leading to strategies to delay or eliminate the use of G-CSF altogether in this context. To test the hypothesis that the infusion of consistently higher doses of stem cells (defined as ≥4 × 106/kg) in Auto-HSCT will obviate the need for post-transplantation G-CSF. If so, the impact of withholding G-CSF will be noninferior to the use of G-CSF in terms of length of stay (LOS). The specific objectives were to conduct a prospective, randomized clinical trial primarily examining the impact of post-transplantation G-CSF on LOS, and secondarily on engraftment, infectious complications, antibiotic usage, and incidence of engraftment syndrome after Auto-HSCT in patients receiving versus not receiving G-CSF after Auto-HSCT. Patients with multiple myeloma or non-Hodgkin lymphoma (NHL) who underwent Pegfilgrastim plus Plerixafor-primed stem cell collection followed by Auto-HSCT were randomized to the G-CSF group (receive G-CSF starting at day 3 after Auto-HSCT) or the no G-CSF group (G-CSF withheld after Auto-HSCT). Seventy patients per arm were planned to demonstrate the primary endpoint of noninferiority in LOS between the G-CSF and the no G-CSF groups. Patient outcomes in the two groups were followed up and compared after Auto-HSCT, and an interim analysis for futility was planned when accrual reached 50%.The primary finding of this study was that despite only a 2-day longer median absolute neutrophil count (ANC) recovery in the no G-CSF arm (median 11 versus 13 days; P = .001), LOS was 4 days longer in patients not treated with G-CSF (median 11 days versus 15 days; P = .001). G-CSF use was associated with more robust incremental daily increases in ANC once recovered (P = .001), fewer days of febrile neutropenia (P = .001), and fewer days on antibiotics (P = .001), potentially contributing to this disproportionate finding. Inferiority in LOS in the no G-CSF group was demonstrated on the interim analysis, and the study was closed at the half-way point. There were no significant group differences in platelet recovery, documented infections, hospital readmissions, or overall survival at 1 year. Engraftment syndrome occurred in 54.3% of patients and was not related to G-CSF use. These results suggest that the increased LOS associated with the omission of G-CSF is largely due to concerns regarding the potential for infection in patients without a stable, recovered ANC in a hospital setting. Engraftment syndrome represented a significant source of febrile neutropenia further contributing to patient safety concerns and requires strategies to decrease its incidence. Infectious complications and death were not affected by the omission of G-CSF supporting a carefully monitored outpatient approach to Auto-HSCT in which white blood cell growth factor is eliminated or given as needed for documented infection. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Dolores Grosso
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Carabasi
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanne Filicko-O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John L Wagner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Mateja
- Office of Clinical Research, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Onder Alpdogan
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Margaret Kasner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Keiffer
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Klumpp
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ubaldo Outschoorn Martinez
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neil Palmisiano
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pierluigi Porcu
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Usama Gergis
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neal Flomenberg
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
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An endothelial proinflammatory phenotype precedes the development of the engraftment syndrome after autologous Hct. Bone Marrow Transplant 2022; 57:721-728. [DOI: 10.1038/s41409-022-01610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022]
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Martínez-Roca A, Rodríguez-Lobato LG, Ballestar N, Gallego C, Fernández-Avilés F. Personalized at-home autologous hematopoietic stem cell transplantation during the SARS-CoV-2 outbreak. Leuk Res 2021; 106:106589. [PMID: 33971562 PMCID: PMC8064822 DOI: 10.1016/j.leukres.2021.106589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Martínez-Roca
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain.
| | - Luis Gerardo Rodríguez-Lobato
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Ballestar
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Cristina Gallego
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Francesc Fernández-Avilés
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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