1
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Rotz SJ, Bhatt NS, Hamilton BK, Duncan C, Aljurf M, Atsuta Y, Beebe K, Buchbinder D, Burkhard P, Carpenter PA, Chaudhri N, Elemary M, Elsawy M, Guilcher GMT, Hamad N, Karduss A, Peric Z, Purtill D, Rizzo D, Rodrigues M, Ostriz MBR, Salooja N, Schoemans H, Seber A, Sharma A, Srivastava A, Stewart SK, Baker KS, Majhail NS, Phelan R. International recommendations for screening and preventative practices for long-term survivors of transplantation and cellular therapy: a 2023 update. Bone Marrow Transplant 2024; 59:717-741. [PMID: 38413823 DOI: 10.1038/s41409-023-02190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024]
Abstract
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the volume of HCT performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long-term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and other underlying risk-factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and updated in 2012. To review contemporary literature and update the recommendations while considering the changing practice of HCT and cellular therapy, an international group of experts was again convened. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed but cGVHD management is not covered in detail. These guidelines emphasize special needs of patients with distinct underlying HCT indications or comorbidities (e.g., hemoglobinopathies, older adults) but do not replace more detailed group, disease, or condition specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
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Affiliation(s)
- Seth J Rotz
- Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | | | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christine Duncan
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard University, Boston, MA, USA
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Kristen Beebe
- Phoenix Children's Hospital and Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Peggy Burkhard
- National Bone Marrow Transplant Link, Southfield, MI, USA
| | | | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Elemary
- Hematology and BMT, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
- QEII Health Sciences Center, Halifax, NS, Canada
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Transplant and Cellular Therapy, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, NSW, Australia
- St Vincent's Clinical School Sydney, University of New South Wales, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, WA, Australia
| | - Amado Karduss
- Bone Marrow Transplant Program, Clinica las Americas, Medellin, Colombia
| | - Zinaida Peric
- BMT Unit, Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Duncan Purtill
- Fiona Stanley Hospital, Murdoch, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Maria Belén Rosales Ostriz
- Division of hematology and bone marrow transplantation, Instituto de trasplante y alta complejidad (ITAC), Buenos Aires, Argentina
| | - Nina Salooja
- Centre for Haematology, Imperial College London, London, UK
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven-University of Leuven, Leuven, Belgium
| | | | - Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | - Susan K Stewart
- Blood & Marrow Transplant Information Network, Highland Park, IL, 60035, USA
| | | | - Navneet S Majhail
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, TN, USA
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Newcomb RA, Gao L, Vanderklish J, Tse A, Saylor M, Danielson C, Wali N, Frigault M, McAfee S, Spitzer T, DeFilipp Z, Chen YB, Amonoo HL, El-Jawahri A. Outcomes of a Formal Hematopoietic Cell Transplantation Survivorship Program on Screening for Late Effects. Transplant Cell Ther 2024:S2666-6367(24)00371-3. [PMID: 38685402 DOI: 10.1016/j.jtct.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) survivors may benefit from routine screening for post-transplant complications. However, the impact of formal survivorship efforts to promote screening adherence is uncertain. The effect of a formal HCT survivorship program to promote screening adherence was evaluated. We conducted a retrospective analysis of an academic formal HCT survivorship program with primary and specialty consult components. We included patients who underwent allogeneic HCT and were alive and relapse-free 1-year post-HCT. We excluded patients who died <2-year post-HCT or transferred care. We measured screening adherence to cardiovascular, pulmonary, ocular, secondary cancer, and endocrine evaluations. The primary outcome was proportion of patients completing ≥1 evaluation per screening domain prior to 2-year post-HCT. We examined screening adherence during 3 time periods: presurvivorship (2012 to 2014) and 2 postsurvivorship (2016 to 2018 and 2019 to 2021) using multivariate logistic and Cox proportional hazards regression. Four hundred ten patients (2012 to 2014: n = 136, 2016 to 2018: n = 153, 2019 to 2021: n = 121) were included. Compared to the presurvivorship period (16.9%), patients in 2016 to 2018 (47.7%, odds ratio [OR] = 4.9, P < .0001) and 2019 to 2021 (34.7%, OR = 2.7, P = .001) were more likely to complete ≥1 evaluation per screening domain. Except for pulmonary function tests in 2019 to 2021, median time to completion of survivorship evaluations was shorter in the survivorship periods compared to presurvivorship. Patients who completed a formal HCT survivorship consult in 2016 to 2018 and 2019 to 2021 were more likely to complete ≥1 evaluation per screening domain (OR = 5.1, P = .0004). Survivorship consult had similar effect on the primary screening outcome in 2016 to 2018 and 2019 to 2021 (consult × time interaction OR: 2.5, P = .2). However, patients who received a consult in 2019 to 2021 were more likely to complete all screenings (consult × time interaction: OR = 5.7, P = .03). Our HCT survivorship program with primary and specialty components improved screening adherence. Additional studies are needed to evaluate efficacy, dissemination, and implementation of formal HCT survivorship programs.
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Affiliation(s)
- Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Lucy Gao
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Julie Vanderklish
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alexandra Tse
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Meredith Saylor
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Colleen Danielson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nisha Wali
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Matthew Frigault
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Steven McAfee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Thomas Spitzer
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Zachariah DeFilipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Yi-Bin Chen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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3
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Rotz SJ, Bhatt NS, Hamilton BK, Duncan C, Aljurf M, Atsuta Y, Beebe K, Buchbinder D, Burkhard P, Carpenter PA, Chaudhri N, Elemary M, Elsawy M, Guilcher GM, Hamad N, Karduss A, Peric Z, Purtill D, Rizzo D, Rodrigues M, Ostriz MBR, Salooja N, Schoemans H, Seber A, Sharma A, Srivastava A, Stewart SK, Baker KS, Majhail NS, Phelan R. International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update. Transplant Cell Ther 2024; 30:349-385. [PMID: 38413247 DOI: 10.1016/j.jtct.2023.12.001] [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: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
Abstract
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the number of HCTs performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pretransplantation, peritransplantation, and post-transplantation exposures and other underlying risk factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and then updated in 2012. An international group of experts was convened to review the contemporary literature and update the recommendations while considering the changing practices of HCT and cellular therapy. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed, but cGVHD management is not covered in detail. These guidelines emphasize the special needs of patients with distinct underlying HCT indications or comorbidities (eg, hemoglobinopathies, older adults) but do not replace more detailed group-, disease-, or condition-specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Neel S Bhatt
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christine Duncan
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard University, Boston, Massachusetts
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Kristen Beebe
- Phoenix Children's Hospital and Mayo Clinic Arizona, Phoenix, Arizona
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California
| | | | | | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Elemary
- Hematology and BMT, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Gregory Mt Guilcher
- Section of Pediatric Oncology/Transplant and Cellular Therapy, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, St Vincent's Clinical School Sydney, University of New South Wales, School of Medicine Sydney, University of Notre Dame Australia, Australia
| | - Amado Karduss
- Bone Marrow Transplant Program, Clinica las Americas, Medellin, Colombia
| | - Zinaida Peric
- BMT Unit, Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Duncan Purtill
- Fiona Stanley Hospital, Murdoch, PathWest Laboratory Medicine WA, Australia
| | - Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Maria Belén Rosales Ostriz
- Division of hematology and bone marrow transplantation, Instituto de trasplante y alta complejidad (ITAC), Buenos Aires, Argentina
| | - Nina Salooja
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, Department of Public Health and Primary Care, ACCENT VV, KU Leuven, University of Leuven, Leuven, Belgium
| | | | - Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | | | | | - Navneet S Majhail
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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4
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Felicetti F, Gatti F, Faraci D, Rosso D, Zavattaro M, Fortunati N, Marinelli L, Leone S, Gill J, Dionisi-Vici M, Dellacasa C, Busca A, Giaccone L, Arvat E, Bruno B, Brignardello E. Impact of allogeneic stem cell transplantation on thyroid function. J Endocrinol Invest 2023:10.1007/s40618-023-02039-x. [PMID: 36884196 DOI: 10.1007/s40618-023-02039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors. METHODS One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated. RESULTS After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%. CONCLUSIONS About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.
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Affiliation(s)
- F Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy.
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - F Gatti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - D Faraci
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - D Rosso
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - M Zavattaro
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
- Division of Endocrinology, University Hospital "Maggiore della Carità", Novara, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
| | - S Leone
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - J Gill
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - M Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - C Dellacasa
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Busca
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Giaccone
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Arvat
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - B Bruno
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
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5
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Tappeiner C, Heiligenhaus A, Halter JP, Miserocchi E, Bandello F, Goldblum D. Challenges and concepts in the diagnosis and management of ocular graft-versus-host disease. Front Med (Lausanne) 2023; 10:1133381. [PMID: 36891189 PMCID: PMC9987249 DOI: 10.3389/fmed.2023.1133381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/19/2023] Open
Abstract
Graft-versus-host disease (GVHD) is characterized by tissue inflammation in the host following an allogeneic hematopoietic cell transplantation (HCT). The pathophysiology is complex and only incompletely understood yet. Donor lymphocyte interaction with the histocompatibility antigens of the host plays a crucial role in the pathogenesis of the disease. Inflammation may affect multiple organs and tissues, e.g., the gastrointestinal tract, liver, lung, fasciae, vaginal mucosa, and the eye. Subsequently, alloreactive donor-derived T and B lymphocytes may lead to severe inflammation of the ocular surface (i.e., cornea and conjunctiva) and the eyelids. Furthermore, fibrosis of the lacrimal gland may lead to severe dry eye. This review focuses on ocular GVHD (oGVHD) and provides an overview of current challenges and concepts in the diagnosis and management of oGVHD. Ophthalmic manifestations, diagnostic procedures, grading of severity and recommendations for ophthalmic examination intervals are provided. Management of ocular surface disease with lubricants, autologous serum eye drops, topical anti-inflammatory agents and systemic treatment options are described based on the current evidence. Ocular surface scarring and corneal perforation are severe complications of oGVHD. Therefore, ophthalmic screening and interdisciplinary treatment approaches are highly relevant to improve the quality of life of patients and to prevent potentially irreversible visual loss.
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Affiliation(s)
- Christoph Tappeiner
- Department of Ophthalmology, Pallas Klinik, Olten, Switzerland.,Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | - Joerg P Halter
- Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - David Goldblum
- Department of Ophthalmology, Pallas Klinik, Olten, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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6
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Alabdaljabar MS, Durani U, Thompson CA, Constine LS, Hashmi SK. The forgotten survivor: A comprehensive review on Non-Hodgkin lymphoma survivorship. Am J Hematol 2022; 97:1627-1637. [PMID: 36069675 DOI: 10.1002/ajh.26719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 01/31/2023]
Abstract
The number of non-Hodgkin lymphoma (NHL) survivors is increasing. With the advancement of NHL therapies, it is crucial to focus on the challenges these survivors may face. Three main categories are to be considered in NHL survivorship, including quality of life and uncertainty about the future, possible physical health complications (including cardiovascular disease, infertility, and subsequent neoplasms), and the impact of novel NHL treatments and their potential complications. The latter includes CAR T-cell therapy, monoclonal antibodies, checkpoint inhibitors, and hematopoietic stem cell transplantation. In this report, we aim to shed the light on these aspects and to discuss survivorship care plan for NHL.
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Affiliation(s)
| | - Urshila Durani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie A Thompson
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, New York City, New York, USA
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Sheikh Shakhbout Medical City / Mayo Clinic, Abu Dhabi, United Arab Emirates
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7
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Baer LK, Brister L, Mazanec SR. Development and Implementation of an Advanced Practitioner-Led Survivorship Clinic for Patients Status Post Allogeneic Transplant. J Adv Pract Oncol 2022; 12:775-783. [PMID: 35295542 PMCID: PMC8631341 DOI: 10.6004/jadpro.2021.12.8.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Survivor recovery from hematopoietic cell transplantation (HCT) is long term, with significant physical and psychological morbidities that impact quality of life and reentry into personal and social lives. The optimal timing of when and how to deliver comprehensive HCT survivorship care is not well defined. Purpose: The purpose of this study was to design, implement, and evaluate an advanced practitioner (AP)-led pilot survivorship clinic incorporating an individual and group format for patients post HCT at the 1-year transition period. Methods: A survey assessing physical, social, emotional, and spiritual needs and concerns was mailed to a sample of patients who underwent HCT between 2009 and 2014. This phase 1 survey was utilized in the phase 2 design of an AP-led pilot survivorship clinic for patients post allogeneic HCT. A total of 15 patients were approached, out of which 7 enrolled over a 12-month period in the pilot survivorship clinic. Results: The needs assessment survey noted the most prevalent moderate to high concerns were in the emotional domain, with 52% of respondents identifying fear of cancer returning and new cancer developing. The pilot survivorship clinic incorporating a group visit format with multiple sessions was not feasible for both patients and APs within the context of a small- to medium-sized HCT program. Conclusion: The needs assessment survey underscored the importance of addressing all four quality of life domains in cancer survivors. A hybrid survivorship clinic with one comprehensive group visit may be beneficial for HCT survivors at the 1-year transition for small- to medium-sized HCT programs.
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Affiliation(s)
- Linda K Baer
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Lauren Brister
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Susan R Mazanec
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
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8
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Assessing long-term effects after stem cell transplantation: design of the MOSA study. J Clin Epidemiol 2022; 148:10-16. [DOI: 10.1016/j.jclinepi.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/14/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022]
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9
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Morken C, Tevaarwerk AJ, Juckett MB, Swiecichowski AK, Haine JE, Zhang X, Williams ZT, Norslien K, Campbell B, Wassenaar T, Sesto ME. Barriers and facilitators to the use of survivorship care plans by hematopoietic stem cell transplant survivors and clinicians. Support Care Cancer 2022; 30:1323-1330. [PMID: 34482447 PMCID: PMC8732291 DOI: 10.1007/s00520-021-06492-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Survivors of hematopoietic stem cell transplants (HSCT) have complex care needs for the remainder of their lives, known as the survivorship period. Survivorship care plans (SCPs) have been proposed to improve care coordination and ultimately survivorship outcomes. We explored the barriers and facilitators of SCP use among HSCT survivors and their clinicians in order to develop more useful SCPs for the HSCT context. METHODS Analogous surveys regarding perceived barriers to and facilitators of SCP use based on a sample SCP for a female allogenic HSCT survivor were administered to HSCT survivors and non-transplant oncology and primary care clinicians. RESULTS Twenty-seven HSCT survivors and 18 clinicians completed the survey. The main barriers to SCP use were lack of awareness of SCP existence, uncertainty regarding where to find SCP, unclear roles and responsibilities among healthcare teams, length of SCP, and difficultly understanding SCPs. The facilitators of SCP use were increased understanding of survivorship care needs, clarified roles and responsibilities of survivors and clinicians, SCPs that are readily available and searchable in electronic health record, increased awareness of SCP existence and provision to all survivors, and if the SCP is survivor-specific and up-to-date. CONCLUSIONS Much of the work regarding SCPs has looked at barriers to creation and provision; however, our study examines factors influencing use of SCPs. By determining the barriers and facilitators surrounding SCP use for HSCT survivors and their clinicians, we can create SCP templates and clinical workflows to optimize SCP use, ideally leading to better outcomes for HSCT survivors.
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Affiliation(s)
| | - Amye J Tevaarwerk
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | - James E Haine
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, WI
| | | | | | | | | | - Mary E Sesto
- University of Wisconsin, Madison, WI,Carbone Cancer Center, University of Wisconsin, Madison, WI
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10
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Incidence of subsequent malignancies after total body irradiation-based allogeneic HSCT in children with ALL - long-term follow-up from the prospective ALL-SCT 2003 trial. Leukemia 2022; 36:2567-2576. [PMID: 36097283 PMCID: PMC9613465 DOI: 10.1038/s41375-022-01693-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022]
Abstract
Total body irradiation (TBI)-based conditioning is associated with superior leukemia-free survival in children with ALL undergoing HSCT. However, the risk for subsequent malignant neoplasms (SMN) remains a significant concern. We analyzed 705 pediatric patients enrolled in the prospective ALL-SCT-BFM-2003 trial and its subsequent registry. Patients >2 years received conditioning with TBI 12 Gy/etoposide (n = 558) and children ≤2 years of age or with contraindications for TBI received busulfan/cyclophosphamide/etoposide (n = 110). The 5- and 10-year cumulative incidence of SMN was 0.02 ± 0.01 and 0.13 ± 0.03, respectively. In total, 39 SMN (34 solid tumors, 5 MDS/AML) were diagnosed in 33 patients at a median of 5.8 years (1.7-13.4), exclusively in the TBI group. Of 33 affected patients, 21 (64%) are alive at a median follow-up of 5.1 years (0-9.9) after diagnosis of their first SMN. In univariate analysis, neither age at HSCT, donor type, acute GVHD, chronic GVHD, nor CMV constituted a significant risk factor for SMN. The only significant risk factor was TBI versus non-TBI based conditioning. This analysis confirms and quantifies the increased risk of SMN in children with ALL after conditioning with TBI. Future strategies to avoid TBI will need careful tailoring within prospective, controlled studies to prevent unfavorable outcomes.
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11
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Zhao H, Duan Z, Li M, Chiao E, Ahmed S, Shih YCT, Hwang JP. Increased Incidence of Human Papillomavirus-Related Precancer or Second Malignancy Among Allogeneic Stem Cell Transplantation Patients: A SEER-Medicare Population Study. Transplant Cell Ther 2021; 27:1016.e1-1016.e9. [PMID: 34474166 DOI: 10.1016/j.jtct.2021.08.020] [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: 07/01/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Each year, more than 8000 allogeneic stem cell transplantations (allo-SCT) are performed in the United States, with approximately 30% of these patients age ≥60 years. Allo-SCT recipients are at increased risk for developing human papillomavirus (HPV)-related precancer or second malignancy. It is important to evaluate HPV-related precancer or second malignancy among allo-SCT recipients to develop or enhance screening and preventive practice guidelines to improve patients' survival and quality of life. In this retrospective matched case-control study, we estimated the cumulative incidence of HPV-related precancer or second malignancy in both male and female Medicare beneficiaries who underwent allo-SCT and compared it with the cumulative incidence in non-SCT controls and noncancer controls. Hematologic cancer patients age ≥18 years who underwent allo-SCT between 2002 and 2011 were matched 1:5 to non-SCT controls and to noncancer controls by age, sex, race/ethnicity, and duration of follow-up. Proportions of HPV-related precancer or second malignancy were estimated and compared between cases and controls using the chi-square test and logistic regression. Kaplan-Meier cumulative incidences were estimated and compared using log-rank tests. We identified 700 allo-SCT cases (median age, 64 years; median follow-up post-transplantation, 4.3 years) matched with 3159 non-SCT controls and 3302 noncancer controls. Approximately 3.7% of allo-SCT cases developed HPV-related precancer or second malignancy post-transplantation, compared with 1.9% of the non-SCT controls and 1.1% of the noncancer controls. The odds ratio of developing HPV-related precancer or second malignancy of allo-SCT cases compared with non-SCT controls and noncancer controls was 2.0 (95% confidence interval [CI], 1.25 to 3.18) and 3.5 (95% CI, 2.1 to 5.8), respectively. Both allo-SCT cases and non-SCT controls had significantly higher proportions and odds of developing HPV-related precancer or second malignancy compared with noncancer controls. The 5-year cumulative incidence in allo-SCT cases was 5%, compared with 2.1% in non-SCT controls and 1.2% in noncancer controls. The cumulative incidence of HPV-related precancer or second malignancy was statistically significantly higher in the allo-SCT than in either of the 2 matched control groups, and the non-SCT controls had a higher cumulative incidence of HPV-related precancer or second malignancy than the noncancer controls. The allo-SCT cases were at increased risk of developing HPV-related precancer or second malignancy compared with the non-SCT controls and noncancer controls. Routine screening of HPV-related precancer or second malignancy in allo-SCT recipients is needed to help prevent HPV-related precancer or second malignancy. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Zhigang Duan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meng Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica P Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Rotz SJ, Ryan TD, Hayek SS. Cardiovascular disease and its management in children and adults undergoing hematopoietic stem cell transplantation. J Thromb Thrombolysis 2021; 51:854-869. [PMID: 33230704 PMCID: PMC8085022 DOI: 10.1007/s11239-020-02344-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many malignancies, hemoglobinopathies, metabolic diseases, bone marrow failure syndromes, and primary immune deficiencies. Despite the significant improvement in survival afforded by HSCT, the therapy is associated with major short and long-term morbidity and mortality. Cardiovascular complications such as cardiomyopathy, arrhythmias, pulmonary hypertension, and pericardial effusions are increasingly recognized as potential outcomes following HSCT. The incidence of cardiac complications is related to various factors such as age, co-morbid medical conditions, whether patients received cardiotoxic chemotherapy prior to HSCT, the type of HSCT (autologous versus allogeneic), and the specific conditioning regimen. Thus, the cardiovascular evaluation has become a core component of the pre-transplant assessment, however, the practice differs from center to center as national guidelines and contemporary high-quality studies are lacking. We review the incidence of cardiotoxicity in pediatric and adult HSCT, potential mechanisms of injury, and effects on long-term outcomes. We also discuss the possible therapeutic approaches when disease arises, as well as the indications and need for surveillance before, during, and after transplantation.
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Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Thomas D Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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13
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Functional capacity, pulmonary function, and quality of life in hematopoietic stem cell transplantation survivors. Support Care Cancer 2021; 29:4015-4021. [PMID: 33394196 DOI: 10.1007/s00520-020-05947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Hematopoietic stem cell transplantation (HSCT) is used as a treatment for several diseases. The objective was to evaluate the functional capacity, pulmonary function, and quality of life (QoL) in HSCT survivors. METHODS The patients were submitted to spirometry and six-minute walk test (6MWT) and evaluation of QoL (Functional Assessment of Cancer Therapy Bone Marrow Transplantation-FACT-BMT) and the level of physical activity (Human Activity Profile-HAP) in the post-HSCT outpatient ambulatory. RESULTS The sample was composed of 103 individuals with a mean age of 42.1 ± 12 and a median HSCT time of 5 (2-11) years. The average distance walked in the 6MWT was 524.7 ± 73.5 m; the FACT-BMT score, 82 ± 8.7 points; FEV1, 76.8 ± 22.6%; and HAP, 71.9 ± 11.2 points. There was a significant difference between debilitated and physically active individuals for the variables: forced expiratory volume in the first second (FEV1) in liters (p = 0.008) and % of predicted (p = 0.017), FEV1/FVC (p = 0.032), distance on the 6MWT (p < 0.001), fatigue after the 6MWT (p < 0.001), and physical well-being (p = 0.005). CONCLUSIONS HSCT survivors have long-term changes in functional capacity, pulmonary function, and QoL. Subjects more active had better results in pulmonary function and functional capacity.
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14
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Seneviratne AK, Wright C, Lam W, Lipton JH, Michelis FV. Comorbidity profile of adult survivors at 20 years following allogeneic hematopoietic cell transplantation. Eur J Haematol 2020; 106:241-249. [PMID: 33128242 DOI: 10.1111/ejh.13542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
Numerous chronic medical conditions and complications can arise following allogeneic hematopoietic cell transplantation (HCT) that may have a negative impact on survival and quality of life. OBJECTIVE The purpose of the present study was to review the comorbidities of a single-center cohort of allogeneic HCT recipients that survived 20 years postallogeneic transplantation. METHODS We retrospectively investigated 172 patients that underwent allogeneic HCT at the Princess Margaret Cancer Centre between 1979 and 1998 and who survived at least 20 years post-HCT. RESULTS The most frequent individual comorbidities documented were dyslipidemia (29%), hypertension (31%), osteoporosis (15%), hypothyroidism (15%), and depression/anxiety (13%). Follow-up data following the 20-year mark were available for 135 patients, overall survival (OS) of that group at 5 and 10 years was 94% and 90%, respectively. When grouped by the number of concurrent comorbidities, there was a significant difference in OS between the groups with 0-1, 2-3, and ≥4 comorbidities (P = .01). CONCLUSIONS Evidently, long-term allogeneic HCT recipients may develop a number of comorbidities that negatively influence survival even past the 20-year post-transplant mark. These findings warrant the continuous long-term medical follow-up of allogeneic transplant patients, regardless of age or time that has lapsed post-HCT.
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Affiliation(s)
- Ayesh K Seneviratne
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Clare Wright
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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15
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Preussler JM, Denzen EM, Majhail NS, Baker KS, McCann M, Burns LJ, Yi J, Syrjala KL. Engaging hematopoietic cell transplantation patients and caregivers in the design of print and mobile application individualized survivorship care plan tools. Support Care Cancer 2020; 28:2805-2816. [PMID: 31729567 PMCID: PMC7189809 DOI: 10.1007/s00520-019-05114-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/01/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE INSPIRE (INteractive Survivorship Program with Information and REsources) is an online health program that includes a mobile app, website, health action plan, and individualized survivorship care plans for adult hematopoietic cell transplant (HCT) survivors. The INSPIRE program integrates two previously effective randomized control trials that tested an internet-based program and patient-centered survivorship care plans for HCT survivors. METHODS Three focus groups were conducted with a total of 22 participants (20 patients, 2 caregivers/patient advocates) to explore patient and caregiver preferences and to optimize the patient-centered emphasis of INSPIRE. Adult (age > 18 years at the time of study entry) HCT recipients had to be at least 1-year post-HCT to participate; caregivers/patient advocates were also eligible. Participants had to be able to communicate in English, could have any diagnosis, transplant type, or donor source, and could have had multiple transplants. RESULTS All patient participants received an allogeneic HCT; average time since HCT was 8 years (range 2-22 years). The majority of participants were female (77.3%). Overall, the tools were well received by participants in this study, particularly the personalized features of all the tools. Major themes included interest in having the ability to tailor features to individual needs, and an interest in tracking information over time. DISCUSSION Engaging patients and caregivers is invaluable to optimize tools designed to improve HCT survivorship care. Print, online, and mobile-based tools, tailored to individual patients' treatment history and requisite follow-up care, can provide otherwise unavailable expertise and guidelines for care.
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Affiliation(s)
- Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, 55401, USA.
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, 55401, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA
| | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Meggan McCann
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, 55401, USA
| | - Jean Yi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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16
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Eeltink CM, Incrocci L, Leeuw IMVD, Zweegman S. Recommended patient information sheet on the impact of haematopoietic cell transplantation on sexual functioning and sexuality. Ecancermedicalscience 2020; 13:987. [PMID: 32010211 PMCID: PMC6974367 DOI: 10.3332/ecancer.2019.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/30/2022] Open
Abstract
Sexual concerns are common after haematopoietic cell transplantation (HCT). Exposure to total body irradiation (TBI), alkylating agent and graft versus host disease (GvHD) can all affect sexual function, leading to problems in sexual desire, arousal and the orgasm phase of the sexual response cycle. In high-risk haematological malignancies, such as acute leukaemia and myelodysplastic syndromes, HCT often offers the highest chance for long-term survival. In addition, these haematological diseases and HCT can have an impact on body image, self-esteem, (sexual) relationship and psychosocial factors, all of which are able to affect sexuality and sexual function. Five years post HCT, 80% of the female survivors and 46% of the male survivors report sexual dysfunction. It has been shown that these patients cope better after having discussed sexual health. While healthcare providers (HCPs) have the responsibility to address sexual issues, it has been demonstrated that 48%–82% HCT recipients reported not having discussed sexual issues with their HCPs and that only one-third of the HCPs routinely discussed sexual issues with their patients. HCPs describe a lack of knowledge and being uncomfortable with the topic as the most important reasons for not addressing sexual functioning. Even so, it would help >90% HCPs if the patient initiated discussing sexual issues. However, to empower patients addressing sexual issues, adequate comprehensive patient information is needed. In an effort to better meet the patients’ need, a patient information sheet: ‘Information for patients undergoing Hematopoietic Cell Transplantation: the impact of the disease and treatment on sexual function and sexuality’, has been created. In this review, we describe what is known about the impact of HCT on sexual function and briefly the management of sexual problems.
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Affiliation(s)
- Corien M Eeltink
- Amsterdam University Medical Center, Cancer Center Amsterdam, Department of Hematology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, Department of Clinical Psychology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.,Department of Otolaryngology, Amsterdam University Medical Centers (Amsterdam UMC), location VUmc, 1105 AZ Amsterdam, The Netherlands.,Cancer Center Amsterdam, EMGO+ Institute, 1081 HV Amsterdam, The Netherlands
| | - Sonja Zweegman
- Amsterdam University Medical Center, Cancer Center Amsterdam, Department of Hematology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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17
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Jeong C, Kim HJ, Lee S, Kang MI, Ha J. Effect of Denosumab on Bone Mineral Density of Hematopoietic Stem Cell Transplantation Recipients. Int J Endocrinol 2020; 2020:3410921. [PMID: 32454821 PMCID: PMC7218957 DOI: 10.1155/2020/3410921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Denosumab is a monoclonal antibody that prevents the development of osteoclasts. The effect of denosumab in solid organ transplant recipients has been elucidated, but its effect in haematopoietic stem cell transplantation recipients has not been studied yet. The aim of this study was to determine the effectiveness and safety of denosumab in haematopoietic stem cell transplantation recipients. METHODS We retrospectively evaluated 33 female patients with osteoporosis (mean age 52.6 ± 9.8 years) following allogeneic haematopoietic stem cell transplantation. Patients were treated with denosumab every 6 months for 12 months. Changes in bone mineral density were evaluated for denosumab-treated patients in a 12-month interval after the first administration of denosumab. RESULTS Significant increases in bone mineral density were observed in all measured skeletal sites including 4.39 ± 6.63% in the lumbar spine (p=0.014), 3.11 ± 7.69% in the femoral neck (p=0.048), and 1.97 ± 6.01% in the total hip (p=0.138). The bone turnover marker serum cross-linked C-terminal telopeptide of type 1 collagen was decreased at 18 months (-51.6 ± 17.6%, p < 0.001). No serious symptomatic hypocalcaemia was observed. Serious adverse drug reactions requiring drug discontinuation were not observed. CONCLUSION Denosumab improved bone mineral density in haematopoietic stem cell transplantation recipients. The use of denosumab could be a good therapeutic option without causing severe adverse effects in recipients of haematopoietic transplantation.
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Affiliation(s)
- Chaiho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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18
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Dunn-Pirio AM, Heyman BM, Kaufman DS, Kinkel RP. Outcomes and Cost-Effectiveness of Autologous Hematopoietic Cell Transplant for Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:53. [PMID: 31624926 DOI: 10.1007/s11940-019-0588-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review presents a critical appraisal of the use of autologous hematopoietic cell transplant (AHCT) for the treatment of multiple sclerosis. We present the reader with a brief review on the AHCT procedure, its immunomodulatory mechanism of action in MS, the most recent evidence in support of its use in patients with relapsing-remitting multiple sclerosis (RRMS), as well as its cost considerations. RECENT FINDINGS The first meta-analysis of clinical trials of AHCT for patients with MS demonstrated durable 5-year progression-free survival rates and low treatment-related mortality. Recently, the first randomized controlled phase III clinical trial demonstrated AHCT to be superior to best available therapy for a subset of patients with RRMS. This led to the American society for transplant and cellular therapies (ASTCT) to recommend AHCT "for patients with relapsing forms of MS who have prognostic factors that indicate a high risk of future disability." AHCT should be considered for patients with RRMS with evidence of clinical activity who have failed 2 lines of therapy or at least one highly active disease-modifying therapy.
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Affiliation(s)
- Anastasie M Dunn-Pirio
- Division of Neuroimmunology, Department of Neurosciences, UC San Diego, La Jolla, CA, 92093, USA
| | - Benjamin M Heyman
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center, UC San Diego, MC 0695, La Jolla, CA, 92093, USA.
| | - Dan S Kaufman
- Division of Regenerative Medicine, Department of Medicine, Moores Cancer Center, UC San Diego, MC 0695, La Jolla, CA, 92093, USA
| | - Revere P Kinkel
- Division of Neuroimmunology, Department of Neurosciences, UC San Diego, La Jolla, CA, 92093, USA
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19
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Morken CM, Tevaarwerk AJ, Swiecichowski AK, Haine JE, Williams ZT, Norslien K, Arroyo N, Zhang X, Campbell B, Mendonca EA, Juckett MB, Sesto ME. Survivor and Clinician Assessment of Survivorship Care Plans for Hematopoietic Stem Cell Transplantation Patients: An Engineering, Primary Care, and Oncology Collaborative for Survivorship Health. Biol Blood Marrow Transplant 2019; 25:1240-1246. [PMID: 30763727 DOI: 10.1016/j.bbmt.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
The long-term care of hematopoietic stem cell transplantation (HSCT) survivors poses special challenges owing to a myriad of possible chronic and/or late complications. Survivorship care plans (SCPs) have been proposed as tools to communicate information on the late effects of treatment and recommended follow-up care to clinicians and survivors. The primary aims of this study were to determine SCP content and format, as well as to assess the preferred timing of SCP provision following HSCT. HSCT survivors and nontransplantation clinicians (oncologists and primary care physicians) were invited to participate in a survey evaluating the usefulness and utility of a sample HSCT-specific SCP with a treatment summary generated by autopopulation from an electronic health record (EHR). All participating HSCT survivors (n = 29) and clinicians (n = 18) indicated a desire to receive an SCP. More than 85% of the participants perceived information about treatments received, recommended follow-up and health maintenance including vaccinations, survivor and clinician resources, and graft-versus-host disease and other late/chronic side effects to be useful. The majority of survivors also believed that care team contact information was useful. In addition, >85% of survivors and clinicians agreed that the SCP increased their understanding of treatments and chronic/late side effects, improved health care provided, and were satisfied with the SCP and found it understandable and easy to use. The majority of survivors indicated that additional information should be added to the SCP, whereas some clinicians deemed the SCP too long. Survivors preferred to receive the SCP as a paper document at the end of a regular follow-up visit and review it with a cancer clinician, whereas clinicians preferred to receive the SCP through the EHR. These findings will help improve the design of future SCPs for use by HSCT survivors and clinicians. Future work will include leveraging the EHR to ease the burden of creating user-centered documents.
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Affiliation(s)
- Colleen M Morken
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Amye J Tevaarwerk
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | | | - James E Haine
- Division of General Internal Medicine, University of Wisconsin, Madison, Wisconsin
| | | | | | - Natalia Arroyo
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Xiao Zhang
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | | | - Eneida A Mendonca
- Department of Biostatistics and Medical Informatics and Department of Pediatrics, University of Wisconsin, Madison
| | - Mark B Juckett
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Mary E Sesto
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin.
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Robin M, de Wreede LC, Wolschke C, Schetelig J, Eikema DJ, Van Lint MT, Knelange NS, Beelen D, Brecht A, Niederwieser D, Vitek A, Bethge W, Arnold R, Finke J, Volin L, Yakoub-Agha I, Nagler A, Poiré X, Einsele H, Chevallier P, Holler E, Ljungman P, Robinson S, Radujkovic A, McLornan D, Chalandon Y, Kröger N. Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis. Haematologica 2019; 104:1782-1788. [PMID: 30733269 PMCID: PMC6717573 DOI: 10.3324/haematol.2018.205211] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/31/2019] [Indexed: 12/25/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplant remains the only curative treatment for myelofibrosis. Most post-transplantation events occur during the first two years and hence we aimed to analyze the outcome of 2-year disease-free survivors. A total of 1055 patients with myelofibrosis transplanted between 1995 and 2014 and registered in the registry of the European Society for Blood and Marrow Transplantation were included. Survival was compared to the matched general population to determine excess mortality and the risk factors that are associated. In the 2-year survivors, disease-free survival was 64% (60-68%) and overall survival was 74% (71-78%) at ten years; results were better in younger individuals and in women. Excess mortality was 14% (8-21%) in patients aged <45 years and 33% (13-53%) in patients aged ≥65 years. The main cause of death was relapse of the primary disease. Graft-versus-host disease (GvHD) before two years decreased the risk of relapse. Multivariable analysis of excess mortality showed that age, male sex recipient, secondary myelofibrosis and no GvHD disease prior to the 2-year landmark increased the risk of excess mortality. This is the largest study to date analyzing long-term outcome in patients with myelofibrosis undergoing transplant. Overall it shows a good survival in patients alive and in remission at two years. However, the occurrence of late complications, including late relapses, infectious complications and secondary malignancies, highlights the importance of screening and monitoring of long-term survivors.
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Affiliation(s)
- Marie Robin
- Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands and DKMS CTU, Dresden, Germany
| | | | - Johannes Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Antonin Vitek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | - Jürgen Finke
- Division of Medicine I, Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg, Germany
| | - Liisa Volin
- HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Donal McLornan
- Comprehensive Cancer Centre, Department of Haematology, Kings College, London, UK
| | - Yves Chalandon
- Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Poręba M, Gać P, Usnarska-Zubkiewicz L, Pilecki W, Kuliczkowski K, Mazur G, Gonerska M, Sobieszczańska M, Poręba R. Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies. Med Oncol 2018; 35:162. [PMID: 30382530 PMCID: PMC6208856 DOI: 10.1007/s12032-018-1221-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: Tp-e and Tp-e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, Tp-e interval and Tp-e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in Tp-e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.
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Affiliation(s)
- Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, 50-368, Wroclaw, Poland
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368, Wroclaw, Poland.
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteur 4, 50-367, Wroclaw, Poland
| | - Witold Pilecki
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, 50-368, Wroclaw, Poland
| | - Kazimierz Kuliczkowski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Pasteur 4, 50-367, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Marzena Gonerska
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, 50-368, Wroclaw, Poland
| | - Małgorzata Sobieszczańska
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, 50-368, Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Hamidieh AA, Eslami Shahre Babaki A, Rostami T, Kasaeian A, Koochakzadeh L, Sharifi Aliabadi L, Behfar M, Ghavamzadeh A. A Single-Center Experience With Hematopoietic Stem Cell Transplantation for Pediatric Acute Lymphoblastic Leukemia: A Modest Pitch for Non-Total Body Irradiation Conditioning Regimens. EXP CLIN TRANSPLANT 2018; 17:243-250. [PMID: 30295587 DOI: 10.6002/ect.2017.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Allogeneic hematopoietic stem cell transplantation has been used for several decades to treat patients with acute lymphoblastic leukemia. Total body irradiation has been promoted as an important component of conditioning regimens for this process; however, recent reports of chemotherapy-based conditioning regimens have shown comparable outcomes. MATERIALS AND METHODS We report our experience with radiation-free conditioning using busulfan and cyclophosphamide in 127 pediatric patients with acute lymphoblastic leukemia who were treated between 1997 and 2014. The median age was 11 years (range, < 1 to 15 y), 70% of patients were male, 81.1% received transplants from HLA-matched siblings, 83% received peripheral blood stem cells, 41% were in second complete remission at the time of transplant, and 83% had B-lineage immunophenotype. RESULTS In patients who were in complete remission at the time of transplant, 5-year overall survival, leukemia-free survival, and relapse rates were 62.48% (95% confidence interval, 52.29-71.09%), 49.43% (95% confidence interval, 39.57-58.53%), and 45.64% (95% confidence interval, 35.85-54.88%), respectively. We observed significant differences between outcomes in patients by time of transplant, presence of chronic graft-versus-host disease, and remission status. CONCLUSIONS Our relapse rates were comparable to those shown in recent studies, although the transplant-related mortality rate was lower. The results of our study showed that a busulfan/cyclophosphamide conditioning regimen has acceptable outcomes without the undesirable adverse effects of total body irradiation, particularly in pediatric patients. Large multicenter studies are needed to assess less toxic conditioning regimens with fewer adverse effects in these patients.
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Affiliation(s)
- Amir Ali Hamidieh
- From the Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Berghiche A, Khenenou T, Kouzi A, Labiad I. An investigation on the predominant diseases, its diagnosis, and commonly used drugs in the poultry farms in the North-Eastern regions of Algeria. Vet World 2018; 11:986-989. [PMID: 30147270 PMCID: PMC6097571 DOI: 10.14202/vetworld.2018.986-989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022] Open
Abstract
Aim An investigation was carried out to assess the occurrence of diseases, its method of diagnosis, and commonly used drugs in poultry farms in North-Eastern regions of Algeria. Materials and Methods A total of 265 veterinary doctors were surveyed to obtain information on the dominant diseases, its frequency of occurrence, method of diagnosis, and commonly used drugs in poultry farms. Results A study revealed that about 68% of bacterial diseases are due to colibacillosis, mycoplasmosis, and salmonellosis, 22% of viral diseases are due to Newcastle, Gumboro, and infectious bronchitis, and 10% others including coccidiosis and ascites syndrome. The study also showed that about 57% of cases were diagnosed by clinical signs, 36% by necropsy findings, and the remaining 7% through therapeutic and laboratory analysis. Antibiotics, a predominance of the anarchic veterinary drugs, were massively used to control the diseases. Hence, there is a need for strict regulations on the use of veterinary drugs to guarantee food safety. Conclusion These results remain non-exhaustive but contribute strongly to determine the status of health of the birds in the region.
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Affiliation(s)
- Amine Berghiche
- Department of Veterinary Science, Institute of Agronomic and Veterinarian Sciences, University of Mohamed Cherif Messaâdia, Souk Ahras, Algeria
| | - Tarek Khenenou
- Laboratory of Animal Production, Biotechnology and Health, University of Mohamed Cherif Messaâdia, Souk Ahras, Algeria
| | - Ahmed Kouzi
- Laboratory of Animal Production, Biotechnology and Health, University of Mohamed Cherif Messaâdia, Souk Ahras, Algeria
| | - Ibtissem Labiad
- Laboratory of Science and Technique of Living, Institute of Agronomic and Veterinarian Sciences, University of Mohamed Cherif Messaâdia, Souk Ahras, Algeria
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Pathak M, Diep PP, Lai X, Brinch L, Ruud E, Drolsum L. Ocular findings and ocular graft-versus-host disease after allogeneic stem cell transplantation without total body irradiation. Bone Marrow Transplant 2018; 53:863-872. [PMID: 29382955 PMCID: PMC6039390 DOI: 10.1038/s41409-018-0090-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/10/2017] [Accepted: 12/23/2017] [Indexed: 12/05/2022]
Abstract
Patients treated with allogeneic stem cell transplantation (allo-SCT) often develop ocular complications. To investigate the ocular findings in young long-term survivors after allo-SCT without TBI, we examined 96 patients more than 5 years after transplantation. All patients were under 30 years of age at transplantation. The mean follow-up time was 16.8 years (range 6.0-26.1 years). The study was a part of the Norwegian Allo Survivorship Study investigating health impairments in young survivors after allo-SCT. Ophthalmological examination included visual acuity, tear break-up time, corneal fluorescein staining, Schirmer I test, tear film osmolarity, biomicroscopy and dilated ophthalmoscopy. In patients with known systemic chronic GVHD (cGVHD), ocular GVHD (oGVHD) diagnosed by clinical examination was compared with diagnosis using National Institutes of Health (NIH) or International Chronic Ocular Graft-vs-Host-Disease (ICCGVHD) Consensus Group criteria. We diagnosed dry eye disease (DED) in 52 patients (54%), cataract in 3 patients (3%) and retinopathy in 1 patient (1%). Systemic cGVHD was a risk factor for DED (OR 4.40, CI 1.33-14.56, p = 0.02). Comparison of diagnostic criteria suggests that the more stringent ICCGVHD criteria can better differentiate DED from oGVHD after allo-SCT as compared with the NIH criteria.
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Affiliation(s)
- Meeta Pathak
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
- University of Oslo, Oslo, Norway.
| | - Phoi Phoi Diep
- University of Oslo, Oslo, Norway
- Children and Adolescent's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Xiaoran Lai
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Lorentz Brinch
- Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ellen Ruud
- University of Oslo, Oslo, Norway
- Children and Adolescent's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Liv Drolsum
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
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Dirou S, Chambellan A, Chevallier P, Germaud P, Lamirault G, Gourraud PA, Perrot B, Delasalle B, Forestier B, Guillaume T, Peterlin P, Garnier A, Magnan A, Blanc FX, Lemarchand P. Deconditioning, fatigue and impaired quality of life in long-term survivors after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 53:281-290. [PMID: 29269801 DOI: 10.1038/s41409-017-0057-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/18/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022]
Abstract
Long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk for treatment-related adverse events, that may worsen physical capacity and may induce fatigue and disability. The aims of this prospective study were to evaluate exercise capacity in allotransplant survivors and its relationship with fatigue and disability. Patient-reported outcomes and exercise capacity were evaluated in 71 non-relapse patients 1 year after allo-HSCT, using validated questionnaires, cardiopulmonary exercise testing (CPET) with measure of peak oxygen uptake (peakVO2) and deconditioning, pulmonary function testing, echocardiography and 6-min walk test. A high proportion (75.4%) of allo-HSCT survivors showed abnormal cardiopulmonary exercise testing parameters as compared to predicted normal values, including 49.3% patients who exhibited moderate to severe impairment in exercise capacity and 37.7% patients with physical deconditioning. PeakVO2 values were not accurately predicted by 6-min walk distances (r = 0.53). Disability and fatigue were strongly associated with decreased peakVO2 values (p = 0.002 and p = 0.008, respectively). Exercise capacity was reduced in most allo-HSCT long-term survivors. Because reduced exercise capacity was associated with fatigue, disability and a decrease in quality of life, cardiopulmonary exercise testing should be performed in every patient who reports fatigue and disability.
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Affiliation(s)
- Stéphanie Dirou
- l'institut du thorax, UNIV Nantes, CHU Nantes, Nantes, 44000, France.
| | - Arnaud Chambellan
- Laboratory "Movement, Interactions, Performance", UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | - Patrice Chevallier
- Hematology, department Inserm UMR U892, CHU Nantes, Nantes, 44000, France
| | | | - Guillaume Lamirault
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | - Pierre-Antoine Gourraud
- Equipe ATIP-Avenir INSERM, UNIV Nantes, CHU Nantes, Nantes, 44000, France.,Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bastien Perrot
- Plateforme de biométrie, CHU Nantes, Nantes, 44000, France
| | - Béatrice Delasalle
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | | | | | | | - Alice Garnier
- Hematology department, CHU Nantes, Nantes, 44000, France
| | - Antoine Magnan
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | | | - Patricia Lemarchand
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
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26
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Premstaller M, Perren M, Koçack K, Arranto C, Favre G, Lohri A, Gerull S, Passweg JR, Halter JP, Leuppi-Taegtmeyer AB. Dyslipidemia and lipid-lowering treatment in a hematopoietic stem cell transplant cohort: 25 years of follow-up data. J Clin Lipidol 2017; 12:464-480.e3. [PMID: 29310991 DOI: 10.1016/j.jacl.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dyslipidemia is common after hematopoietic stem cell transplantation (HSCT). Few data regarding the time course of lipid profiles after HSCT, the effect of multiple transplantations, and efficacy and safety of lipid-lowering treatments are available. OBJECTIVE The objective of the study was to determine the prevalence and treatment of dyslipidemia over a 25-year period in a large, single-center cohort. METHODS One thousand one hundred ninety-six adult patients (≥16 years) who underwent HSCT during 1973 to 2013 and who survived ≥100 days were studied retrospectively. RESULTS The prevalence of dyslipidemia before transplantation was 36% and 28% in the autologous and allogeneic groups, respectively (P < .001). Three months after HSCT, the prevalence rose to 62% and 74% (P < .001), and at 25 years, it was 67% and 89%. Lipid profiles were similar after first and subsequent transplants. Baseline dyslipidemia (odds ratio [OR] = 2.72), allogeneic transplant (OR = 2.44), and age ≥ 35 years (OR = 2.33) were independent risk factors for dyslipidemia at 1 year. Lipid-lowering treatment was given to 223 (19%) patients, primarily in the form of statins (86%) and was associated with a decrease in total cholesterol from 246 to 192 mg/dL (P < .01) and from 244 to 195 mg/dL (P < .001) in the autologous and allogeneic groups, respectively. There were 10 cases (4%) of muscle symptoms prompting cessation of lipid-lowering therapy, including 1 case of rhabdomyolysis. The OR for dyslipidemia among patients who suffered a cardiovascular event (conditional logistic regression) was 3.5 (95% confidence interval = 1.6-7.7, P = .002). CONCLUSION This study confirms that dyslipidemia is a common and long-lasting phenomenon among both allogeneic and autologous HSCT patients. Statins are effective, generally well-tolerated and should be highly recommended for the management of post-HSCT dyslipidemia.
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Affiliation(s)
- Melanie Premstaller
- Medical University Clinic, Cantonal Hospital Baselland, Liestal and University of Basel, Basel, Switzerland
| | - Melanie Perren
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Kuebra Koçack
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christian Arranto
- Department of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Geneviève Favre
- Medical University Clinic, Cantonal Hospital Baselland, Liestal and University of Basel, Basel, Switzerland
| | - Andreas Lohri
- Medical University Clinic, Cantonal Hospital Baselland, Liestal and University of Basel, Basel, Switzerland
| | - Sabine Gerull
- Department of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob R Passweg
- Department of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland.
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Teixeira JFC, dos Santos Maia‐Lemos P, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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28
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Teixeira JFC, Maia-Lemos PDS, Cypriano MDS, Pisani LP. The influence of antineoplastic treatment on the weight of survivors of childhood cancer. J Pediatr (Rio J) 2016; 92:559-566. [PMID: 27327565 DOI: 10.1016/j.jped.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Obesity is a late effect in survivors of childhood cancer and correlates with chronic complications. Survivors of leukemia, brain tumors, and hematopoietic stem cell transplantation are more likely to develop obesity resulting from treatment modalities such as radiotherapy and glucocorticoids. This paper analyzes and integrates the current data available to health professionals in order to clarify strategies that can be used to treat and prevent obesity in childhood cancer survivors. SOURCES This is a literature review from on scientifically reliable electronic databases. We selected articles published in the last five years and earlier articles of great scientific importance. DATA SYNTHESIS The mechanisms involved in the pathophysiology of obesity in cancer survivors are not completely understood, but it is believed that damage to the hypothalamus and endocrine disorders such as insulin resistance, leptin resistance, and hormone deficiency may be involved. The body composition of this group includes a predominance of adipose tissue, especially in those undergoing hematopoietic stem cell transplant and total body irradiation. The use of body mass index in these patients may lead to an underestimation of individuals' risk for metabolic complications. CONCLUSION Early identification of groups using accurate anthropometric assessments, interventional treatment, and/or preventative measures and counseling is essential to minimize the adverse effects of treatment. Physical activity and healthy eating to promote adequacy of weight in the whole population should be encouraged.
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Affiliation(s)
| | - Priscila Dos Santos Maia-Lemos
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
| | - Mônica Dos Santos Cypriano
- Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP/GRAACC), São Paulo, SP, Brazil
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Atsuta Y, Hirakawa A, Nakasone H, Kurosawa S, Oshima K, Sakai R, Ohashi K, Takahashi S, Mori T, Ozawa Y, Fukuda T, Kanamori H, Morishima Y, Kato K, Yabe H, Sakamaki H, Taniguchi S, Yamashita T. Late Mortality and Causes of Death among Long-Term Survivors after Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1702-1709. [PMID: 27246369 DOI: 10.1016/j.bbmt.2016.05.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/19/2016] [Indexed: 01/05/2023]
Abstract
We sought to assess the late mortality risks and causes of death among long-term survivors of allogeneic hematopoietic stem cell transplantation (HCT). The cases of 11,047 relapse-free survivors of a first HCT at least 2 years after HCT were analyzed. Standardized mortality ratios (SMR) were calculated and specific causes of death were compared with those of the Japanese population. Among relapse-free survivors at 2 years, overall survival percentages at 10 and 15 years were 87% and 83%, respectively. The overall risk of mortality was significantly higher compared with that of the general population. The risk of mortality was significantly higher from infection (SMR = 57.0), new hematologic malignancies (SMR = 2.2), other new malignancies (SMR = 3.0), respiratory causes (SMR = 109.3), gastrointestinal causes (SMR = 3.8), liver dysfunction (SMR = 6.1), genitourinary dysfunction (SMR = 17.6), and external or accidental causes (SMR = 2.3). The overall annual mortality rate showed a steep decrease from 2 to 5 years after HCT; however, the decrease rate slowed after 10 years but was still higher than that of the general population at 20 years after HCT. SMRs in the earlier period of 2 to 4 years after HCT and 5 years or longer after HCT were 16.1 and 7.4, respectively. Long-term survivors after allogeneic HCT are at higher risk of mortality from various causes other than the underlying disease that led to HCT. Screening and preventive measures should be given a central role in reducing the morbidity and mortality of HCT recipients on long-term follow-up.
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Affiliation(s)
- Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Akihiro Hirakawa
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Saiko Kurosawa
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Kumi Oshima
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kazuteru Ohashi
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Molecular Therapy, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Heiwa Kanamori
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yasuo Morishima
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hisashi Sakamaki
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Takuya Yamashita
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
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Dyer G, Larsen SR, Gilroy N, Brice L, Greenwood M, Hertzberg M, Kabir M, Brown L, Hogg M, Huang G, Moore J, Gottlieb D, Kwan J, Tan J, Ward C, Kerridge I. Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT). Cancer Med 2016; 5:1702-16. [PMID: 27108674 PMCID: PMC4944898 DOI: 10.1002/cam4.729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022] Open
Abstract
Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Camperdown, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Westmead, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Poor growth, thyroid dysfunction and vitamin D deficiency remain prevalent despite reduced intensity chemotherapy for hematopoietic stem cell transplantation in children and young adults. Bone Marrow Transplant 2016; 51:980-4. [PMID: 26974276 PMCID: PMC4935546 DOI: 10.1038/bmt.2016.39] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/05/2016] [Accepted: 01/21/2016] [Indexed: 11/09/2022]
Abstract
Myeloablative conditioning regimens for hematopoietic stem cell transplant (HSCT) are known to affect endocrine function, but little is known regarding reduced intensity conditioning (RIC) regimens. We retrospectively reviewed 114 children and young adults after single RIC HSCT. The analysis was grouped by age (<2 and ⩾2 years) and diagnosis (hemophagocytic lymphohistiocystosis/X-linked lymphoproliferative syndrome (HLH/XLP), other immune disorders, metabolic/genetic disorders). All groups displayed short stature by mean height-adjusted Z-score (HAZ) before (-1.29) and after HSCT (HAZ -1.38, P=0.47). After HSCT, younger children with HLH/XLP grew better (HAZ -3.41 vs -1.65, P=0.006), whereas older subjects had decline in growth (HAZ -0.8 vs -1.01, P=0.06). Those with steroid therapy beyond standard GVHD prophylaxis were shorter than those without (P 0.04). After HSCT, older subjects with HLH/XLP became thinner with a mean body mass index (BMI) Z-score of 1.20 vs 0.64, P=0.02, and similar to metabolic/genetic disorders (BMI-Z= 0.59 vs -0.99, P<0.001). BMI increased among younger children in these same groups. Thyroid function was abnormal in 24% (18/76). 25-OH vitamin D levels were insufficient in 73% (49/65), with low bone mineral density in 8 of 19 evaluable subjects. Despite RIC, children and young adults still have significant late endocrine effects. Further research is required to compare post-transplant endocrine effects after RIC to those after standard chemotherapy protocols.
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Dyer G, Gilroy N, Brown L, Hogg M, Brice L, Kabir M, Greenwood M, Larsen SR, Moore J, Hertzberg M, Kwan J, Huang G, Tan J, Ward C, Kerridge I. What They Want: Inclusion of Blood and Marrow Transplantation Survivor Preference in the Development of Models of Care for Long-Term Health in Sydney, Australia. Biol Blood Marrow Transplant 2015; 22:731-743. [PMID: 26746819 DOI: 10.1016/j.bbmt.2015.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022]
Abstract
Four hundred forty-one adult allogeneic blood and marrow transplantation (BMT) survivors participated in a cross-sectional survey to assess long-term follow-up (LTFU) model of care preference. Survey instruments included the Sydney Post BMT Survey, Functional Assessment of Cancer Therapy-BMT, Depression Anxiety Stress Scales 21, the Chronic GVHD Activity Assessment-Patient Self Report (Form B), the Lee Chronic GVHD Symptom Scale and the Post-Traumatic Growth Inventory. We found most BMT survivors (74%) would prefer LTFU with their transplantation physicians alone or in combination with transplantation center-linked services (satellite clinics or telemedicine) Over one-quarter indicated a preference for receiving comprehensive post-transplantation care in a "satellite" clinic staffed by their BMT team situated closer to their place of residence, with higher income, higher educational level, and sexual morbidity being significant social factors influencing this preference. Regular exercise was reported less often in those who preferred telemedicine, which may reflect reduced mobility. The factor most strongly associated with a preference for transplantation center follow-up was the severity of chronic graft-versus-host disease. Full- and part-time work were negatively associated with transplantation center follow-up, possibly implying decreased dependency on the center and some return to normalcy. This study is the first to explore the preferences of BMT survivors for long-term post-transplantation care. These data provides the basis for LTFU model of care development and health service reform consistent with the preferences of BMT survivors.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia.
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Moore
- Department of Haematology, St. Vincents Hospital, Sydney, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jeff Tan
- Department of Haematology, St. Vincents Hospital, Sydney, New South Wales, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
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Value of Screening Spirometry for Early Diagnosis of Bronchiolitis Obliterans Syndrome in Children After Allogeneic Hematopoietic Stem Cell Transplantation. J Pediatr Hematol Oncol 2015; 37:e462-7. [PMID: 26334431 DOI: 10.1097/mph.0000000000000421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a chronic graft-versus-host disease that occurs in the lungs after hematopoietic stem cell transplantation (HSCT). Serial screening pulmonary function test (PFT) is recommended after transplantation for early diagnosis of BOS. However, little is known about the value or the optimum methods of serial PFT in this context. One hundred and 10 consecutive patients of 6 to 17 years of age at the time of transplantation who underwent allogeneic HSCT were recruited for this study. Screening PFTs were performed 1 week before transplantation and 3, 6, 9, and 12 months after transplantation. When findings of obstructive lung disease were found on PFT, chest high-resolution computed tomography was performed. Of the 110 patients, 5 (4.5%) developed BOS. Of the 5 patients who developed BOS, 2 patients were diagnosed early by screening PFT. However, screening PFT did not allow for early diagnosis of BOS in the other 3 patients because BOS developed after 12 months of transplantation, which is beyond the PFT screening period. In conclusion, trimonthly PFTs performed through 12 months after transplantation in patients who underwent allogeneic HSCT helped in the early diagnosis of BOS; however, there are some limitations to this screening protocol. Future studies will aid in the development of a new screening protocol that can subsequently be evaluated.
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Carpenter PA, Kitko CL, Elad S, Flowers MED, Gea-Banacloche JC, Halter JP, Hoodin F, Johnston L, Lawitschka A, McDonald GB, Opipari AW, Savani BN, Schultz KR, Smith SR, Syrjala KL, Treister N, Vogelsang GB, Williams KM, Pavletic SZ, Martin PJ, Lee SJ, Couriel DR. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant 2015; 21:1167-87. [PMID: 25838185 DOI: 10.1016/j.bbmt.2015.03.024] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.
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Affiliation(s)
- Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juan C Gea-Banacloche
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Laura Johnston
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University, Vienna, Austria
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony W Opipari
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and University of BC, Vancouver, British Columbia
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
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Ferreira EE, Guerra DC, Baluz K, de Resende Furtado W, da Silva Bouzas LF. Nutritional status of patients submitted to transplantation of allogeneic hematopoietic stem cells: a retrospective study. Rev Bras Hematol Hemoter 2014; 36:414-9. [PMID: 25453651 PMCID: PMC4318470 DOI: 10.1016/j.bjhh.2014.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/08/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE This study aimed to describe and compare the nutritional status of adult patients submitted to allogeneic hematopoietic stem cell transplantation at two different time points (admission and discharge). METHODS A retrospective, descriptive and quantitative study was performed based on clinical, laboratory and nutritional data obtained from medical records of adult patients of both genders submitted to allogeneic hematopoietic stem cell transplantation in a bone marrow transplantation reference center in Rio de Janeiro in the period from 2010 to 2013. Statistical analysis was performed using the SPSS software (version 22.0). RESULTS Sixty-four patients were evaluated. The mean age was 42.1±3.2 years and the most prevalent disease was acute myeloid leukemia (39%). There was a high prevalence of gastrointestinal symptoms including nausea (100%), vomiting (97%) and mucositis (93%). Between admission and discharge there was a significant decrease in the median weight (-2.5kg; 71.5 vs. 68.75kg; p-value<0.001), body mass index (-0.9kg/m(2); 24.8 vs. 24.4kg/m(2); p-value<0.001), and serum albumin levels (-0.2g/dL; 3.7 vs. 3.6g/dL; p-value=0.024). The survival time after hematopoietic stem cell transplantation correlated negatively with C-reactive protein at discharge (CC=-0.72; p-value<0.001) and positively with serum albumin levels (CC=0.56; p-value=0.004) and with high total protein level at discharge (CC=0.53; p-value=0.006). CONCLUSION Our results suggest that patients submitted to allogeneic hematopoietic stem cell transplantation have compromised nutritional status during the hospital stay for transplantation.
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Affiliation(s)
- Erika Elias Ferreira
- Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | - Daiane Cristina Guerra
- Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Kátia Baluz
- Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil
| | - Wander de Resende Furtado
- Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Can We Predict Clinical Cardiotoxicity with Cardiac Biomarkers in Patients After Haematopoietic Stem Cell Transplantation? Cardiovasc Toxicol 2014; 15:210-6. [DOI: 10.1007/s12012-014-9286-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Furquim CP, Pivovar A, Cavalcanti LG, Araújo RF, Sales Bonfim CM, Torres-Pereira CC. Mouth self-examination as a screening tool for oral cancer in a high-risk group of patients with Fanconi anemia. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:440-6. [DOI: 10.1016/j.oooo.2014.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/25/2022]
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38
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Cheng MJ, Hourigan CS, Smith TJ. Adult Acute Myeloid Leukemia Long-term Survivors. JOURNAL OF LEUKEMIA (LOS ANGELES, CALIF.) 2014; 2:26855. [PMID: 25243197 PMCID: PMC4167020 DOI: 10.4172/2329-6917.1000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The number of leukemia patients and survivors is growing. This review summarizes what is known regarding the health related quality of life (HRQOL) and medical complications associated with acute myeloid leukemia (AML) disease and treatment and highlights understudied aspects of adult AML survivorship care, and potential novel areas for intervention.
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Affiliation(s)
- M Jennifer Cheng
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Christopher S Hourigan
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Thomas J Smith
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
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Ruiz MA. The Guidelines Project: Brazilian guidelines for acute promyelocytic leukemia. Rev Bras Hematol Hemoter 2014; 36:1-2. [PMID: 24624024 PMCID: PMC3948654 DOI: 10.5581/1516-8484.20140001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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40
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Torres-Pereira CC, Stramandinoli-Zanicotti RT, Amenábar JM, Sassi LM, Galbiatti Pedruzzi PA, Piazzetta CM, Bonfim C. Oral squamous cell carcinoma in two siblings with Fanconi anemia after allogeneic bone marrow transplantation. SPECIAL CARE IN DENTISTRY 2013; 34:212-5. [DOI: 10.1111/scd.12058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | | | - José Miguel Amenábar
- Stomatology Department Professor; Universidade Federal do Paraná; Curitiba Paraná Brazil
| | - Laurindo Moacir Sassi
- Chief of Oral and Maxillofacial Surgery Service of the Erasto Gaertner Hospital; Curitiba Paraná Brazil
| | | | - Cleto M. Piazzetta
- Stomatology Department Professor; Universidade Federal do Paraná; Curitiba Paraná Brazil
| | - Carmem Bonfim
- Bone Marrow Transplant Unit, Hospital de Clínicas; Universidade Federal do Paraná; Curitiba Paraná Brazil
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Prospective cohort study comparing intravenous busulfan to total body irradiation in hematopoietic cell transplantation. Blood 2013; 122:3871-8. [PMID: 24081656 DOI: 10.1182/blood-2013-08-519009] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We conducted a prospective cohort study testing the noninferiority of survival of ablative intravenous busulfan (IV-BU) vs ablative total body irradiation (TBI)-based regimens in myeloid malignancies. A total of 1483 patients undergoing transplantation for myeloid malignancies (IV-BU, N = 1025; TBI, N = 458) were enrolled. Cohorts were similar with respect to age, gender, race, performance score, disease, and disease stage at transplantation. Most patients had acute myeloid leukemia (68% IV-BU, 78% TBI). Grafts were primarily peripheral blood (77%) from HLA-matched siblings (40%) or well-matched unrelated donors (48%). Two-year probabilities of survival (95% confidence interval [CI]), were 56% (95% CI, 53%-60%) and 48% (95% CI, 43%-54%, P = .019) for IV-BU (relative risk, 0.82; 95% CI, 0.68-0.98, P = .03) and TBI, respectively. Corresponding incidences of transplant-related mortality (TRM) were 18% (95% CI, 16%-21%) and 19% (95% CI, 15%-23%, P = .75) and disease progression were 34% (95% CI, 31%-37%) and 39% (95% CI, 34%-44%, P = .08). The incidence of hepatic veno-occlusive disease (VOD) was 5% for IV-BU and 1% with TBI (P < .001). There were no differences in progression-free survival and graft-versus-host disease. Compared with TBI, IV-BU resulted in superior survival with no increased risk for relapse or TRM. These results support the use of myeloablative IV-BU vs TBI-based conditioning regimens for treatment of myeloid malignancies.
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Moore HK, Santibañez MEB, Denzen EM, Carr DW, Murphy EA. Barriers to Accessing Health Care for Hematopoietic Cell Transplantation Recipients Living in Rural Areas. Clin J Oncol Nurs 2013; 17:405-11. [DOI: 10.1188/13.cjon.405-411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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