1
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Cutler C. Skin Cancer after Ruxolitinib or Belumosudil. N Engl J Med 2023; 389:1154-1155. [PMID: 37733324 DOI: 10.1056/nejmc2309427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
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2
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Aghel N, Lui M, Wang V, Khalaf D, Mian H, Hillis C, Walker I, Leber B, Lipton JH, Aljama M, Lepic K, Berg T, Garcia-Horton A, Petropoulos J, Masoom H, Leong DP. Cardiovascular events among recipients of hematopoietic stem cell transplantation-A systematic review and meta-analysis. Bone Marrow Transplant 2023; 58:478-490. [PMID: 36849807 DOI: 10.1038/s41409-023-01928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/01/2023]
Abstract
Cardiovascular diseases are an emerging cause of mortality and morbidity in survivors of hematopoietic stem cell transplantation (HSCT); however, the incidence of cardiovascular events (CVEs) in this population is not well described. This systematic review summarizes the evidence on the incidence of CVEs in HSCT recipients. Medline and Embase were searched from inception to December 2020. Inclusion criteria were cohort studies and phase 3 randomized controlled trials that reported CVEs among adults who underwent HSCT for hematological malignancies. After reviewing 8386 citations, 57 studies were included. The incidence of CVEs at 100 days was 0.19 (95% CI: 0.17-0.21) per 100 person-days after autologous HSCT and 0.06 (95% CI: 0.05-0.07) per 100 person-days after allogeneic HSCT. This higher incidence after autologous HSCT was driven by reports of arrhythmia from one population-based study in patients with multiple myeloma. The incidence of long-term CVEs was 3.98 (95% CI; 3.44-4.63) per 1000 person-years in survivors of autologous HSCT and 3.06 (95% CI; 2.69-3.48) per 1000 person-years in survivors of allogeneic HSCT. CVEs remain an important but under-reported cause of morbidity and mortality in recipients of HSCT. Future studies are required to better understand the incidence and risk factors for CVEs in HSCT recipients.
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Affiliation(s)
- N Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada.
| | - M Lui
- Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - V Wang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - D Khalaf
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - H Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - C Hillis
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - I Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Leber
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - K Lepic
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - T Berg
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - A Garcia-Horton
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - J Petropoulos
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - H Masoom
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D P Leong
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2022; 57:1150-1163. [PMID: 35523848 DOI: 10.1038/s41409-022-01591-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
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Affiliation(s)
- Rachel Phelan
- CIBMTR® (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.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Burns
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Pinki Prasad
- Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, Department of Pediatrics, New Orleans, LA, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, NC, USA
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Flatau
- Association of Cancer Online Resources, Association of Cancer Online Resources, Austin, TX, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, FL, USA
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, PA, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/ Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John A Snowden
- The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Hélène 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
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5
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Transplant Cell Ther 2021:S2666-6367(21)01329-4. [PMID: 34757220 DOI: 10.1016/j.jtct.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. OBJECTIVE Here, we provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. STUDY DESIGN We utilized systematic review methodology to summarize incidence, risk factors, screening, prevention and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research. RESULTS Most of the evidence regarding male GvHD is still based on limited data, precluding strong therapeutic recommendations. We therefore recommend to systematically screen for male genital GvHD regularly and report it to large registries to allow for a better understanding. Future research should also address treatment since little published evidence is available to date. Male-specific endocrine consequences of HCT include hypogonadism which may also affect bone health. Since the evidence is scarce, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, which warrants offering sperm preservation in all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, hence the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent than in the general population; however, subsequent malignancies in general seem to be more prevalent in males than females, and special attention should be given to skin and oral mucosa. CONCLUSION Male-specific late effects, probably more under-reported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplant physicians and specialists from other involved disciplines. Future research should be directed towards better data collection on male-specific late effects and on studies about the interrelationship between these late effects, to allow the development of evidence based effective management practices.
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6
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Morel S, Delvin E, Marcil V, Levy E. Intestinal Dysbiosis and Development of Cardiometabolic Disorders in Childhood Cancer Survivors: A Critical Review. Antioxid Redox Signal 2021; 34:223-251. [PMID: 32390455 DOI: 10.1089/ars.2020.8102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Significance: Survivors of pediatric cancers have a high risk of developing side effects after the end of their treatments. Many potential factors have been associated with the onset of cardiometabolic disorders (CMD), including cancer disease itself, chemotherapy, hormonal treatment, radiotherapy, and genetics. However, the precise etiology and underlying mechanisms of these long-term complications are poorly understood. Recent Advances: Greater awareness is currently paid to the role of microbiota in the emergence of cancers and modulation of cancer therapies in both children and adults. Alterations in the composition and diversity of intestinal microbiota can clearly influence tumor development and progression as well as immune responses and clinical output. As dysbiosis is closely linked to the development of host metabolic diseases, including obesity, metabolic syndrome, type 2 diabetes, and non-alcoholic fatty liver disease, it may increase the risk of CMD in cancer populations. Critical Issues: Only limited studies targeting the profile of intestinal dysbiosis before and after cancer treatment have been conducted. Further, the exact contribution of intestinal dysbiosis to the development of CMD in cancer survivors is poorly appreciated. This review intends to clarify the influence of gut microbiota on CMD in childhood cancer survivors, elucidate the potential mechanisms, and evaluate the latest research on the interplay between diet/food supplement, microbiota, and cancer-related CMD. Future Directions: The implication of intestinal dysbiosis in late metabolic complications of childhood cancer survivors should be clarified. Intervention strategies could be developed to reduce the risk of survivors to CMD. Antioxid. Redox Signal. 34, 223-251.
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Affiliation(s)
- Sophia Morel
- Research Centre, Sainte-Justine University Hospital Health Center, Université de Montréal, Montreal, Canada.,Department of Nutrition and Université de Montréal, Montreal, Canada
| | - Edgard Delvin
- Research Centre, Sainte-Justine University Hospital Health Center, Université de Montréal, Montreal, Canada
| | - Valérie Marcil
- Research Centre, Sainte-Justine University Hospital Health Center, Université de Montréal, Montreal, Canada.,Department of Nutrition and Université de Montréal, Montreal, Canada
| | - Emile Levy
- Research Centre, Sainte-Justine University Hospital Health Center, Université de Montréal, Montreal, Canada.,Department of Nutrition and Université de Montréal, Montreal, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Canada
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7
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Gabriel M, Hoeben BAW, Uhlving HH, Zajac-Spychala O, Lawitschka A, Bresters D, Ifversen M. A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia. Front Pediatr 2021; 9:774853. [PMID: 35004543 PMCID: PMC8734594 DOI: 10.3389/fped.2021.774853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Despite advances in haematopoietic stem cell transplant (HSCT) techniques, the risk of serious side effects and complications still exists. Neurological complications, both acute and long term, are common following HSCT and contribute to significant morbidity and mortality. The aetiology of neurotoxicity includes infections and a wide variety of non-infectious causes such as drug toxicities, metabolic abnormalities, irradiation, vascular and immunologic events and the leukaemia itself. The majority of the literature on this subject is focussed on adults. The impact of the combination of neurotoxic drugs given before and during HSCT, radiotherapy and neurological complications on the developing and vulnerable paediatric and adolescent brain remains unclear. Moreover, the age-related sensitivity of the nervous system to toxic insults is still being investigated. In this article, we review current evidence regarding neurotoxicity following HSCT for acute lymphoblastic leukaemia in childhood. We focus on acute and long-term impacts. Understanding the aetiology and long-term sequelae of neurological complications in children is particularly important in the current era of immunotherapy for acute lymphoblastic leukaemia (such as chimeric antigen receptor T cells and bi-specific T-cell engager antibodies), which have well-known and common neurological side effects and may represent a future treatment modality for at least a fraction of HSCT-recipients.
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Affiliation(s)
- Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Hilde Hylland Uhlving
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anita Lawitschka
- Haematopoietic Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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8
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Oliveira GH, Al-Kindi SG, Guha A, Dey AK, Rhea IB, deLima MJ. Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:544-551. [PMID: 33130819 DOI: 10.1038/s41409-020-01080-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023]
Abstract
The purpose of this review is to provide a framework for the cardiovascular evaluation and management of patients undergoing hematopoietic cell transplantation (HCT). To accomplish this, we have performed an extensive literature review, critically analyzed the available evidence, and developed a set of recommendations to guide best practice. Herein, we discuss the cardiovascular risk profile of patients undergoing HCT along with putative mechanisms of HCT-induced cardiovascular injury. We then present an algorithm for cardiovascular testing and risk mitigation of potential recipients. Last, we address the management of the most prevalent cardiovascular conditions associated with HCT recipients.
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Affiliation(s)
- Guilherme H Oliveira
- Heart and Vascular Institute, University of South Florida, Tampa General Hospital and Moffitt Cancer Center, Tampa, FL, USA.
| | - Sadeer G Al-Kindi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Avirup Guha
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Amit K Dey
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Isaac B Rhea
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marcos J deLima
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Stem Cell Transplant Program, Seidman Cancer Center, Cleveland, OH, USA
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9
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Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a kind of autoimmune-mediated inflammation and demyelinating disease. The etiology is mainly related to autoimmune dysfunction. The conventional treatments of CIDP have relied on immunomodulation and inhibition therapies such as adrenal cortex hormone, intravenous immunoglobulin (IVIg) and plasma exchange. Hematopoietic stem cell transplantation (HSCT) is known as a novel therapy for autoimmune disorders, which provides the chance to cure CIDP. More than 70 patients with refractory CIDP have received HSCT. The clinical symptoms and electrophysiological examination results of most patients have been improved. However, the treatment still has risks. This review describes the pathogenesis of CIDP and the current conventional treatments, and highlights the application of HSCT in CIDP, including its efficacy and safety.
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Affiliation(s)
- Zhen Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011, Hunan, China
| | - Qianyi Huang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011, Hunan, China
| | - Jiangying Zou
- Healing With Stem Cell Therapy Inc, PO Box 2289, Shawnee Mission, 66201, KS, USA
| | - Lisha Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011, Hunan, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011, Hunan, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Renmin Road 139#, Changsha, 410011, Hunan, China
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10
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11
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Hemu M, Zimmerman A, Kalra D, Okwuosa T. Pretransplant Cardiac Evaluation Using Novel Technology. J Clin Med 2019; 8:E690. [PMID: 31100854 DOI: 10.3390/jcm8050690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/03/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is a complex procedure that has been increasingly successful in treating malignant and nonmalignant conditions. Despite its effectiveness, it can be associated with potentially life-threatening adverse effects. New onset heart failure, ischemic disease, and arrhythmias are among the most notable cardiovascular complications post-HSCT. As a result, appropriate cardiac risk stratification prior to transplant could result in decreased morbidity and mortality by identifying patients with a higher probability of tolerating possible toxicities associated with HSCT. In this review, we aim to discuss the utility of cardiac screening using novel modalities of imaging technology in the pre-HSCT phase.
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12
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Faraci M, Diesch T, Labopin M, Dalissier A, Lankester A, Gennery A, Sundin M, Uckan-Cetinkaya D, Bierings M, Peters AMJ, Garwer M, Schulz A, Michel G, Giorgiani G, Gruhn B, Locatelli F, Giardino S, Uyttebroeck A, Rialland F, Itäla-Remes M, Dreger P, Shaw PJ, Bordon V, Schlegel PG, Mellgren K, Moraleda JM, Patrick K, Schneider P, Jubert C, Lawitschka A, Salooja N, Basak GW, Corbacioglu S, Duarte R, Bader P. Gonadal Function after Busulfan Compared with Treosulfan in Children and Adolescents Undergoing Allogeneic Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2019; 25:1786-1791. [PMID: 31082473 DOI: 10.1016/j.bbmt.2019.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/27/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
Gonadal impairment is an important late effect with a significant impact on quality of life of transplanted patients. The aim of this study was to compare gonadal function after busulfan (Bu) or treosulfan (Treo) conditioning regimens in pre- and postpubertal children. This retrospective, multicenter study included children transplanted in pediatric European Society for Blood and Marrow Transplantation (EBMT) centers between 1992 and 2012 who did not receive gonadotoxic chemoradiotherapy before the transplant. We evaluated 137 patients transplanted in 25 pediatric EBMT centers. Median age at transplant was 11.04 years (range, 5 to 18); 89 patients were boys and 48 girls. Eighty-nine patients were prepubertal at transplant and 48 postpubertal. One hundred eighteen children received Bu and 19 Treo. A higher proportion of girls treated with Treo in the prepubertal stage reached spontaneous puberty compared with those treated with Bu (P = .02). Spontaneous menarche was more frequent after Treo than after Bu (P < .001). Postpubertal boys and girls treated with Treo had significantly lower luteinizing hormone levels (P = .03 and P = .04, respectively) compared with the Bu group. Frequency of gonadal damage associated with Treo was significantly lower than that observed after Bu. These results need to be confirmed in a larger population.
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Affiliation(s)
- Maura Faraci
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy.
| | - Tamara Diesch
- University Children's Hospital Basel, Division of Pediatric Oncology/Hematology, Basel, Switzerland
| | - Myriam Labopin
- Hȏpital Saint-Antoine, Department of Hematology and Cell Therapy, Paris, France
| | - Arnaud Dalissier
- EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Department of Hematology, Paris, France
| | - Arian Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Department of Pediatric Stem Cell Transplantation, Leiden, Netherlands
| | - Andrew Gennery
- Children's Hospital Newcastle upon Tyne, Pediatric Team Children's BMT Unit, Newcastle upon Tyne, United Kingdom
| | - Mikael Sundin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Hematology/Immunology Section, Stockholm, Sweden
| | - Duygu Uckan-Cetinkaya
- Hacettepe University Faculty of Medicine, Bone Marrow Transplantation Unit, Department of Pediatrics, Ankara, Turkey
| | - Marc Bierings
- Princess Maxima Centre for Pediatric Oncology and University Children's Hospital, Utrecht, Netherlands
| | - Anke M J Peters
- Medical Center, University of Freiburg, Center for Pediatrics, Department of Pediatric Hematology and Oncology, Freiburg, Germany
| | - Martina Garwer
- University Hamburg-Eppendorf, Pediatric Hematology Clinic and Policlinic of Oncology, Hamburg-Eppendorf, Germany
| | - Ansgar Schulz
- University Medical Center Ulm, Department of Pediatrics, Ulm, Germany
| | - Gerard Michel
- Hopital d'Enfants de la Timone Marseille, Marseille, France
| | - Giovanna Giorgiani
- Fondazione IRCCS Policlinico San Matteo, Pediatric Hematology-Oncology, Pavia, Italy
| | - Bernd Gruhn
- Jena University Hospital, Department of Pediatrics, Jena, Germany
| | - Franco Locatelli
- IRCSS Ospedale Pediatrico Bambino Gesù, University La Sapienza, Department of Pediatric Hematology/Oncology, Rome, Italy
| | - Stefano Giardino
- Istituto G. Gaslini, Hematopoietic Stem Cell Transplantation Unit- Hematology-Oncology, Genova, Italy
| | - Anne Uyttebroeck
- University Hospitals Leuven, Department of Pediatric Hematology-Oncology, Leuven, Belgium
| | | | | | | | - Peter J Shaw
- The Children's Hospital at Westmead, Division of Blood and Marrow Transplantation, Sydney, Australia
| | - Victoria Bordon
- Ghent University Hospital, Department of Pediatric Hematology, Oncology and SCT, Ghen, Belgium
| | - Paul G Schlegel
- University Children's Hospital Würzburg, Department of Pediatric Oncology, Würzburg, Germany
| | - Karin Mellgren
- The Queen Silvia's Hospital for Children and Adolescents, University of Göteborg, Pediatric Hematology and Oncology, Göteborg, Sweden
| | - Jose M Moraleda
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, University of Murcia, Barcelona, Spain
| | - Katharine Patrick
- Sheffield Children's Hospital, Department of Hematology and Oncology, Sheffield, United Kingdom
| | - Pascale Schneider
- Pediatric Hemato-Oncology Department, University Hospital, Rouen, Rouen, France
| | - Charlotte Jubert
- Bordeaux University Hospital, Pediatric BMT Unit, Bordeaux, France
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Nina Salooja
- Imperial College London, Department of Medicine, London, United Kingdom
| | - Grzegorz W Basak
- Medical University of Warsaw, Department of Hematology, Oncology and Internal Medicine, Warsaw, Poland
| | - Selim Corbacioglu
- University of Regensburg, Department of Pediatric Hematology, Oncology & Stem Cell Transplantation, Regensburg, Germany
| | - Rafael Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Peter Bader
- Goethe-Universität, Universitätsklinikum Frankfurt, Frankfurt, Germany
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Ketterl TG, Chow EJ, Leisenring WM, Goodman P, Koves IH, Petryk A, Steinberger J, Baker KS. Adipokines, Inflammation, and Adiposity in Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2018; 24:622-626. [PMID: 29197678 PMCID: PMC5831197 DOI: 10.1016/j.bbmt.2017.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
Adult survivors of acute leukemia in childhood have a higher-than-expected frequency of obesity and are at increased risk for metabolic syndrome and early mortality from cardiovascular disease (CVD). Adipose tissue has been recognized as an endocrine and paracrine organ that secretes various adipokines involved in metabolic regulation and inflammatory processes. In this study, we examined inflammatory factors (IL-6 and TNF-α) and adipokines (adiponectin, leptin), in addition to body composition and adiposity, in cancer survivors who underwent hematopoietic cell transplantation (HCT) during childhood compared with sibling controls. Over 2-year survivors of HCT for hematologic malignancies during childhood were recruited from 2 institutions along with a control population of siblings. Participants underwent evaluation for body composition, anthropometric measurements, and assessment of CVD risk factors and adipokines. Cases were stratified by radiation exposure in the preparative regimen (total body irradiation [TBI] + central nervous system [CNS] irradiation, TBI only, chemotherapy only) and adjusted least squares means were estimated for each adipokine and adjusted by age, sex, race, Tanner stage, and percent fat mass (PFM) percentiles (0-24, 25-74, 75+). A total of 151 HCT survivors and 92 siblings underwent evaluation. Significant differences in mean adipokine levels were detected between survivors and siblings; leptin was significantly higher and adiponectin significantly lower in HCT survivors who received TBI with or without CNS irradiation compared with siblings. IL-6 was significantly higher in all groups of HCT survivors compared with siblings. Body mass index (BMI) was similar in survivors and controls, although PFM was significantly higher in all groups of HCT survivors and lean body mass (LBM) was lower in survivors who received TBI with or without CNS radiation compared with siblings. HCT survivors showed an unfavorable profile of inflammation, adipokines, and adiposity, despite similar BMI as controls. Higher PFM and lower LBM may contribute to these findings. TBI exposure is correlated with greater severity of these observations. Increasing LBM may represent a tangible target for mitigating the high cardiometabolic risks of HCT survivors.
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Affiliation(s)
- Tyler G Ketterl
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Pam Goodman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ildi H Koves
- Seattle Children's Hospital, Seattle, Washington
| | - Anna Petryk
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Versluys AB, Grotenhuis HB, Boelens MJJ, Mavinkurve-Groothuis AMC, Breur JMPJ. Predictors and Outcome of Pericardial Effusion After Hematopoietic Stem Cell Transplantation in Children. Pediatr Cardiol 2018; 39:236-44. [PMID: 29058031 DOI: 10.1007/s00246-017-1747-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/04/2017] [Indexed: 11/05/2022]
Abstract
Pericardial Effusion (PE) is a potentially life-threatening complication of Hematopoietic Cell Transplantation (HCT). Our study aim was to identify incidence, risk factors, response to treatment, and outcome of PE after pediatric HCT. All patients after HCT at our tertiary center between 2005 and 2010 were included. Endpoints were PE development and overall survival. We analyzed patient factors, HCT details, and complications and used Cox proportional hazard regression modeling to identify predictors for PE. Twelve out of 129 patients (9.3%) developed PE. Multivariate analysis demonstrated that young age at HCT was a predictor for PE: expressed per year increase in age HR = 0.66 (95% CI 0.46-0.95, p = 0.03). PE had no impact on overall mortality of HCT. Mild respiratory symptoms and vomiting were presenting symptoms for PE. Discontinuation of calcineurin inhibitors-with or without pericardiocentesis-was the only effective treatment for PE, in contrast to diuretics or increased immunosuppression. Seven of 12 PE patients had pericardiocentesis, which was safe and effective in all. Pericardial effusion is not rare after HCT, and young age is the only significant risk factor. Calcineurin inhibitor toxicity appears to be the primary cause of PE after HCT, and discontinuation is effective in the reduction of PE. Pericardiocentesis for PE is a safe and effective procedure. Pericardial effusion did not have an impact on survival after HCT.
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Sauer K, Winkler B, Eyrich M, Schlegel PG, Wiegering V. Indication for allogeneic stem cell transplantation in Glanzmann’s thrombasthenia. Hamostaseologie 2017; 33:305-12. [DOI: 10.5482/hamo-12-08-0014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 06/28/2013] [Indexed: 11/05/2022] Open
Abstract
SummaryGlanzmann’s thrombasthenia (GT) is an autosomal recessive disorder characterized by a lack of thrombocyte aggregation due to the absence of thrombocyte glycoproteins IIb and αIIbβ3. The role of haematopoietic stem cell transplantation (HSCT) in GT remains controversial. However, HSCT offers the only curative approach for patients with a severe clinical phenotype.In this review, we will discuss the limitation of current status evidence and the specific risk of GT, in particular the alloimmunization and refractoriness to thrombocyte infusions. 19 successful HSCT in 18 GT type I patients have been reported. Mean age at transplantation was 5 years. All patients are still alive. The majority received sibling bone marrow transplant with busulfan and cyclophosphamid conditioning. GvHD incidence was within the normal range, but 10 patients showed alloimmunization of thrombocytes. Median follow up is 25 months.
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Bonnesen TG, Winther JF, Andersen KK, Asdahl PH, de Fine Licht S, Gudmundsdottir T, Sällfors Holmqvist A, Madanat-Harjuoja LM, Tryggvadottir L, Wesenberg F, Heilmann C, Olsen JH, Hasle H. Liver diseases in Adult Life after Childhood Cancer in Scandinavia (ALiCCS): A population-based cohort study of 32,839 one-year survivors. Int J Cancer 2017; 142:702-708. [PMID: 29023764 DOI: 10.1002/ijc.31093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/15/2017] [Accepted: 09/20/2017] [Indexed: 12/25/2022]
Abstract
Information on late onset liver complications after childhood cancer is scarce. To ensure an appropriate follow-up of childhood cancer survivors and reducing late liver complications, the need for comprehensive and accurate information is presented. We evaluate the risk of liver diseases in a large childhood cancer survivor cohort. We included all 1-year survivors of childhood cancer treated in the five Nordic countries. A Cox proportional hazards model was used to estimate hospitalisation rate (hazard) ratios (HRs) for each liver outcome according to type of cancer. We used the risk among survivors of central nervous system tumour as internal reference. With a median follow-up time of 10 years, 659 (2%) survivors had been hospitalised at least once for a liver disease. The risk for hospitalisation for any liver disease was high after hepatic tumour (HR = 6.9) and leukaemia (HR = 1.7). The Danish sub-cohort of leukaemia treated with haematopoietic stem cell transplantation had a substantially higher risk for hospitalisation for all liver diseases combined (HR = 3.8). Viral hepatitis accounted for 286 of 659 hospitalisations corresponding to 43% of all survivors hospitalised for liver disease. The 20-year cumulative risk of viral hepatitis was 1.8% for survivors diagnosed with cancer before 1990 but only 0.3% for those diagnosed after 1990. The risk of liver disease was low but significantly increased among survivors of hepatic tumours and leukaemia. Further studies with focus on the different treatment modalities are needed to further strengthen the prevention of treatment-induced late liver complications.
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Affiliation(s)
- Trine Gade Bonnesen
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Jeanette F Winther
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | - Klaus K Andersen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | - Peter H Asdahl
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Sofie de Fine Licht
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | | | - Anna Sällfors Holmqvist
- Department of Clinical Sciences, Paediatric Oncology and Haematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Laura-Maria Madanat-Harjuoja
- Finnish Cancer Registry, Pieni Roobertinkatu 9, Helsinki, 00130, Finland.,Department of Paediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laufey Tryggvadottir
- Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland.,The Icelandic Cancer Registry, Skogarhlid 9, PO Box 5420, Reykjavik, 125, Iceland
| | - Finn Wesenberg
- Cancer Registry of Norway, P.O. Box 5313, Majorstuen, Oslo, Norway.,Department of Paediatrics, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo.,Medical Faculty, University of Oslo, P.O box 1078, Blindern, 0316, Oslo
| | - Carsten Heilmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Jørgen H Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
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17
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Cima LN, Colita A, Fica S. Perspectives on the co-treatment with GnRHa in female patients undergoing hematopoietic stem cell transplantation. Endocr Connect 2017; 6:R162-R170. [PMID: 28947558 PMCID: PMC5655684 DOI: 10.1530/ec-17-0246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 11/08/2022]
Abstract
Outcomes after hematopoietic stem cell transplantation (HSCT) for patients with both malignant and nonmalignant diseases have improved significantly in recent years. However, the endocrine system is highly susceptible to damage by the high-dose chemotherapy and/or irradiation used in the conditioning regimen before HSCT. Ovarian failure and subsequent infertility are frequent complications that long-term HSCT survivors and their partners face with a negative impact on their QoL. Several meta-analyses of randomized clinical trials showed that gonadotropin-releasing hormone agonist (GnRHa) administration in advance of starting standard chemotherapy decreases the risk of gonadal dysfunction and infertility in cancer patients, but GnRHa use for ovarian protection in HSCT patients is not fully determined. In this review, we are discussing the potential preservation of ovarian function and fertility in pubertal girls/premenopausal women who undergo HSCT using GnRHa in parallel with conditioning chemotherapy, focusing on the current data available and making some special remarks regarding the use of GnRHa.
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Affiliation(s)
| | - Anca Colita
- Carol Davila University of Medicine and PharmacyBucharest, Romania
- Hematology DepartmentFundeni Hospital, Bucharest, Romania
| | - Simona Fica
- Carol Davila University of Medicine and PharmacyBucharest, Romania
- Endocrine DepartmentElias Hospital, Bucharest, Romania
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Liu YM, Jaing TH, Chen YC, Tang ST, Li CY, Wen YC, Chang HL, Chen ML. Quality of Life After Hematopoietic Stem Cell Transplantation in Pediatric Survivors: Comparison With Healthy Controls and Risk Factors. Cancer Nurs 2016; 39:502-9. [PMID: 26863053 DOI: 10.1097/NCC.0000000000000339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation has prolonged life for children with life-threatening diseases. Quality of life is an essential outcome for evaluating the long-term effects of transplantation. OBJECTIVE The aims of this study were to compare the quality of life of children posttransplantation to that of healthy peers and explore the variables associated with the quality of life of posttransplant children. METHODS A cross-sectional study was conducted with 43 pediatric transplantation survivors and 43 age- and sex-matched healthy peers. RESULTS The mean age of the transplant group was 12.06 years. The mean time since transplant was 3.73 years. After covariate adjustment, there was no difference between posttransplant and healthy children in each domain and overall quality of life, except for physical functioning where the posttransplant children had lower scores than did the healthy group. Chronic graft-versus-host disease was found to be the primary factor associated with poor posttransplant overall quality of life and emotional and social functioning. Sociodemographic variables, symptom distress, and caregiver depression were not correlated with posttransplant quality of life. CONCLUSIONS The quality of life of pediatric transplantation survivors was comparable to that of healthy peers. IMPLICATIONS FOR PRACTICE The finding that children after transplant may achieve quality of life similar to their healthy peers is important information for parents to consider as they consider treatment options. For those sick children who cannot regularly attend school, their emotional and social functioning should be closely monitored.
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19
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Swart JF, Delemarre EM, van Wijk F, Boelens J, Kuball J, van Laar JM, Wulffraat NM. Haematopoietic stem cell transplantation for autoimmune diseases. Nat Rev Rheumatol 2017; 13:244-56. [DOI: 10.1038/nrrheum.2017.7] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Shanklin VE, Snowden JA, Greenfield DM. Late treatment effects following bone marrow transplant: Efficacy of implementing international guidelines. Eur J Cancer Care (Engl) 2016; 27:e12623. [PMID: 28026132 DOI: 10.1111/ecc.12623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Abstract
An increasing cohort of haematopoietic cell transplantation (HCT) survivors has raised awareness of long-term and late effects. Updated recommendations for HCT late effects screening were published in 2012 [Majhail et al. Biology of Blood and Marrow Transplantation, 18 (2012):348]. We aimed to assess the clinical efficacy of a dedicated screening clinic to identify problems in HCT survivors using the international guidelines. Clinic letters and test results of the first 59 consecutive patients attending the screening clinic were evaluated. 30 females and 29 males (mean age of 49 years, range 22-74) were included. The mean time since transplant was 6 years (0.5-18). 49/65 transplants were allogeneic. Primary indications for HCT were myeloid (56%), lymphoid (37%), solid tumour (5%) and auto-immune diseases (2%). 134 complications were reported (mean 2, range 0-8), with 114 documented further actions/referrals. The most commonly reported concerns were pain 18/59 (31%), fatigue 14/59 (24%), sexual function 14/59 (24%) and sleep disturbance 11/59 (19%). Second primary malignancies were recorded in five cases. Implementation and audit of the international late effect screening guidelines confirm the need for systematic long-term physical and psychological screening and care, thus ensuring timely and efficient identification of problems and the opportunity to minimise morbidity effects and optimise health.
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Affiliation(s)
- V E Shanklin
- Medical School, University of Sheffield, Sheffield, UK
| | - J A Snowden
- Department of Haematology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D M Greenfield
- Weston Park Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Clark CA, Savani M, Mohty M, Savani BN. What do we need to know about allogeneic hematopoietic stem cell transplant survivors? Bone Marrow Transplant 2016; 51:1025-31. [PMID: 27064688 DOI: 10.1038/bmt.2016.95] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for over 70 benign and malignant hematologic and immunological processes. Over the past several decades, significant technological and post-transplant supportive advances have been made, resulting in a decrease in early transplant mortality and continued growth in the population of allo-HSCT survivors. With the expansion in the number of long-term survivors, as well as of those considering a transplant, the focus of transplant medicine has been shifted significantly to include a more prominent role for the care of the 'long-term' survivor. These patients have survived the acute critical phase of transplantation and have potentially achieved remission from their primary disease, yet allo-HSCT patients do not return to pre-transplant health status. For survivors >2 years removed, the time of transplant all-cause mortality is four- to nine-fold higher than age-matched peers within the general population. These patients represent a distinct, high-risk population that must be monitored for long-term transplant complications, including chronic GvHD (cGvHD), multi-organ dysfunctions and secondary malignancies. This article will review in a non-exhaustive manner, the approach to long-term care of an allo-HSCT recipient.
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Abstract
Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Abstract
Prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) has greatly improved. Therefore, long-term survivorship becomes an important issue. A number of malignant and nonmalignant late effects can cause substantial morbidity, with considerable impact on health and quality of life. The main factors responsible for late effects after HSCT are total body irradiation-based conditioning and chronic graft-versus-host disease and its treatment. The knowledge on late effects serves as guidance for surveillance and management decision. Aftercare includes screening and counseling for prevention and treatment of late complications. The care of HSCT recipients tends with time to be transferred from the transplant center back to the primary care provider, who might not be however familiar with the unique needs of long-term survivors. A broad expertise is needed for the post-transplant management; therefore, transplant centers together with primary care providers should ensure complementary care delivery. Standardized follow-up guidelines on late effects represent the best tool to guaranty good management of long-term survivors. Distribution, broad promotion, and applications of these guidelines are therefore needed.
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Affiliation(s)
- André Tichelli
- Division of Hematology, University Hospital of Basel, Petersgraben 4, 4031, Basel, Switzerland,
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Godoy MC, Marom EM, Carter BW, Sorensen J, Truong MT, Abbott GF. Computed Tomography Imaging of Lung Infection in the Oncologic Setting: Typical Features and Potential Pitfalls. Semin Roentgenol 2015; 50:192-6. [DOI: 10.1053/j.ro.2015.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cantú-Rodríguez OG, Sánchez-Cárdenas M, Treviño-Montemayor OR, Gutiérrez-Aguirre CH, Tarín-Arzaga L, Jaime-Pérez JC, Gómez-Almaguer D. Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy. PSYCHOL HEALTH MED 2015; 21:10-9. [PMID: 26125120 DOI: 10.1080/13548506.2015.1054843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.
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Affiliation(s)
- Olga Graciela Cantú-Rodríguez
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Mónica Sánchez-Cárdenas
- b Department of Internal Medicine , Hospital Universitario, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Oscar Rubén Treviño-Montemayor
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Luz Tarín-Arzaga
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - José Carlos Jaime-Pérez
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - David Gómez-Almaguer
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
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Slater ME, Steinberger J, Ross JA, Kelly AS, Chow EJ, Koves IH, Hoffmeister P, Sinaiko AR, Petryk A, Moran A, Lee J, Chow LS, Baker KS. Physical Activity, Fitness, and Cardiometabolic Risk Factors in Adult Survivors of Childhood Cancer with a History of Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1278-83. [PMID: 25865649 DOI: 10.1016/j.bbmt.2015.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
Along with other childhood cancer survivors (CCS), hematopoietic cell transplantation (HCT) survivors are at high risk of treatment-related late effects, including cardiovascular disease and diabetes. Cardiometabolic risk factor abnormalities may be exacerbated by inadequate physical activity (PA). Relationships between PA and cardiometabolic risk factors have not been well described in CCS with HCT. PA (self reported), mobility (timed up and go test), endurance (6-minute walk test), handgrip strength, and cardiometabolic risk factors were measured in 119 HCT survivors and 66 sibling controls ages ≥18 years. Adjusted comparisons between HCT survivors and controls and between categories of low and high PA, mobility, endurance, and strength were performed with linear regression. Among HCT survivors, the high PA group had lower waist circumference (WC) (81.9 ± 2.5 versus 88.6 ± 3.1 cm ± standard error (SE), P = .009) than the low PA group, whereas the high endurance group had lower WC (77.8 ± 2.6 versus 87.8 ± 2.5 cm ± SE, P = .0001) and percent fat mass (33.6 ± 1.8 versus 39.4 ± 1.7% ± SE, P = .0008) and greater insulin sensitivity (IS) (10.9 ± 1.0 versus 7.42 ± 1.14 mg/kg/min ± SE via euglycemic insulin clamp, P = .001) than the low endurance group. Differences were greater in HCT survivors than in controls for WC between low and high PA groups, triglycerides between low and high mobility groups, and WC, systolic blood pressure, and IS between low and high endurance groups (all Pinteraction <.05). Higher endurance was associated with a more favorable cardiometabolic profile in HCT survivors, suggesting that interventions directed to increase endurance in survivors may reduce the risk of future cardiovascular disease.
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Affiliation(s)
- Megan E Slater
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Julie A Ross
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Eric J Chow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - Ildiko H Koves
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - Paul Hoffmeister
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anna Petryk
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jill Lee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lisa S Chow
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
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Utsunomiya A, Nakano N, Takatsuka Y. Recent advances in allogeneic hematopoietic stem cell transplantation for adult T-cell leukemia-lymphoma. ACTA ACUST UNITED AC 2015; 4:39-46. [DOI: 10.7889/hct.4.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vantyghem MC, Cornillon J, Decanter C, Defrance F, Karrouz W, Leroy C, Le Mapihan K, Couturier MA, De Berranger E, Hermet E, Maillard N, Marcais A, Francois S, Tabrizi R, Yakoub-Agha I. Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation. Orphanet J Rare Dis 2014; 9:162. [PMID: 25496809 PMCID: PMC4243320 DOI: 10.1186/s13023-014-0162-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/09/2014] [Indexed: 12/31/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation is mainly indicated in bone marrow dysfunction related to blood diseases, but also in some rare diseases (adrenoleucodystrophy, mitochondrial neurogastrointestinal encephalomyopathy or MNGIE…). After decades, this treatment has proven to be efficient at the cost of numerous early and delayed side effects such as infection, graft-versus-host disease, cardiovascular complications and secondary malignancies. These complications are mainly related to the conditioning, which requires a powerful chemotherapy associated to total body irradiation (myelo-ablation) or immunosuppression (non myelo-ablation). Among side effects, the endocrine complications may be classified as 1) hormonal endocrine deficiencies (particularly gonado- and somatotropic) related to delayed consequences of chemo- and above all radiotherapy, with their consequences on growth, puberty, bone and fertility); 2) auto-immune diseases, particularly dysthyroidism; 3) secondary tumors involving either endocrine glands (thyroid carcinoma) or dependent on hormonal status (breast cancer, meningioma), favored by immune dysregulation and radiotherapy; 4) metabolic complications, especially steroid-induced diabetes and dyslipidemia with their increased cardio-vascular risk. These complications are intricate. Moreover, hormone replacement therapy can modulate the cardio-vascular or the tumoral risk of patients, already increased by radiotherapy and chemotherapy, especially steroids and anthracyclins… Therefore, patients and families should be informed of these side effects and of the importance of a long-term follow-up requiring a multidisciplinary approach.
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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] [What about the content of this article? (0)] [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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Mohty M, Malard F, Savani BN. High-dose total body irradiation and myeloablative conditioning before allogeneic hematopoietic cell transplantation: time to rethink? Biol Blood Marrow Transplant 2014; 21:620-4. [PMID: 25246296 DOI: 10.1016/j.bbmt.2014.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
Over the last decade, the care of patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) has significantly improved, leading to a decrease in deaths related to allo-HCT as well as improved long-term survival. However, for many patients, long-term survivorship is associated with a substantial burden of chronic morbidities. Indeed, malignant and nonmalignant late complications after allo-HCT are numerous and usually multifactorial, with all organs and tissues a potential target. In many cases, these long-term side effects are associated with the use of high-dose total body irradiation, myeloablative conditioning regimens, and the onset of chronic graft-versus-host disease. It appears to be essential to change the natural history of these late effects. This requires the introduction of improved conditioning regimens and the development of lifelong monitoring controls, patient counseling, and preventative treatment measures. This approach will allow us to pursue our efforts to improve patient outcome.
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Affiliation(s)
- Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France; INSERM UMR 938, Paris, France; Université Pierre et Marie Curie, Paris, France.
| | - Florent Malard
- Department of Haematology, Saint Antoine Hospital, Paris, France; INSERM UMR 938, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Bipin N Savani
- Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, Tennessee
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Kirsch M, Mitchell SA, Dobbels F, Stussi G, Basch E, Halter JP, De Geest S. Linguistic and content validation of a German-language PRO-CTCAE-based patient-reported outcomes instrument to evaluate the late effect symptom experience after allogeneic hematopoietic stem cell transplantation. Eur J Oncol Nurs 2014; 19:66-74. [PMID: 25190633 DOI: 10.1016/j.ejon.2014.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this sequential mixed methods study was to develop a PRO-CTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events)-based measure of the symptom experience of late effects in German speaking long-term survivors of allogeneic stem cell transplantation (SCT), and to examine its content validity. METHODS The US National Cancer Institute's PRO-CTAE item library was translated into German and linguistically validated. PRO-CTCAE symptoms prevalent in ≥50% of survivors (n = 15) and recognized in its importance by SCT experts (n = 9) were identified. Additional concepts relevant to the symptom experience and its consequences were elicited. Content validity of the PROVIVO (Patient-Reported Outcomes of long-term survivors after allogeneic SCT) instrument was assessed through an additional round of cognitive debriefing in 15 patients, and item and scale content validity indices by 9 experts. RESULTS PROVIVO is comprised of a total of 49 items capturing the experience of physical, emotional and cognitive symptoms. To improve the instrument's utility for clinical decision-making, questions soliciting limitations in activities of daily living, frequent infections, and overall well-being were added. Cognitive debriefings demonstrated that items were well understood and relevant to the SCT survivor experience. Scale Content Validity Index (CVI) (0.94) and item CVI (median = 1; range 0.75-1) were very high. CONCLUSIONS Qualitative and quantitative data provide preliminary evidence supporting the content validity of PROVIVO and identify a PRO-CTCAE item bundle for use in SCT survivors. A study to evaluate the measurement properties of PROVIVO and to examine its capacity to improve survivorship care planning is underway.
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Affiliation(s)
- Monika Kirsch
- Institute of Nursing Science, University of Basel, Switzerland; Department of Haematology, University Hospital Basel, Switzerland
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, United States
| | - Fabienne Dobbels
- Health Services and Nursing Research, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Georg Stussi
- Department of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Ethan Basch
- Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, University of North Carolina, United States
| | - Jorg P Halter
- Department of Haematology, University Hospital Basel, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, University of Basel, Switzerland; Health Services and Nursing Research, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. [Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation]. Bone Marrow Transplant 2014; 47:337-41. [PMID: 24975331 DOI: 10.1038/bmt.2012.5] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Kato K, Yoshida N, Matsumoto K, Matsuyama T. Fludarabine, cytarabine, granulocyte colony-stimulating factor and melphalan (FALG with L-PAM) as a reduced toxicity conditioning regimen in children with acute leukemia. Pediatr Blood Cancer 2014; 61:712-6. [PMID: 24376191 DOI: 10.1002/pbc.24922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 12/11/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The conventional conditioning regimen for patients with leukemia prior to allogeneic stem cell transplantation is myeloablation to eradicate residual leukemic cells and host immunocompetent cells. This helps prevent leukemic relapse as well as rejection after transplantation. A myeloablative conditioning regimen with busulfan (BU) or total body irradiation (TBI) is effective for eradication of leukemic cells but is also associated with significant toxicities in the acute or late phase in pediatric patients. In an effort to minimize these adverse effects, we conducted bone marrow transplantation (BMT) from unrelated volunteer donors using a conditioning regimen without BU or TBI. PROCEDURE Ten patients with acute leukemia in first or second remission were given a "non-BU, non-TBI conditioning regimen," which consisted of fludarabine (FLU), cytarabine (CA), and melphalan (L-PAM) after FLAG combined with L-PAM. RESULTS Engraftment was obtained in all patients, and two patients died of relapse. Eight of 10 patients have been disease-free for a median of 126 months (116-142) after transplantation. The overall survival, event-free survival, relapse rate, and treatment-related mortality were 80.0%, 80.0%, 20.0% and 0.0%, respectively. In female patients, spontaneous menstruation with normal luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) levels was observed in all four patients at post-pubertal age. CONCLUSIONS This conditioning regimen of FLAG combined with L-PAM (which did not contain BU and TBI) was associated with good outcomes and minimal late adverse effects in children with acute leukemia who have undergone allogeneic BMT from unrelated volunteer donors.
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Affiliation(s)
- Koji Kato
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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Abstract
We are entering an exciting time in the study of immunologic tolerance. Several cellular and molecular strategies have been developed that show promise in nonhuman transplant models and these approaches are just now appearing in clinical trials. Tolerance strategies that prevent immune rejection and obviate the need for immunosuppressive medications (with inherent risk of cancer, infection, and organ toxicity) would improve both graft and patient survival. Each tolerance protocol brings its own set of associated risks. As the results of these trials become available, we must continue to evaluate their successes and failures. The balance of these outcomes will help us answer the question: "Tolerance-Is it worth it?"
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Affiliation(s)
- Erik B Finger
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455
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Joshi S, Savani BN, Chow EJ, Gilleece MH, Halter J, Jacobsohn DA, Pidala J, Quinn GP, Cahn JY, Jakubowski AA, Kamani NR, Lazarus HM, Rizzo JD, Schouten HC, Socie G, Stratton P, Sorror ML, Warwick AB, Wingard JR, Loren AW, Majhail NS. Clinical guide to fertility preservation in hematopoietic cell transplant recipients. Bone Marrow Transplant 2014; 49:477-84. [PMID: 24419521 DOI: 10.1038/bmt.2013.211] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 11/08/2022]
Abstract
With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.
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Armenian SH, Chow EJ. Cardiovascular disease in survivors of hematopoietic cell transplantation. Cancer 2013; 120:469-79. [PMID: 24166350 DOI: 10.1002/cncr.28444] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/12/2022]
Abstract
Hematopoietic cell transplantation (HCT) is increasingly offered as a curative option for many patients with hematologic malignancies. Improvements in HCT strategies and supportive care have resulted in a growing number of long-term survivors. However, these survivors are at an increased risk of developing long-term debilitating chronic health conditions, including premature cardiovascular disease. These complications are more common than in the general population, and there are well-described associations between therapeutic exposures, traditional cardiovascular risk factors, and subsequent cardiovascular disease risk. The authors present herein an overview of the current state of knowledge regarding pathogenesis and risk factors for some of the more commonly occurring cardiovascular complications after HCT, highlighting existing surveillance recommendations and future directions for research to minimize cardiovascular morbidity in these survivors.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California
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Sundberg KK, Wettergren L, Frisk P, Arvidson J. Self-reported quality of life in long-term survivors of childhood lymphoblastic malignancy treated with hematopoietic stem cell transplantation versus conventional therapy. Pediatr Blood Cancer 2013; 60:1382-7. [PMID: 23519958 DOI: 10.1002/pbc.24519] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/07/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic health conditions are known to be both abundant and severe after pediatric hematopoietic stem cell transplantation (SCT). The present objective was to investigate the impact of disease and treatment on individual QoL and health-related quality of life (HRQoL) in long-term survivors of childhood lymphoblastic malignancy treated with conventional therapy versus SCT. PROCEDURE Survivors of lymphoblastic malignancy treated with (n = 18) or without (n = 52) SCT were recruited a median follow-up time of 18 and 14 years, respectively. The indication for SCT was relapsed disease in 17 of 18 cases. Autologous stem cells were used in 15 cases. Total body irradiation (TBI) was included in the conditioning regimen for all SCT patients. A cross-sectional study was conducted using two validated instruments: SEIQoL-DW (individual QoL) and SF-36 (HRQoL). Content analysis was used to analyze SEIQoL-DW and an overall QoL index score was calculated. Two multiple linear regression analyses were performed to detect factors influencing outcomes. RESULTS Poorer ratings of overall QoL and more negative consequences related to physical dysfunctions were shown in the SCT group. The findings indicate that being unemployed or on sick leave are associated with a decline in HRQoL and individual QoL rather than SCT, cranial radiation therapy, present age, or sex. CONCLUSION In this small sample of long-term survivors of SCT, QoL seems reasonably good and similar to that of those having received conventional therapy. However, managing an employment must be acknowledged as an important part of life that has a great impact on QoL.
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Affiliation(s)
- Kay K Sundberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
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Hassan NE, Mageed AS, Sanfilippo DJ, Reischman D, Duffner UA, Rajasekaran S. Risk factors associated with pediatric intensive care unit admission and mortality after pediatric stem cell transplant: possible role of renal involvement. World J Pediatr 2013; 9:140-5. [PMID: 23275103 DOI: 10.1007/s12519-012-0391-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 02/17/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hematopoietic stem-cell transplant (HSCT) is associated with many risk factors for life-threatening complications. Post-transplant critical illness often requires admission to the pediatric intensive care unit (PICU). METHODS A retrospective analysis was made on the risk factors associated with PICU admission and mortality of all HSCT patients at Helen DeVos Children's Hospital from October 1998 to November 2008. RESULTS One hundred and twenty-four patients underwent HSCT, with 19 (15.3%) requiring 29 PICU admissions. Fifty patients received autologous, 38 matched sibling, and 36 matched un-related donor HSCT, with 10%, 13% and 25% of these patients requiring PICU admission, respectively (P=0.01). Among the HSCT patients, those who were admitted to the PICU were more likely to have renal involvement by either malignancy requiring nephrectomy or a post transplant complication increasing the likelihood of decreased renal function (21.1% vs. 4.8%, P=0.03). PICU admissions were also more likely to receive pre-transplant total body irradiation (52.6% vs. 27.6%, P=0.03). Among 29 patients with PICU admission, 3 died on day 1 after admission, and 5 within 30 days (a mortality rate of 17%). Thirty days after PICU admission, non-survivors had a higher incidence of respiratory failure and septic shock on admission compared with survivors (80% vs. 16.7%, P=0.01 and 80% vs. 4.2%, respectively, P=0.001). Two survivors with chronic renal failure underwent renal transplantation successfully. CONCLUSIONS Total body irradiation and renal involvement are associated with higher risk for PICU admissions after HSCT in pediatric patients, while septic shock upon admission and post-admission respiratory failure are associated with mortality.
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Affiliation(s)
- Nabil E Hassan
- Pediatric Critical Care Medicine, Blood and Bone Marrow Transplant, Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI 49503,USA.
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Tichelli A, Labopin M, Rovó A, Badoglio M, Arat M, van Lint MT, Lawitschka A, Schwarze CP, Passweg J, Socié G. Increase of suicide and accidental death after hematopoietic stem cell transplantation: a cohort study on behalf of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Cancer 2013; 119:2012-21. [PMID: 23512286 PMCID: PMC3698695 DOI: 10.1002/cncr.27987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 11/07/2012] [Accepted: 11/14/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relapse and transplant-related complications are leading causes of mortality after hematopoietic stem cell transplantation (HSCT). Suicides and accidents have not been studied in these patients. This study sought to determine whether there is an excess of suicide and accidental deaths after HSCT, and to determine risk factors. METHODS The incidence of suicidal and accidental death in patients after undergoing HSCT, standardized mortality ratio (SMR), and absolute excess risk (AER) of suicide and accidental deaths was determined, compared with the general European population. A case-control analysis was done to define factors associated with suicide and accidental deaths. Data were derived from the European Group for Blood and Marrow Transplantation Registry, including 294,922 patients who underwent autologous or allogeneic HSCT from 1980 to 2009. RESULTS The 10-year cumulative incidence of suicide and accidental deaths was 101.8 and 55.6 per 100,000 patients, respectively. SMR and AER of suicide after HSCT were 2.12 (P < .001) and 10.91, higher than in the European general population for 100,000 deaths, respectively. SMR and AER of accidental death were 1.23 (P < .05) and 2.54, respectively. In the case-control study, relapses were more frequent among patients who committed suicide after autologous HSCT (37% versus 18%; P < .0001). Chronic graft-versus-host disease was higher among patients who committed suicide after allogeneic HSCT (64% versus 37%; P = .001). CONCLUSIONS There is an excess of deaths due to suicide and accidents in patients after undergoing HSCT as compared with the European general population. Relapse was associated with more suicide and accidental deaths after autologous HSCT, and chronic graft-versus-host disease was associated with more deaths by suicide after allogeneic HSCT. Cancer 2013;119:2012–2021. © 2013 American Cancer Society.
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Affiliation(s)
- André Tichelli
- Division of Hematology, University Hospital Basel, Basel, Switzerland.
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Rovó A, Aljurf M, Chiodi S, Spinelli S, Salooja N, Sucak G, Hunter A, Kim TS, Socié G, van Lint MT, Passweg JR, Arat M, Badoglio M, Tichelli A. Paternity wishes in long-term survivors after allogeneic hematopoietic SCT. A study of the late effects working party of the EBMT. Bone Marrow Transplant 2013; 48:878-9. [DOI: 10.1038/bmt.2012.255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Majhail NS, Douglas Rizzo J. Surviving the cure: long term followup of hematopoietic cell transplant recipients. Bone Marrow Transplant 2013; 48:1145-51. [DOI: 10.1038/bmt.2012.258] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/09/2022]
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Lint MTV, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Rev Bras Hematol Hemoter 2012; 34:109-33. [PMID: 23049402 PMCID: PMC3459383 DOI: 10.5581/1516-8484.20120032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 02/06/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- Navneet Singh Majhail
- National Marrow Donor Program, Minneapolis, MN, USA ; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 2012; 5:1-30. [PMID: 22446607 DOI: 10.5144/1658-3876.2012.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- N S Majhail
- National Marrow Donor Program, Minneapolis, MN 55413-1753, USA.
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 18:348-71. [PMID: 22178693 DOI: 10.1016/j.bbmt.2011.12.519] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/07/2011] [Indexed: 12/26/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- Navneet S Majhail
- National Marrow Donor Program, Minneapolis, Minnesota 55413-1753, USA.
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Abstract
Organ transplantation has evolved rapidly and there is now widespread use of donated organs for the treatment of end-stage organ failure. Although the therapeutic options achieving long-term graft survival have improved, acute and chronic rejections are still a major problem. Studies to identify noninvasive biomarkers for rejection and underlying molecular events have increased significantly in the past decade, but a major breakthrough is still missing. The recent discovery of small regulatory RNA molecules (microRNAs) resulted in a new and improved understanding of the mechanisms of gene regulation and also led to the development of the first new microRNA (miRNA)-based therapies. miRNAs are endogenous, single-stranded RNAs consisting of about 19-25 noncoding nucleotides, which have an important role in regulating gene expression. Additionally, circulating miRNAs that might be useful as novel disease biomarkers were detected. Here, we summarise current knowledge about the role of miRNAs in immunology and transplantation medicine and their role as potential biomarkers. We also focus on the molecular mechanisms and therapeutic implications of the use of miRNA-based therapeutic strategies to improve long-term allograft survival.
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Bieri S, Roosnek E, Ozsahin H, Huguet S, Ansari M, Trombetti A, Helg C, Chapuis B, Miralbell R, Passweg J, Chalandon Y. Outcome and risk factors for late-onset complications 24 months beyond allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2011; 87:138-47. [PMID: 21535161 DOI: 10.1111/j.1600-0609.2011.01638.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to assess the incidence of late complications occurring ≥2 years after allogeneic hematopoietic stem cell transplantation (HSCT) for malignant diseases using a T-cell depletion strategy. METHODS Between 1984 and 2004, 142 patients were eligible for the study. Total body irradiation (TBI) was carried out in 85% of the patients and T-cell depletion in 84%. RESULTS Non-relapse mortality (NRM) was 3% (95% CI 0-11) at 10 years, and serious late events affected a substantial number of patients. The cumulative incidence (CI) of chronic graft-versus-host disease (cGvHD) was 30% (95% CI 23-40), and that of infectious complications was 17% (95% CI 11-23). Multivariate analysis showed a higher risk for late complications in patients with cGvHD (HR 1.9, 95% CI 1.2-3.2, P=0.011) and patients receiving methylprednisolone during conditioning (HR 1.9, 95% CI 1.1-3.3, P=0.019 1), patients with cGvHD also having a higher risk for NRM (HR 13.2, 95% CI 1.2-143, P=0.03), as well as those receiving steroids for >3 months (HR 40.3, 95% CI 2.3-718, P=0.02) and those receiving antithymocyte globulin (HR 9.6, 95% CI 0.8-68, P=0.024). CONCLUSIONS A significant proportion of long-term survivors of HSCT had late complications. cGvHD remained an important risk factor for late complications despite T-cell depletion resulting in immunosuppression and infectious complications.
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Affiliation(s)
- Sabine Bieri
- Division of Radiation Oncology, University Hospital, Geneva, Switzerland
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Socié G. Survivors after blood wars. Blood 2011; 118:1194-1195. [DOI: 10.1182/blood-2011-06-361345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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