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Zwicker HM, Fay-McClymont TB, Hou SHJ, Cho S, McDonald K, Guilcher GMT, Yeates KO, Brooks BL, Schulte FSM. Social adjustment in children diagnosed with sickle cell disease: A retrospective study. Pediatr Blood Cancer 2024; 71:e30807. [PMID: 38110802 DOI: 10.1002/pbc.30807] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at risk for physical, psychological, and social adjustment challenges. This study sought to investigate social adjustment and related factors in children living with SCD. METHODS Data from 32 children (50% male, mean age = 10.32 years, SD = 3.27) were retrospectively collected from a neuropsychology clinic at a tertiary care pediatric hospital. Social adjustment was measured using the Behavior Assessment System for Children (BASC-3) parent-proxy, withdrawal subscale, and the Pediatric Quality of Life Inventory (PedsQL) Generic Module Social Functioning self- and parent-proxy subscales. Other measures captured executive functioning (i.e., Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) Parent Form) and non-disease-related associations with social adjustment, including number of years in Canada and family functioning (i.e., PedsQL Family Impact Module). RESULTS Sixteen percent of patients reported elevated social adjustment difficulties. Multiple linear regression found better family functioning [B = .48, t = 2.65, p = .016], and higher executive functioning [B = -.43, t = -2.39, p = .028] were related to higher scores on the PedsQL parent-proxy ratings of social adjustment [F(4,18) = 5.88, p = .003]. Male sex [B = .54, t = 3.08, p = .005], and having lived more years in Canada [B = .55, t = 2.81, p = .009], were related to higher PedsQL self-reported social adjustment [F(4,23) = 3.75, p = .017]. The model examining the BASC-3 withdrawal subscale was not statistically significant [F(4,16) = 1.63, p = .22]. IMPLICATIONS Social adjustment in children diagnosed with SCD warrants future research to understand the influence of executive function, and non-disease-related factors, particularly focusing on sociocultural factors.
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Affiliation(s)
- Hailey M Zwicker
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn B Fay-McClymont
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sharon H J Hou
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sara Cho
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaelyn McDonald
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith O Yeates
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Neuropsychology Services, Alberta Children's Hospital, Calgary, Alberta, Canada
- Child Brain and Mental Health, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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Rotz SJ, Bhatt NS, Hamilton BK, Duncan C, Aljurf M, Atsuta Y, Beebe K, Buchbinder D, Burkhard P, Carpenter PA, Chaudhri N, Elemary M, Elsawy M, Guilcher GMT, Hamad N, Karduss A, Peric Z, Purtill D, Rizzo D, Rodrigues M, Ostriz MBR, Salooja N, Schoemans H, Seber A, Sharma A, Srivastava A, Stewart SK, Baker KS, Majhail NS, Phelan R. International recommendations for screening and preventative practices for long-term survivors of transplantation and cellular therapy: a 2023 update. Bone Marrow Transplant 2024:10.1038/s41409-023-02190-2. [PMID: 38413823 DOI: 10.1038/s41409-023-02190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024]
Abstract
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the volume of HCT performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long-term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and other underlying risk-factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and updated in 2012. To review contemporary literature and update the recommendations while considering the changing practice of HCT and cellular therapy, an international group of experts was again convened. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed but cGVHD management is not covered in detail. These guidelines emphasize special needs of patients with distinct underlying HCT indications or comorbidities (e.g., hemoglobinopathies, older adults) but do not replace more detailed group, disease, or condition specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
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Affiliation(s)
- Seth J Rotz
- Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | | | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christine Duncan
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard University, Boston, MA, USA
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Kristen Beebe
- Phoenix Children's Hospital and Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Peggy Burkhard
- National Bone Marrow Transplant Link, Southfield, MI, USA
| | | | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Elemary
- Hematology and BMT, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
- QEII Health Sciences Center, Halifax, NS, Canada
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Transplant and Cellular Therapy, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, NSW, Australia
- St Vincent's Clinical School Sydney, University of New South Wales, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, WA, Australia
| | - Amado Karduss
- Bone Marrow Transplant Program, Clinica las Americas, Medellin, Colombia
| | - Zinaida Peric
- BMT Unit, Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Duncan Purtill
- Fiona Stanley Hospital, Murdoch, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Douglas Rizzo
- Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Maria Belén Rosales Ostriz
- Division of hematology and bone marrow transplantation, Instituto de trasplante y alta complejidad (ITAC), Buenos Aires, Argentina
| | - Nina Salooja
- Centre for Haematology, Imperial College London, London, UK
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven-University of Leuven, Leuven, Belgium
| | | | - Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | - Susan K Stewart
- Blood & Marrow Transplant Information Network, Highland Park, IL, 60035, USA
| | | | - Navneet S Majhail
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, TN, USA
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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3
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Hou SHJ, Stokoe M, Zwicker H, Young-Speirs M, Pelletier W, Guilcher GMT, Khu M, Schulte FSM. Pediatric Hematopoietic Cell Transplantation: A Longitudinal Assessment of Health-Related Quality of Life of Pediatric Donors. J Clin Psychol Med Settings 2023; 30:836-845. [PMID: 36670334 PMCID: PMC9860226 DOI: 10.1007/s10880-022-09933-1] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Pediatric donors may be at increased risk of psychological and social challenges following hematopoietic cell transplantation (HCT). Through a retrospective chart review, we evaluated the health-related quality of life (HRQL) of pediatric donors over time and examined facilitators and barriers to implementing a longitudinal psychosocial assessment. Fifty-one pediatric donors (M = 10.7 years, SD = 3.7) completed an HRQL questionnaire across six time points (T1 to T6) from prior to donation to 2 years after. Change in mean scores was assessed using a linear mixed-effect model for repeated measures design. Facilitators and barriers to implementation were examined. HRQL of pediatric donors improved between T1 and T6 with significant change in physical, emotional, and overall functioning. Facilitators to retention included the support of a clinical coordinator. Barriers to implementation included the absence of infrastructure to maintain contact with pediatric and their families. HRQL of pediatric donors of HCT improved steadily over time. Pattern of results suggests a need to further explore factors that contribute to change across time. Development of a longitudinal standardized assessment protocol that can be prospectively and feasibly implemented is integral to supporting the well-being of this group.
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Affiliation(s)
- Sharon H J Hou
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
- Department of Psychology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Mehak Stokoe
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Hailey Zwicker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Morgan Young-Speirs
- Faculty of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Wendy Pelletier
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie Khu
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Fiona S M Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada.
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4
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Bauman BM, Dorjbal B, Pittaluga S, Zhang Y, Niemela JE, Stoddard JL, Rosenzweig SD, Anderson R, Guilcher GMT, Auer I, Perrier R, Campbell M, Bhandal SK, Alba C, Sukumar G, Dalgard CL, Schelotto M, Wright NAM, Su HC, Snow AL. Subcutaneous panniculitis-like T-cell lymphoma in two unrelated individuals with BENTA disease. Clin Immunol 2023; 255:109732. [PMID: 37562721 PMCID: PMC10551883 DOI: 10.1016/j.clim.2023.109732] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/12/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous non-Hodgkin lymphoma involving CD8+ T cells, the genetic underpinnings of which remain incompletely understood. Here we report two unrelated patients with B cell Expansion with NF-κB and T cell Anergy (BENTA) disease and a novel presentation of SPTCL. Patient 1 presented early in life with recurrent infections and B cell lymphocytosis, linked to a novel gain-of-function (GOF) CARD11 mutation (p.Lys238del). He developed SPTCL-like lesions and membranoproliferative glomerulonephritis by age 2, treated successfully with cyclosporine. Patient 2 presented at 13 months with splenomegaly, lymphadenopathy, and SPTCL with evidence of hemophagocytic lymphohistiocytosis. Genetic analysis revealed two in cis germline GOF CARD11 variants (p.Glu121Asp/p.Gly126Ser). Autologous bone marrow transplant resulted in SPTCL remission despite persistent B cell lymphocytosis. These cases illuminate an unusual pathological manifestation for BENTA disease, suggesting that CARD11 GOF mutations can manifest in cutaneous CD4+and CD8+ T cell malignancies.
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Affiliation(s)
- Bradly M Bauman
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Batsukh Dorjbal
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yu Zhang
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; NIAID Clinical Genomics Program, National Institutes of Health, Bethesda, MD, USA
| | - Julie E Niemela
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Jennifer L Stoddard
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ronald Anderson
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Iwona Auer
- Alberta Precision Laboratories, University of Calgary, Calgary, AB, Canada
| | - Renee Perrier
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
| | | | | | - Camille Alba
- The American Genome Center, Precision Medicine Initiative for Military Medical Education and Research (PRIMER), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Gauthaman Sukumar
- The American Genome Center, Precision Medicine Initiative for Military Medical Education and Research (PRIMER), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Clifton L Dalgard
- The American Genome Center, Precision Medicine Initiative for Military Medical Education and Research (PRIMER), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Magdalena Schelotto
- Department of Pediatric Hematology and Oncology, Fundación Pérez Scremini, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Nicola A M Wright
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Helen C Su
- Laboratory of Clinical Immunology & Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; NIAID Clinical Genomics Program, National Institutes of Health, Bethesda, MD, USA
| | - Andrew L Snow
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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5
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Harper A, Schulte F, Guilcher GMT, Truong TH, Reynolds K, Spavor M, Logie N, Lee J, Fidler-Benaoudia MM. Alberta Childhood Cancer Survivorship Research Program. Cancers (Basel) 2023; 15:3932. [PMID: 37568747 PMCID: PMC10417797 DOI: 10.3390/cancers15153932] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 08/13/2023] Open
Abstract
Adverse outcomes after childhood cancer have been assessed in a range of settings, but most existing studies are historical and ascertain outcomes only after 5-year survival. Here, we describe the Alberta Childhood Cancer Survivorship Research Program and its foundational retrospective, population-based cohort of Albertan residents diagnosed with a first primary neoplasm between the ages of 0 and 17 years from 1 January 2001 to 31 December 2018. The cohort was established in collaboration with the Alberta Cancer Registry and Cancer in Young People in Canada program and has been linked to existing administrative health databases and patient-reported outcome questionnaires. The cohort comprised 2580 survivors of childhood cancer, 1379 (53.4%) of whom were 5-year survivors. Approximately 48% of the cohort was female, 47% of the cohort was diagnosed between 0 and 4 years of age, and the most frequent diagnoses were leukemias (25.4%), central nervous system tumors (24.0%), and lymphomas (14.9%). Detailed treatment information was available for 1741 survivors (67.5%), with manual abstraction ongoing for those with missing data. By the study exit date, the median time since diagnosis was 5.5 years overall and 10.4 years for 5-year survivors. During the follow-up time, 82 subsequent primary cancers were diagnosed, 20,355 inpatient and 555,425 ambulatory/outpatient events occurred, 606,773 claims were reported, and 437 survivors died. The results from this research program seek to inform and improve clinical care and reduce cancer-related sequelae via tertiary prevention strategies.
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Affiliation(s)
- Andrew Harper
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (G.M.T.G.); (T.H.T.)
- Long Term Survivor’s Clinic, Alberta Children’s Hospital, Calgary, AB T2N 4N1, Canada;
| | - Gregory M. T. Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (G.M.T.G.); (T.H.T.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tony H. Truong
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (G.M.T.G.); (T.H.T.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Kathleen Reynolds
- Long Term Survivor’s Clinic, Alberta Children’s Hospital, Calgary, AB T2N 4N1, Canada;
- Department of Supplementary Medicine, Faculty of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Maria Spavor
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Natalie Logie
- Division of Radiation Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada;
| | - Joon Lee
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Miranda M. Fidler-Benaoudia
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (G.M.T.G.); (T.H.T.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Patel P, Robinson PD, Phillips R, Baggott C, Devine K, Gibson P, Guilcher GMT, Holdsworth MT, Neumann E, Orsey AD, Spinelli D, Thackray J, van de Wetering M, Cabral S, Sung L, Dupuis LL. Treatment of breakthrough and prevention of refractory chemotherapy-induced nausea and vomiting in pediatric cancer patients: Clinical practice guideline update. Pediatr Blood Cancer 2023:e30395. [PMID: 37178438 DOI: 10.1002/pbc.30395] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
This clinical practice guideline update provides recommendations for treating breakthrough chemotherapy-induced nausea and vomiting (CINV) and preventing refractory CINV in pediatric patients. Two systematic reviews of randomized controlled trials in adult and pediatric patients informed the recommendations. In patients with breakthrough CINV, escalation of antiemetic agents to those recommended for chemotherapy of the next higher level of emetogenic risk is strongly recommended. A similar recommendation to escalate therapy is made to prevent refractory CINV in patients who did not experience complete breakthrough CINV control and are receiving minimally or low emetogenic chemotherapy. A strong recommendation to use antiemetic agents that controlled breakthrough CINV for the prevention of refractory CINV is also made.
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Affiliation(s)
- Priya Patel
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Robert Phillips
- Department of Haematology and Oncology, NHS Trust, Leeds Teaching Hospital, Leeds, UK
| | - Christina Baggott
- Cancer Clinical Trials Office, Stanford Cancer Institute, Palo Alto, California, USA
| | - Katie Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Paul Gibson
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Gregory M T Guilcher
- Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, Alberta, Canada
- Departments of Oncology and Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mark T Holdsworth
- College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Eloise Neumann
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Andrea D Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - Jennifer Thackray
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Sandra Cabral
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Lillian Sung
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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7
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Friend BD, Broglie L, Logan BR, Chhabra S, Bupp C, Schiller G, Beitinjaneh A, Perez MAD, Guilcher GMT, Hashem H, Hildebrandt GC, Krem MM, Lazarus HM, Nishihori T, Nusrat R, Rotz SJ, Wirk B, Wieduwilt M, Pasquini M, Savani BN, Stadtmauer EA, Sorror ML, Thakar MS. Adapting the HCT-CI Definitions for Children, Adolescents, and Young Adults with Hematologic Malignancies Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023; 29:123.e1-123.e10. [PMID: 36442769 PMCID: PMC9911376 DOI: 10.1016/j.jtct.2022.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/22/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Allogeneic hematopoietic cell transplantation is a curative procedure for hematologic malignancies but is associated with a significant risk of non-relapse mortality (NRM). The Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) is a prognostic tool that discriminates this risk in all age groups. A recent survey of transplant physicians demonstrated that 79% of pediatric providers used the HCT-CI infrequently, and most reported concerns about its applicability in the younger population. We conducted a retrospective study using the Center for International Blood and Marrow Transplant Research database to examine the impact of expanded HCT-CI definitions on NRM in pediatric and young adult patients with hematologic malignancies. We included 5790 patients <40 years old receiving allogeneic transplants between 2008 and 2017 to examine broader definitions of comorbidities in the HCT-CI, including history of mechanical ventilation and fungal infection, estimated glomerular filtration rate, and body mass index (BMI) percentiles. Multivariable Fine-Gray models were created to determine the effect of each HCT-CI defining comorbidity and its modification on NRM and were used to develop 2 novel risk scores. We next developed the expanded HCT-CI for children and young adults (youth with malignancies; expanded ymHCT-CI), where 23% patients had an increased comorbidity score, compared to the HCT-CI. Comorbidities with hazard ratio < 1.2 were then removed to create the simplified HCT-CI for children and young adults (youth with malignancies; simplified ymHCT-CI), which demonstrated higher scores corresponded to a greater risk of NRM (P < .001). These novel comorbidity indexes with broader definitions are more relevant to pediatric and young adult patients, and prospective studies are needed to validate these in the younger patient population. It remains to be seen whether the development of these pediatric-specific and practical risk indexes increases their use by the pediatric transplant community.
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Affiliation(s)
- Brian D Friend
- Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | | | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Matthew Wieduwilt
- Department of Medicine, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward A Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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8
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Stenger E, Xiang Y, Wetzel M, Gillespie S, Chellapandian D, Shah R, Arnold SD, Bhatia M, Chaudhury S, Eckrich MJ, Kanter J, Kasow KA, Krajewski J, Nickel RS, Ngwube AI, Olson TS, Rangarajan HG, Wobma H, Guilcher GMT, Horan JT, Krishnamurti L, Shenoy S, Abraham A. Long-Term Organ Function After HCT for SCD: A Report From the Sickle Cell Transplant Advocacy and Research Alliance. Transplant Cell Ther 2023; 29:47.e1-47.e10. [PMID: 36273784 DOI: 10.1016/j.jtct.2022.10.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an established cure for sickle cell disease (SCD) supported by long-term survival, but long-term organ function data are lacking. We sought to describe organ function and assess predictors for dysfunction in a retrospective cohort (n = 247) through the Sickle cell Transplant Advocacy and Research alliance. Patients with <1-year follow-up or graft rejection/second HCT were excluded. Organ function data were collected from last follow-up. Primary measures were organ function, comparing pre- and post-HCT. Bivariable and multivariable analyses were performed for predictors of dysfunction. Median age at HCT was 9.4 years; the majority had HbSS (88.2%) and severe clinical phenotype (65.4%). Most received matched related (76.9%) bone marrow (83.3%) with myeloablative conditioning (MAC; 57.1%). Acute and chronic graft-versus-host disease (GVHD) developed in 24.0% and 24.8%. Thirteen patients (5.3%) died ≥1 year after HCT, primarily from GVHD or infection. More post-HCT patients had low ejection or shortening fractions than pre-HCT (0.6% → 6.0%, P = .007 and 0% → 4.6%, P = .003). The proportion with lung disease remained stable. Eight patients (3.2%) had overt stroke; most had normal (28.3%) or stable (50.3%) brain magnetic resonance imaging. On multivariable analysis, cardiac dysfunction was associated with MAC (odds ratio [OR] = 2.71; 95% confidence interval [CI], 1.09-6.77; P = .033) and severe acute GVHD (OR = 2.41; 95% CI, 1.04-5.62; P = .041). Neurologic events were associated with central nervous system indication (OR = 2.88; 95% CI, 2.00-4.12; P < .001). Overall organ dysfunction was associated with age ≥16 years (OR = 2.26; 95% CI, 1.35-3.78; P = .002) and clinically severe disease (OR = 1.64; 95% CI, 1.02-2.63; P = .043). In conclusion, our results support consideration of HCT at younger age and use of less intense conditioning.
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Affiliation(s)
- Elizabeth Stenger
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta/Emory University, Atlanta, Georgia.
| | - Yijin Xiang
- Biostatistics Core, Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
| | - Martha Wetzel
- Biostatistics Core, Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
| | - Scott Gillespie
- Biostatistics Core, Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
| | | | - Rikin Shah
- Orlando Health - Arnold Palmer Hospital for Children, Orlando, Florida
| | - Staci D Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta/Emory University, Atlanta, Georgia
| | - Monica Bhatia
- Columbia University Irving Medical Center, New York, New York
| | | | | | - Julie Kanter
- University of Alabama Birmingham; Birmingham, Alabama
| | | | | | - Robert S Nickel
- Division of Blood and Marrow Transplantation, Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia
| | | | - Tim S Olson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Holly Wobma
- Boston Children's Hospital, Boston, Massachusetts
| | - Gregory M T Guilcher
- Section of Pediatric Hematology, Oncology and BMT, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - John T Horan
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Shalini Shenoy
- Washington University Medical Center, St. Louis, Missouri
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia
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9
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Waldner RC, Guilcher GMT, Monagel DA, Ho J, Desai S, Rosolowsky ET. Gonadal health in recipients of nonmyeloablative hematopoietic stem cell transplantation in children and adolescents with sickle cell disease. Pediatr Hematol Oncol 2022; 40:682-687. [PMID: 36382784 DOI: 10.1080/08880018.2022.2138659] [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] [Received: 07/13/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Richelle C Waldner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dania A Monagel
- King Saud bin Abdulaziz University for Health Sciences/KAIMRC, Jeddah, Saudi Arabia
| | - Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sunil Desai
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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10
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Monagel DA, Guilcher GMT, Nettel-Aguirre A, Bendiak GN. Pulmonary function in children and adolescents with sickle cell disease after nonmyeloablative hematopoietic cell transplantation. Pediatr Blood Cancer 2022; 69:e29927. [PMID: 35927947 DOI: 10.1002/pbc.29927] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary complications are common in sickle cell disease (SCD). The use of standard myeloablative conditioning regimens may increase the risk of lung injury. We report serial pulmonary function testing (PFT) outcomes in children with SCD who underwent a matched-sibling donor hematopoietic cell transplantation (HCT) using nonmyeloablative (NMA) protocol. METHODS This is a retrospective chart review describing pulmonary outcomes in pediatric patients post HCT. The conditioning regimen consisted of alemtuzumab and a single fraction of 300 cGy of total body irradiation (TBI), and sirolimus for graft-versus-host disease (GVHD) prophylaxis. Serial PFT testing was performed pre and post HCT. The evaluated pulmonary measures included: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ), FEV1 /FVC, and forced expiratory flow (FEF25-75 ). RESULTS Twelve subjects were included in the analysis. All had HbSS genotype, and five of the 12 patients had one or more episodes of acute chest syndrome prior to HCT. Serial PFT measures were completed per patient. No patient was diagnosed with chronic GVHD of any organ post HCT. The baseline median FVC, FEV1 , FEV1 /FVC, and FEF25-75 were within the normal range and remained relatively unchanged post HCT. A linear mixed effects model, adjusting for gender and time from HCT, suggested no significant relationship between HCT and PFT parameters, including FVC, FEV1 , and FEV1 /FVC. Interestingly, the FEF25-75 results exhibited a shift in the means post HCT (pre-HCT 86.2% predicted and post-HCT 93.05% predicted, p-value = .018). CONCLUSION Our study suggests that HCT in children with SCD may prevent the anticipated decline in pulmonary function over time.
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Affiliation(s)
- Dania A Monagel
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Gregory M T Guilcher
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- National Institute for Applied Statistics Research Australia (NIASRA), School of Mathematics and Applied Statistics, Faculty of Engineering and Information Services, University of Wollongong, Wollongong, New South Wales, Australia
| | - Glenda N Bendiak
- Section of Respiratory Medicine, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
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11
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Fay-McClymont TB, Monagel DA, Singh G, Schulte F, Brooks BL, MacAllister WS, Désiré N, Mineyko A, Vasserman M, Leaker MT, Truong TH, Shah R, Lewis VA, Yeates KO, Guilcher GMT. Neuropsychological, behavioral, and quality-of-life outcomes in children and adolescents with sickle cell disease treated with nonmyeloablative matched sibling donor hematopoietic cell transplantation: A case series. Pediatr Blood Cancer 2022; 69:e29893. [PMID: 35891584 DOI: 10.1002/pbc.29893] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND/OBJECTIVES Despite advances in the treatment of sickle cell disease (SCD), cerebrovascular and cognitive insults can have lifelong consequences. Hematopoietic cell transplantation (HCT) is an established curative therapy, and recent studies have demonstrated efficacy with reduced toxicity nonmyeloablative (NMA) regimens, but little is known about neuropsychological outcomes. The objective of this study was to describe neuropsychological, behavioral, and quality-of-life outcomes with medical correlates in children with SCD who received an NMA matched sibling donor (MSD) HCT. DESIGN/METHODS Retrospective cohort analysis of nine recipients with hemoglobin SS SCD who underwent MSD HCT using the National Institutes of Health (NIH) NMA protocol. RESULTS Mean full-scale intellectual functioning (FSIQ) was average pre-HCT (FSIQ = 92.1, SD 9.0; n = 8) and 2 years post-HCT (mean FSIQ = 96.6; SD 11.1; N = 9). Neuropsychological functioning was largely average across all cognitive domains, and no pre/post-HCT differences were found to be statistically significant given the small sample size. However, effect sizes revealed moderate improvements in processing speed (Cohen's d = .72) and verbal memory (Cohen's d = .60) post-HCT, and declines in measures of attention (Cohen's d = -.54) and fine motor speed and dexterity (Cohen's d = -.94). Parents endorsed better quality of life (Cohen's d = .91), less impact of SCD on their family, and less worry about their child's future (Cohen's d = 1.44). CONCLUSION Neuropsychological functioning in a sample of children and adolescents treated uniformly with NMA MSD HCT remained stable or improved in most cognitive domains, and improvements in quality of life and family functioning were observed.
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Affiliation(s)
- Taryn B Fay-McClymont
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Irving K. Barber Faculty of Arts and Social Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Dania A Monagel
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Gurpreet Singh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Schulte
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - William S MacAllister
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naddley Désiré
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aleksandra Mineyko
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Marsha Vasserman
- Neuropsychology/Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael T Leaker
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ravi Shah
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Victor A Lewis
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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12
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Lewis J, Greenway SC, Khan F, Singh G, Bhatia M, Guilcher GMT. Assessment of donor cell engraftment after hematopoietic stem cell transplantation for sickle cell disease: A review of current and future methods. Am J Hematol 2022; 97:1359-1371. [PMID: 35583381 DOI: 10.1002/ajh.26599] [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: 02/24/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 01/24/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the only established curative treatment for sickle cell disease (SCD), a debilitating red blood cell (RBC) disorder with significant prevalence worldwide. Accurate assessment of RBC engraftment following HSCT is essential to evaluate the status of the graft and can enable early intervention to treat or prevent graft rejection. Currently, chimerism measurement is performed on whole blood samples, which mainly reflect white blood cell (WBC) chimerism. This approach has limitations in assessing engraftment in patients with SCD because RBCs engraft non-linearly with WBCs. Direct measures of RBC chimerism exist but are not routinely used. In this review, we critically examine the current methodologies for assessing donor engraftment; highlight the limitations of these different methods, and present emerging and novel technologies with the potential to improve clinical monitoring of RBC engraftment post-HSCT for SCD. Promising alternative methodologies include RBC-specific flow cytometry, RBC-specific RNA analysis, and quantification of plasma cell-free DNA derived specifically from nucleated RBCs.
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Affiliation(s)
- Jasmine Lewis
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven C Greenway
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Faisal Khan
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gurpreet Singh
- Department of Pediatrics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Monica Bhatia
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Gregory M T Guilcher
- Department of Pediatrics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Bruce AAK, Guilcher GMT, Desai S, Truong TH, Leaker M, Alaazi DA, Pedersen SJV, Salami B. ADaPTS "(AD)olescents (P)ath through (T)ransplant (S)ickle cell disease". Health Qual Life Outcomes 2022; 20:118. [PMID: 35907865 PMCID: PMC9338650 DOI: 10.1186/s12955-022-02021-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sickle cell disease is an inherited chronic hematological disorder with an average lifespan of fifty years. The human cost of sickle cell disease includes missed school days, occupational opportunities, social isolation, stigmatization, and psychological sequelae. Hematopoietic cell transplantation (HCT) is the only curative therapy available but comes with potential morbidity and mortality. Our study explores how quality of life (QoL) is affected from the perspective of an adolescent who has undergone a nonmyeloablative matched sibling donor HCT. Methods We employed multiple case study methodology with purposeful sampling by selecting information-rich cases. Data sources: 1) QoL inventories 2) patient interviews 3) parent interview 4) vital support interview 5) medical record analysis. Data analysis: Intra-case analysis by assembling evidence within a single case and then analyzing the differences within cases to create a rich case description. Next, a time series analysis was completed to track changes in patients’ QoL. We used multiple sources of data to compose a timeline and changes across time. Then, we employed pattern matching as an analytical technique allowing for examination of patterns across cases. Finally, we used cross case synthesis to review results of each case. Results Quality of life was reported across the physical, social and psychological domains for 5 participants. All had sickle cell HgSS genotype, 80% were male and 80% were born outside of Canada. Physical domain: pre-transplant, 100% of patients experienced pain, and the majority suffered from fatigue, insomnia, and fevers resulting in hospitalizations. Afterwards, participants reported improved physical wellbeing. Social domain: pre-transplant, QoL was poor characterized by stigma, social isolation, and parental absenteeism. Post-HSCT adolescents gained social acceptance in areas that had stigmatized and excluded them. They were able to participate freely in activities with peers and their social life vastly improved. Psychological pre-transplant life experiences were overshadowed by psychological stress. The majority commented that their future was bleak and may lead to premature death. Afterwards adolescents described a crisis free life with positive psychological outcomes. Conclusions Adolescents with sickle cell disease who undertook HCT demonstrated improved QoL one year post transplant with regard to physical, social and psychological well-being.
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Affiliation(s)
- Aisha A K Bruce
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada. .,Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada.
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - Sunil Desai
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada.,Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Tony H Truong
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | - Michael Leaker
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, Cumming School of Medicine, Calgary, AB, Canada
| | | | - Sasia J V Pedersen
- Division of Pediatric Hematology and Oncology, 3-467 Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, Faculty of Medicine, University of Alberta, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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14
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Horkoff MJ, Kendal JK, Blackmore C, Truong TH, Guilcher GMT, Brindle ME. A population-based analysis of the presentation and outcomes of pediatric patients with osteosarcoma in Canada: a report from CYP-C. Can J Surg 2022; 65:E527-E533. [PMID: 35961660 PMCID: PMC9377546 DOI: 10.1503/cjs.008220] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Frequently occurring in adolescents, osteosarcoma is the most common primary malignant bone disease, with a reported 15% of patients who present with metastasis. With advances in imaging and improvements in surgical care, an updated analysis is warranted on the outcomes of pediatric patients with osteosarcoma. Methods: We completed a retrospective review of pediatric patients who presented with osteosarcoma between 2001 and 2017, using The Cancer in Young People in Canada (CYP-C) national database. Data on 304 patients aged younger than 15 years were analyzed. Results: The proportion of patients who presented with metastasis was 23.0%. The overall 5-year survival (OS) for patients who presented with metastasis was 37.4%. Overall survival and event-free survival (EFS) were lower in these patients than in patients with localized disease (hazard ratio [HR] 4.3, p < 0.0001 and HR 3.1, p < 0.0001). For patients who presented with metastatic disease, the OS for those undergoing an operative intervention was 44.1% compared with 17.6% for those who did not undergo resection (p < 0.0001). Conclusion: The proportion of patients who presented with metastatic osteosarcoma in our population is higher than previously reported. Overall outcomes of patients with metastatic disease have not changed. Our data reaffirm a role for surgical resection in patients with metastasis with a need to explore new treatment strategies to improve the overall prognosis of these patients.
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Affiliation(s)
- Michael J Horkoff
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta
| | - Joseph K Kendal
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta
| | - Christopher Blackmore
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta
| | - Tony H Truong
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta
| | - Gregory M T Guilcher
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta
| | - Mary E Brindle
- Department of Surgery, Sections of General Surgery (Horkoff) and Orthopaedic Surgery (Kendal), University of Calgary, Calgary, Alta.; Department of Surgery, Division of Pediatric General Surgery (Blackmore), Dalhousie University, Halifax, NS; Arnie Charbonneau Cancer Research Institute (Truong, Guilcher), Department of Oncology, and Alberta Children's Hospital Research Institute (Truong, Guilcher, Brindle), Department of Pediatrics, Cumming School of Medicine (Truong, Guilcher), and Department of Surgery (Brindle), Section of Pediatric Surgery, University of Calgary, Calgary, Alta.
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15
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Tutelman PR, Chambers CT, Heathcote LC, Fernandez CV, Flanders A, Patton M, Schulte FSM, Guilcher GMT, Simard S, MacLeod J, Stern M. Measuring Fear of Cancer Recurrence in Survivors of Childhood Cancer: Development and Preliminary Validation of the FCRI-Child and FCRI-Parent Versions. Psychooncology 2022; 31:911-919. [PMID: 35018689 DOI: 10.1002/pon.5879] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer aged 8-18 years (FCRI-C) and their parents (FCRI-P) to self-report on their own FCR and to examine the initial psychometric properties. METHODS The FCRI-SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI-C and FCRI-P were examined in 124 survivors of childhood cancer (43% female; Mage =14.58 years, SD=2.90) and 106 parents (90% mothers). RESULTS All FCRI-SF items were retained for the FCRI-C with simplified language. The internal consistencies of the FCRI-C (α= .88) and FCRI-P (α= .83) were good. Exploratory factor analyses yielded one-factor structures for both measures. Higher scores on the FCRI-C and FCRI-P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. CONCLUSIONS The FCRI-C and FCRI-P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI-C and FCRI-P to measure FCR in survivors of childhood cancer aged 8-18 years and their parents. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sébastien Simard
- Department of Health Sciences, Centre intersectoriel en santé durable (CIUSD), Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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16
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Moules NJ, Laing CM, Pelletier W, Guilcher GMT, Chan JA. Enduring Cell Lines: Parents' Experiences of Postmortem Tumor Banking in Childhood Cancer. J Fam Nurs 2021; 27:285-294. [PMID: 33855892 PMCID: PMC8642166 DOI: 10.1177/10748407211001431] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While cure rates in pediatric oncology have improved over the past 30 years, childhood cancer remains the second leading cause of death in children aged 1 to 14. Developing therapies often require using cancerous tissues, which may come from deceased donors. Tumor banks collect, store, and distribute these donated samples. While tumor banking is more common, factors that contribute to parents' decision and the impact of it on the family are not well understood. The purpose of this hermeneutic study was to understand the meaning and impact of tumor banking for parents of children who have died from cancer. Findings suggest that parents donating their child's tumors unexpectedly found a sense of meaning in their loss. They also found a legacy of their child's life; the living cells in some ways assisted the parents with grief. Aspects of this sensitive conversation and decision are discussed from the perspective of the parents' experiences.
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17
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Lachance S, Gomes MM, Bambace NM, Bittencourt H, Lepic K, Shafey M, Karpinski J, Guilcher GMT. Recognition of Hematopoietic Stem Cell Transplantation and Cellular Therapy Expertise to Promote Care Accessibility: A Formally Credentialed Area of Focused Competence in Canada. Transplant Cell Ther 2021; 27:702-706. [PMID: 34153503 DOI: 10.1016/j.jtct.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) and cellular therapy (CT) exploit the therapeutic potential of manipulated or unmanipulated hematopoietic cells to treat diseases. While initially dedicated to the treatment of hematologic malignancies and disorders, the use of these therapies in several diseases and cancers is currently under investigation. Indications are currently booming. In the midst of this expansion, both the American Society for Transplantation and Cellular Therapy (ASTCT) and the European Society for Blood and Marrow Transplantation (EBMT) have highlighted the global shortage of hematologists adequately trained in this field of high expertise. This shortage in transplant physicians and cellular therapists can significantly impact patients' access to cell-based therapy. To address this unmet need and attract aspiring hematologists to the field of cellular therapy, as well as to standardize training, anticipating this trend, a Canadian national task force aiming to develop a structured academic program in HSCT and CT was created. Workshops were organized to identify and establish the fundamentals of the practice in HSCT and CT. These workshops followed a rigorous process in developing the competency-based training program established by the Royal College. The program begins with the development of the main tasks associated with the practice of the discipline and the evidence that trainees must provide to demonstrate that they can perform these tasks independently (the competence portfolio). It continues with the development of training requirements that summarize the knowledge, skills, and aptitudes required to perform these tasks, followed by specific exposure during training (milestones) essential to demonstrate the acquisition of these skills. HSCT and CT together is now formally recognized as an Area of Focused Competence (AFC) by the Royal College of Physicians and Surgeons of Canada, a national organization that provides oversight of the medical education of specialists in Canada. AFCs are areas of specialty medicine that address a legitimate societal and patient population need previously unmet by the system of primary and subspecialty disciplines. The AFC designation for HSCT and CT provides a standardized curriculum, training experience, and accreditation process to attract young hematologists and promote expertise and quality care to meet the needs of both patients and society. A critical number of highly qualified hematologists will ensure continuing expansion of accessibility to HSCT and CT.
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Affiliation(s)
- Sylvie Lachance
- Institut Universitaire d'Hémato-oncologie et Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, Montréal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
| | - Marcio M Gomes
- Specialties Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadia M Bambace
- Institut Universitaire d'Hémato-oncologie et Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, Montréal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Henrique Bittencourt
- Cell Therapy Program, Hematology-Oncology Division, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Kylie Lepic
- Cellular Therapy and Transplant Program, Division of Hematology and Thromboembolism, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mona Shafey
- Specialties Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada; Hematopoietic Cell Transplant Program, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jolanta Karpinski
- Specialties Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Gregory M T Guilcher
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; Section of Pediatric Oncology/BMT, Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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18
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Wurz A, McLaughlin E, Lategan C, Chamorro Viña C, Grimshaw SL, Hamari L, Götte M, Kesting S, Rossi F, van der Torre P, Guilcher GMT, McIntyre K, Culos-Reed SN. The international Pediatric Oncology Exercise Guidelines (iPOEG). Transl Behav Med 2021; 11:1915-1922. [PMID: 34037786 PMCID: PMC8604278 DOI: 10.1093/tbm/ibab028] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Physical activity (PA) and exercise are safe and beneficial for children and
adolescents affected by cancer. Yet, this population is not active enough to
receive benefits. PA guideline and recommendation statements can support
individual behavior and practice change. The purpose of this project was to
develop the international Pediatric Oncology Exercise Guidelines (iPOEG),
comprised of guideline and recommendation statements, to promote PA among
children and adolescents affected by cancer. Guideline development procedures,
stakeholder engagement strategies, and the Delphi technique were used. Four
online surveys were distributed to the iPOEG network (n = 9
core team members, n = 122 expert consensus committee members).
Surveys included closed- and open-ended items informed by a literature synthesis
and an in-person meeting. Responses were analyzed using descriptive statistics
and content analysis. Consensus was defined as ≥ 80% agreement. Response
rates to online surveys ranged from 82% to 91%. The iPOEG network agreed on four
guideline and five recommendation statements, which highlight that movement is
important for all children and adolescents affected by cancer. These statements
are generic in nature as more research is still required to provide specific
guidance on the frequency, intensity, time, and type of PA for this population.
Nevertheless, the iPOEG statements represent available evidence and expert
opinion, collectively suggesting that it is time for children and adolescents
affected by cancer to move more. Physical activity is safe and beneficial for children and adolescents affected by
cancer. Yet, most are not active enough to receive benefits. Guideline and
recommendation statements can help change individual behavior and practice. To
develop such statements, guideline development procedures, stakeholder
engagement strategies, and the Delphi technique were used. Four online surveys
were distributed to an international network (n = 131 experts).
Surveys asked closed- and open-ended questions informed by a literature
synthesis and an in-person meeting. Findings from the online surveys resulted in
the international Pediatric Oncology Exercise Guidelines statements, which
highlight that it is time for children and adolescents affected by cancer to
move more.
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Affiliation(s)
- Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Emma McLaughlin
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Conné Lategan
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolina Chamorro Viña
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Kids Cancer Care Foundation of Alberta, Calgary, Canada
| | | | - Lotta Hamari
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Miriam Götte
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, University Hospital Essen, Essen, Germany
| | - Sabine Kesting
- Kinderklinik München Schwabing, TUM School of Medicine, Department of Pediatrics and Children's Cancer Research Center, TUM, Munich, Germany
| | - Francesca Rossi
- Rehabilitation Service, Public Health and Pediatric Sciences Department, A.O.U. Città della Salute e della Scienza-Regina Margherita Children's Hospital, Turin, Italy
| | - Patrick van der Torre
- Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Oncology/Bone Marrow Transplant, Alberta Children's Hospital, Calgary, Canada
| | - Krista McIntyre
- Section of Oncology/Bone Marrow Transplant, Alberta Children's Hospital, Calgary, Canada
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19
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Sinclair S, Bouchal SR, Schulte F, M T Guilcher G, Kuhn S, Rapoport A, Punnett A, Fernandez CV, Letourneau N, Chung J. Compassion in pediatric oncology: A patient, parent and healthcare provider empirical model. Psychooncology 2021; 30:1728-1738. [PMID: 34021652 PMCID: PMC8518637 DOI: 10.1002/pon.5737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022]
Abstract
Objective Compassion has long been considered a cornerstone of quality pediatric healthcare by patients, parents, healthcare providers and systems leaders. However, little dedicated research on the nature, components and delivery of compassion in pediatric settings has been conducted. This study aimed to define and develop a patient, parent, and healthcare provider informed empirical model of compassion in pediatric oncology in order to begin to delineate the key qualities, skills and behaviors of compassion within pediatric healthcare. Methods Data was collected via semi‐structured interviews with pediatric oncology patients (n = 33), parents (n = 16) and healthcare providers (n = 17) from 4 Canadian academic medical centers and was analyzed in accordance with Straussian Grounded Theory. Results Four domains and 13 related themes were identified, generating the Pediatric Compassion Model, that depicts the dimensions of compassion and their relationship to one another. A collective definition of compassion was generated–a beneficent response that seeks to address the suffering and needs of a person and their family through relational understanding, shared humanity, and action. Conclusions A patient, parent, and healthcare provider informed empirical pediatric model of compassion was generated from this study providing insight into compassion from both those who experience it and those who express it. Future research on compassion in pediatric oncology and healthcare should focus on barriers and facilitators of compassion, measure development, and intervention research aimed at equipping healthcare providers and system leaders with tools and training aimed at improving it.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Canada.,Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Canada
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adam Rapoport
- Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Emily's House Children Hospice, Toronto, Canada
| | - Angela Punnett
- Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Pediatric Haematology/Oncology, The Hospital for Sick Kids, Toronto, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joanna Chung
- Medical Psychology and Hematology/Oncology/BMT Program, British Columbia Children's Hospital, Vancouver, Canada
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20
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Gorner A, Wang D, Guilcher GMT, Dotchin SA. Diffuse large B-cell lymphoma presenting with ocular involvement in an 8-year-old boy. Can J Ophthalmol 2021; 56:e176-e179. [PMID: 33865802 DOI: 10.1016/j.jcjo.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Adam Gorner
- Cumming School of Medicine, University of Calgary, Calgary, Alb..
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21
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Monagel DA, Jadusingh E, Jupp J, Ho J, Guilcher GMT. Absence of clinically relevant sirolimus-related hyperlipidemia in a cohort of children posthematopoietic cell transplantation for sickle cell disease. Pediatr Blood Cancer 2021; 68:e28782. [PMID: 33128440 DOI: 10.1002/pbc.28782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dania A Monagel
- Departments of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Esther Jadusingh
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Jupp
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Josephine Ho
- Departments of Pediatrics, Division of Pediatric Endocrinology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
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22
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Guilcher GMT, Rivard L, Huang JT, Wright NAM, Anderson L, Eissa H, Pelletier W, Ramachandran S, Schechter T, Shah AJ, Wong K, Chow EJ. Immune function in childhood cancer survivors: a Children's Oncology Group review. Lancet Child Adolesc Health 2021; 5:284-294. [PMID: 33600774 PMCID: PMC8725381 DOI: 10.1016/s2352-4642(20)30312-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022]
Abstract
Childhood cancer and its treatment often impact the haematopoietic and lymphatic systems, with immunological consequences. Immunological assessments are not routinely included in surveillance guidelines for most survivors of childhood cancer, although a robust body of literature describes immunological outcomes, testing recommendations, and revaccination guidelines after allogeneic haematopoietic cell transplantation. Survivorship care providers might not fully consider the impaired recovery of a child's immune system after cancer treatment if the child has not undergone haematopoietic cell transplantation. We did a scoping review to collate the existing literature describing immune function after childhood cancer therapy, including both standard-dose chemotherapy and high-dose chemotherapy with haematopoietic cell rescue. This Review aims to summarise: the principles of immunology and testing of immune function; the body of literature describing immunological outcomes after childhood cancer therapy, with an emphasis on the risk of infection, when is testing indicated, and preventive strategies; and knowledge gaps and opportunities for future research.
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Affiliation(s)
- Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Linda Rivard
- Pediatric Hematology and Oncology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Jennifer T Huang
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Nicola A M Wright
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Hesham Eissa
- Department of Pediatrics, University of Colorado, Aurora, CO, USA; Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, CO, USA
| | - Wendy Pelletier
- Section of Pediatric Oncology and BMT, Alberta Children's Hospital, Calgary, AB, Canada
| | - Shanti Ramachandran
- School of Paediatrics and Child Health, University of Western Australia, Nedland, WA, Australia; Department of Oncology, Haematology, Blood and Marrow Transplantation, Child and Adolescent Health Services, Perth Children's Hospital, Nedland, WA, Australia
| | - Tal Schechter
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Department of Pediatrics, Stem Cell Transplantation and Regenerative Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Ken Wong
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Cancer and Blood Disease Institute, Los Angeles, CA, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Clinical Research and Public Health Sciences Divisions, Seattle, WA, USA
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23
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Meier ER, Abraham AA, Ngwube A, Janson IA, Guilcher GMT, Horan J, Kasow KA. Hematopoietic stem cell transplant referral patterns for children with sickle cell disease vary among pediatric hematologist/oncologists' practice focus: A Sickle Cell Transplant Advocacy and Research Alliance (STAR) study. Pediatr Blood Cancer 2021; 68:e28861. [PMID: 33405370 DOI: 10.1002/pbc.28861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 08/12/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) provides a curative therapy for children severely affected by sickle cell disease (SCD). Rejection-free survival after matched sibling donor (MSD) HSCT is very high, but adoption of HSCT as a curative SCD therapy has been slow. In this study, we assess providers' perceptions about MSD HSCT for children with variable SCD severity, and determine the influence of provider characteristics on HSCT referrals. PROCEDURE After our Institutional Review Board deemed the study exempt, American Society of Pediatric Hematology/Oncology Clinical Forum listserv subscribers and American Society of Hematology members who self-identified as pediatric hematologists/oncologists (PHO) were emailed a survey. Analysis was performed to describe and evaluate correlations between participant demographics (including practice focus within PHO) and likelihood of HSCT referral for each scenario. RESULTS Spearman's rank correlation analysis did not reveal any significant relationship between demographic characteristics except practice focus and likelihood to refer to HSCT for any scenarios. Providers focused on SCD and HSCT were more likely to refer a child who had never been admitted to the hospital or had suboptimal adherence to hydroxyurea than general PHOs. A significantly higher proportion of all respondents would refer a child with β-thalassemia major (87%) than an asymptomatic child with HbSS (47%, P < .00001) or non-HbSS variant (23%, P < .00001). CONCLUSION PSCD and HSCT physicians are more likely to refer for MSD HSCT in almost every condition than general PHO practitioners, likely because of increased awareness of long-term effects of SCD and safety of MSD HSCT for children with SCD.
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Affiliation(s)
| | - Allistair A Abraham
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Alex Ngwube
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona
| | - Isaac A Janson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Gregory M T Guilcher
- Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Oncology and Paediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - John Horan
- Boston Children's Hospital, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
| | - Kimberly A Kasow
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
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24
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Wurz A, McLaughlin E, Chamorro Viña C, Grimshaw SL, Hamari L, Götte M, Kesting S, Rossi F, van der Torre P, Guilcher GMT, McIntyre K, Culos-Reed SN. Advancing the Field of Pediatric Exercise Oncology: Research and Innovation Needs. Curr Oncol 2021; 28:619-629. [PMID: 33498499 PMCID: PMC7924382 DOI: 10.3390/curroncol28010061] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
The field of pediatric exercise oncology explores the relationships between physical activity (PA), including exercise, and a range of outcomes among children and adolescents affected by cancer. Although PA is safe and beneficial for this population, several important gaps in knowledge and practice remain. In this article, we describe research and innovation needs that were developed with a team of international experts and relevant literature, a series of online surveys, and an in-person meeting. Addressing these needs will contribute valuable knowledge and practice outputs to advance this field, ultimately enabling a greater number of children and adolescents affected by cancer to realize the benefits of moving more.
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Affiliation(s)
- Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.W.); (E.M.); (C.C.V.)
| | - Emma McLaughlin
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.W.); (E.M.); (C.C.V.)
| | - Carolina Chamorro Viña
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.W.); (E.M.); (C.C.V.)
- Kids Cancer Care Foundation of Alberta, Calgary, Alberta T2N 1N4, Canada
| | - Sarah L. Grimshaw
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Lotta Hamari
- Department of Nursing Science, University of Turku, 20520 Turku, Finland;
| | - Miriam Götte
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, University Hospital Essen, 45147 Essen, Germany;
| | - Sabine Kesting
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich (TUM), 80804 Munich, Germany;
- Kinderklinik München Schwabing, TUM School of Medicine, Department of Pediatrics and Children’s Cancer Research Center, TUM, 80992 Munich, Germany
| | - Francesca Rossi
- Rehabilitation Service, Public Health and Pediatric Sciences Department, A.O.U. Città della Salute e della Scienza—Regina Margherita Children’s Hospital, 10126 Turin, Italy;
| | - Patrick van der Torre
- Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Gregory M. T. Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Section of Oncology/Bone Marrow Transplant, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Krista McIntyre
- Section of Oncology/Bone Marrow Transplant, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada;
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (A.W.); (E.M.); (C.C.V.)
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
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Pedersen SJV, Monagel DA, Mammen C, Lewis VA, Guilcher GMT, Bruce AA. Stable renal function in children and adolescents with sickle cell disease after nonmyeloablative hematopoietic stem cell transplantation. Pediatr Blood Cancer 2020; 67:e28568. [PMID: 32672896 DOI: 10.1002/pbc.28568] [Citation(s) in RCA: 5] [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] [Received: 12/15/2019] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with renal complications starting as early as infancy. Allogeneic hematopoietic stem cell transplant (HSCT) treatments using newer nonmyeloablative (NMA) conditioning regimens show promising results in treating SCD in the pediatric population, but renal outcome parameters after transplantation have not been described. AIM To describe baseline renal parameters as well as short- and long-term renal outcomes in pediatric patients with SCD who underwent NMA-HSCT. METHODS A retrospective chart review of pediatric patients who received NMA-HSCT in Alberta, Canada. Short-term renal outcomes evaluated were: (1) acute kidney injury (AKI), (2) fluid overload (FO), and (3) hypertension. Long-term outcomes evaluated were: (1) estimated glomerular filtration rate (eGFR) development and at last follow-up with hyperfiltration defined as eGFR ≥ 150 mL/min/1.73 m2 , (2) proteinuria, and (3) hypertension. RESULTS The mean follow-up time was 128.6 weeks (standard deviations, 69.3). No posttransplant AKI events or FO were observed. eGFR remained > 90 mL/min/1.73 m2 at last follow-up in all patients, whereas hyperfiltration was present in eight (44.4%) and four (22.2%) patients pre- and post-HSCT, respectively, which are significantly different (P < 0.0001). Consequently, median GFR was significantly higher pre-HSCT compared with 24 months HSCT (P < 0.009). Long-term hypertension post-HSCT was present in six patients (33.3%). CONCLUSION This study describes stable kidney function in children with SCD after NMA-HSCT without evidence of AKI or FO episodes. Rates of hyperfiltration decreased post-HSCT, which signifies that NMA-HSCT could potentially preserve long-term renal function in this population at risk of progressive chronic kidney disease. Further prospective studies are needed to confirm these novel findings.
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Affiliation(s)
- Sasia J V Pedersen
- Department of Pediatrics, Division of Immunology, Hematology/Oncology and Palliative Care, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Dania A Monagel
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Cherry Mammen
- Department of Pediatrics, Division of Nephrology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Victor A Lewis
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Gregory M T Guilcher
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Aisha A Bruce
- Department of Pediatrics, Division of Immunology, Hematology/Oncology and Palliative Care, Stollery Children's Hospital, Edmonton, AB, Canada
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Morhun JM, Racine NM, Guilcher GMT, Tomfohr-Madsen LM, Schulte FSM. Health-related quality of life and well-being in parents of infants and toddlers with cancer. ACTA ACUST UNITED AC 2020; 27:e206-e215. [PMID: 32489270 DOI: 10.3747/co.27.4937] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The unique psychosocial needs of parents and caregivers of young children with cancer are poorly understood. The aims of the present study were to examine health-related quality of life (hrqol), stress, and psychological distress in parents of young children (0-4 years) diagnosed with cancer; and the associations between parent psychosocial functioning and child treatment characteristics. Methods Parents (n = 35) with a child (n = 19 male, 54.3%) 0-48 months of age (median: 31.06 months) on active cancer therapy were recruited. Parents completed questionnaires related to demographics, parent hrqol, parenting stress, posttraumatic stress symptoms, and parent psychological distress. Results Parents reported clinically elevated parenting stress (5.9%), posttraumatic stress symptoms (18.2%), and psychological distress (21.9%). Compared with population norms, parents reported lower hrqol in the vitality (t = 5.37, p < 0.001), mental health (t = 4.02, p < 0.001), role limitation-emotional (t = 3.52, p < 0.001), and general health perceptions (t = 2.25, p = 0.025) domains. Social functioning (β = 0.33, p = 0.041) predicted general health perceptions; vitality (β = 0.30, p = 0.134) and parent mental health (β = 0.24, p = 0.285) did not [F (3,29) = 12.64, p < 0.001, R 2 = 0.57]. Conclusions A subset of parents of young children on active cancer treatment experience clinically elevated psychosocial symptoms. Having poor social connections put parents at risk of perceiving their health more poorly in general. Supports that focus on preventing the emergence of clinically significant distress should focus on parents of young children with cancer who are most at risk of poor outcomes.
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Affiliation(s)
- J M Morhun
- Department of Psychology, University of Calgary, Calgary, AB.,Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB
| | - N M Racine
- Department of Psychology, University of Calgary, Calgary, AB
| | - G M T Guilcher
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB.,Alberta Children's Hospital Research Institute, Calgary, AB
| | | | - F S M Schulte
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB.,Alberta Children's Hospital Research Institute, Calgary, AB.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB
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Sinclair S, Kondejewski J, Schulte F, Letourneau N, Kuhn S, Raffin-Bouchal S, Guilcher GMT, Strother D. Compassion in Pediatric Healthcare: A Scoping Review. J Pediatr Nurs 2020; 51:57-66. [PMID: 31901770 DOI: 10.1016/j.pedn.2019.12.009] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 12/30/2022]
Abstract
PROBLEM Compassion has been described as a central construct or essential feature of quality healthcare and is as important to patients' and families' overall healthcare experience as the health interventions and treatments they receive. However, there is little shared understanding of what constitutes compassion, how it is delivered within a pediatric setting, and pediatric patients' and families perspectives and preferences for receiving it. ELIGIBILITY CRITERIA Studies that (1) described the nature of the existing literature on compassion in pediatric healthcare; (2) summarized key concepts in the existing evidence base that pertain to compassion in pediatric healthcare; and 3) identified factors that are associated with compassion in pediatric healthcare were eligible for inclusion in this review. SAMPLE Twenty-nine papers were included in the review. RESULTS Findings revealed several factors are associated with compassion in pediatric healthcare, including continuity of care, communication, and coordination of care. Most notably, identified studies treated compassion in a subsidiary fashion, and this review revealed no studies that provided a patient-informed evidence-based definition of compassion in the pediatric healthcare setting. CONCLUSION Future research is required to generate a comprehensive and accurate understanding of the terms 'compassion' and 'compassionate care' when used in the context of pediatric healthcare. IMPLICATIONS This research will inform the therapeutic processes and ultimately enable the development of strategies to improve the delivery of compassionate healthcare to pediatric patients.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, Canada; Compassion Research Lab, University of Calgary, Canada; Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, Canada.
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, Canada; Compassion Research Lab, University of Calgary, Canada
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Canada; Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada
| | | | - Gregory M T Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
| | - Douglas Strother
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
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28
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Shank J, Chamorro-Viña C, Guilcher GMT, Langelier DM, Schulte F, Culos-Reed SN. Evaluation Tools for Physical Activity Programs for Childhood Cancer: A Scoping Review. J Pediatr Oncol Nurs 2019; 37:163-179. [PMID: 31847707 DOI: 10.1177/1043454219891987] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Research on the benefits of physical activity (PA) in childhood cancer has been translated into a handful of community-based programs. However, to foster further translation, an understanding of how to evaluate participant outcomes would be beneficial to provide feedback to participants and stimulate future research. Such a review would provide a summary of acceptable tools for work in this area. The purpose of this scoping review was to identify the evaluation tools that have been used in PA/exercise studies or programs for childhood cancer. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the review used physical and psychosocial evaluation tools within PA and exercise programs or research for childhood cancer. In addition, studies with measures of health behavior such as PA levels and activities of daily living were included. Tools that assessed physical fitness and physical performance were excluded. Information on the types of evaluation tools used, mean age of participants, and type of cancer was extracted. Psychometric properties of each evaluation tool are reported. The most commonly assessed patient outcomes were motor performance, fatigue, well-being, functional mobility, and quality of life. Less commonly reported patient outcomes were hope, self-efficacy, and self-perception. None of the evaluation tools reported in the PA/exercise and pediatric oncology literature assess physical literacy. This review was the first step in a knowledge translation process, identifying evaluation tools that have been used in PA/exercise programs in childhood cancer survivors, that will guide the development and evaluation of current and future community-based programs.
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Affiliation(s)
- Jena Shank
- University of Calgary, Calgary, Alberta, Canada
| | - Carolina Chamorro-Viña
- University of Calgary, Calgary, Alberta, Canada.,Kids Cancer Care Foundation of Alberta, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | - S Nicole Culos-Reed
- University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
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Truong TH, Prokopishyn NL, Luu H, Guilcher GMT, Lewis VA. Predictive factors for successful peripheral blood stem cell mobilization and collection in children. J Clin Apher 2019; 34:598-606. [DOI: 10.1002/jca.21738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/07/2019] [Accepted: 07/22/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Tony H. Truong
- Department of Oncology and PediatricsSection of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary Calgary Alberta
| | - Nicole L. Prokopishyn
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary Alberta
| | - Henry Luu
- Department of Oncology and PediatricsSection of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary Calgary Alberta
| | - Gregory M. T. Guilcher
- Department of Oncology and PediatricsSection of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary Calgary Alberta
| | - Victor A. Lewis
- Department of Oncology and PediatricsSection of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary Calgary Alberta
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30
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Tutelman PR, Chambers CT, Urquhart R, Fernandez CV, Heathcote LC, Noel M, Flanders A, Guilcher GMT, Schulte F, Stinson JN, MacLeod J, Stern M. When "a headache is not just a headache": A qualitative examination of parent and child experiences of pain after childhood cancer. Psychooncology 2019; 28:1901-1909. [PMID: 31276614 DOI: 10.1002/pon.5170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 02/28/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Today, more than 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by exploring childhood cancer survivors' (CCS') experiences of pain from their perspective and the perspective of their parents. METHODS Twenty semi-structured interviews were completed with CCS (50% female; mean age = 13.20 y, range = 8-17 y) and their parents (90% mothers). Data were analyzed using interpretive phenomenological analysis. RESULTS Analyses revealed three superordinate themes present in the data: (a) pain is a changed experience after childhood cancer; (b) new or ambiguous pains may be interpreted by CCS and parents as a threat of disease recurrence, late effects, or a secondary cancer; and (c) pain interpretation occurs within the broader context of how CCS and parents appraise their cancer experience. Parents generally appraised their child's cancer and pain as more threatening and were influential in guiding their child's interpretations. CONCLUSIONS The cancer experience played an important role in shaping CCS' and their parents' experience and interpretation of pain in survivorship. This study provides novel data to inform the development and refinement of new and existing conceptual models of pain and symptom perception after cancer. The results also point to key areas for future investigation and clinical intervention to address the issue of pain in cancer survivorship.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona Schulte
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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Schulte F, Russell KB, Pelletier W, Scott-Lane L, Guilcher GMT, Strother D, Dewey D. Screening for psychosocial distress in pediatric cancer patients: An examination of feasibility in a single institution. Pediatr Hematol Oncol 2019; 36:125-137. [PMID: 30983467 DOI: 10.1080/08880018.2019.1600082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/27/2022]
Abstract
Despite the availability of tools to assess psychosocial screening in pediatric oncology, little is known about the feasibility and acceptability of systematic screening. We aimed to assess the feasibility of implementing a tool, or set of tools, capable of screening for psychosocial distress in pediatric cancer patients across the cancer continuum (on treatment, off treatment). Psychometric criteria were also evaluated. Patients 8-18 years were recruited from a pediatric oncology program. Patients completed self-report measures of the Distress Thermometer (DT) and Pediatric Quality of Life Inventory (PedsQL). One parent of each patient completed three screening tools: DT (proxy-report); PedsQL (proxy-report), and the Psychosocial Assessment Tool adapted for the Canadian context (PATrev), as well as a measure of patient psychological functioning (Behavioral Assessment System for Children-2), and an assessment of screening tool acceptability. Recruitment rates and acceptability informed feasibility of implementation. Ninety-five patients (58 men) with a mean age of 11.47 participated in the study (on treatment, n = 43; off treatment, n = 52). Recruitment rates were on treatment: 56.6% and off treatment: 47.3%. Mean acceptability scores of tools ranged from 3.41 to 4.97 out of 7. Screening tools were comparable with respect to their psychometric properties. The DT took the least amount of time to complete, while the PATrev offered the most robust data with respect to psychometrics. Feasibility of screening for psychosocial distress with our tool was moderate and may be enhanced when administered by a known health-care provider. Future research exploring how to further enhance feasibility of implementation for pediatric cancer patients is warranted.
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Affiliation(s)
- Fiona Schulte
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - K Brooke Russell
- c Department of Psychology , Faculty of Arts, University of Calgary , Alberta , Canada
| | - Wendy Pelletier
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Laura Scott-Lane
- b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada
| | - Gregory M T Guilcher
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Douglas Strother
- a Department of Oncology , Cumming School of Medicine, University of Calgary , Alberta , Canada.,b Haematology, Oncology and Transplant Program , Alberta Children's Hospital , Alberta , Canada.,d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada
| | - Deborah Dewey
- d Department of Pediatrics , Cumming School of Medicine, University of Calgary , Alberta , Canada.,e Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Alberta , Canada
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32
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Moules NJ, Laing CM, Estefan A, Schulte F, Guilcher GMT. "Family Is Who They Say They Are" a: Examining the Effects of Cancer on the Romantic Partners of Adolescents and Young Adults. J Fam Nurs 2018; 24:374-404. [PMID: 30024325 DOI: 10.1177/1074840718786985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.
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Affiliation(s)
| | | | | | - Fiona Schulte
- 1 University of Calgary, Alberta, Canada
- 2 Alberta Children's Hospital, Calgary, Canada
| | - Gregory M T Guilcher
- 1 University of Calgary, Alberta, Canada
- 2 Alberta Children's Hospital, Calgary, Canada
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33
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Guilcher GMT, Truong TH, Saraf SL, Joseph JJ, Rondelli D, Hsieh MM. Curative therapies: Allogeneic hematopoietic cell transplantation from matched related donors using myeloablative, reduced intensity, and nonmyeloablative conditioning in sickle cell disease. Semin Hematol 2018; 55:87-93. [PMID: 29958564 DOI: 10.1053/j.seminhematol.2018.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 12/23/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
Sickle cell disease (SCD) chronically damages multiple organs over the lifetime of affected individuals. Allogeneic hematopoietic cell transplantation (allo-HCT) is the most studied curative intervention. Fully matched related marrow, peripheral blood derived, or cord blood HCT have the best transplant outcome for symptomatic patients with SCD. For patients with asymptomatic or milder disease who have this donor option available, risks and benefits of HCT should be discussed among the patient, family, treating hematologist, and transplant physician, and decision to proceed to HCT should be individualized. Myeloablative conditioning with busulfan, cyclophosphamide, and ATG has been a commonly employed regimen for children and young adults. Recently, low intensity conditioning with low dose total body irradiation and alemtuzumab is emerging as an efficacious and safe regimen for adults, young adults, and possibly children. Mixed donor chimerism (minimum ≥20% myeloid cells), from myeloablative or nonmyeloablative conditioning regimen, produces robust normal donor erythropoiesis and is sufficient to provide a clinical cure. The proportion of patients remaining on immunosuppression beyond 2 years post-HCT is likely <10% with either myeloablative or low intensity regimens. Late effects from myeloablative or reduced intensity conditioning, or from several more months of immunosuppression in low intensity conditioning may be less common than those observed in HCT for malignant indications. Nonmyeloablative approaches with low toxicities should be the focus of future research efforts. Prevention of GVHD is a shared goal in all approaches of allo-HCT in SCD.
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Affiliation(s)
- Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Santosh L Saraf
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Jacinth J Joseph
- Department of Hematology, Washington Hospital Center/Georgetown University, Washington, DC; Sickle Cell Branch, NHLBI, NIH, Bethesda, MD
| | - Damiano Rondelli
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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Guilcher GMT, Shah R, Shenoy S. Principles of alemtuzumab immunoablation in hematopoietic cell transplantation for non-malignant diseases in children: A review. Pediatr Transplant 2018; 22. [PMID: 29352515 DOI: 10.1111/petr.13142] [Citation(s) in RCA: 8] [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] [Accepted: 12/29/2017] [Indexed: 12/19/2022]
Abstract
Alemtuzumab is a humanized mAb targeted to CD52. Alemtuzumab is highly immunosuppressive with the ability to deplete T and B cells (in addition to other immune cell lines). A growing understanding of the PKs, dosing, and timing of administration of alemtuzumab has allowed for the study of its use as a conditioning agent for allogeneic HCT. The highly immunosuppressive properties of the drug are particularly appealing in the setting of non-malignant HCT, where GVHD provides no clinical benefit and relapse of malignancy is not applicable. In addition, the degree of immune suppression achieved with alemtuzumab has allowed for a reduction in the intensity of myeloablative cytotoxic agents included in some HCT conditioning regimens, allowing for fewer acute and late toxicities. This review paper will provide a comprehensive summary of the mechanism of action, PKs, dosing, and timing of alemtuzumab, a brief description of its use in various allogeneic HCT protocols for non-malignant conditions and a summary of the data regarding its use for GVHD therapy. The goal of this review was to provide an understanding as to how alemtuzumab might be safely incorporated into HCT conditioning regimens for children with non-malignant disease, allowing for expanded access to curative HCT therapy.
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Affiliation(s)
- Gregory M T Guilcher
- Section of Paediatric Oncology/BMT, Departments of Oncology and Paediatrics, University of Calgary, Calgary, AB, Canada
| | - Ravi Shah
- Department of Paediatric Haematology/BMT, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, USA
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Racine NM, Khu M, Reynolds K, Guilcher GMT, Schulte FSM. Quality of life in pediatric cancer survivors: contributions of parental distress and psychosocial family risk. ACTA ACUST UNITED AC 2018; 25:41-48. [PMID: 29507482 DOI: 10.3747/co.25.3768] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Pediatric survivors of childhood cancer are at increased risk of poor quality of life and social-emotional outcomes following treatment. The relationship between parent psychological distress and child adjustment in pediatric cancer survivors has been well established. However, limited research has examined the factors that may buffer this association. The current study examined the associations between psychosocial family risk factors, parental psychological distress, and health-related quality of life (hrql) in pediatric cancer survivors. Methods Fifty-two pediatric cancer survivors (34 males, 18 females, mean age = 11.92) and their parents were recruited from a long-term cancer survivor clinic. Children and their parents who consented to participate completed the Pediatric Quality of Life Inventory 4.0. Parents completed a demographic information form, the Psychosocial Assessment Tool (pat 2.0) and the Brief Symptom Inventory (bsi). The Intensity of Treatment Rating (itr-3) was evaluated by the research team. Results Multiple regression analyses revealed that parental psychological distress negatively predicted parent-reported hrql, while treatment intensity, gender, and psychosocial risk negatively predicted parent and child-reported hrql. Psychosocial risk moderated the association between parent psychological distress and parent-reported child hrql (p = 0.03), whereby parents with high psychological distress but low levels of psychosocial risk reported their children to have higher hrql. Conclusion Low levels of family psychosocial risk buffer the impact of parent psychological distress on child hrql in pediatric cancer survivors. The findings highlight the importance of identifying parents and families with at-risk psychological distress and psychosocial risk in order to provide targeted support interventions to mitigate the impact on hrql.
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Affiliation(s)
- N M Racine
- Department of Psychology, University of Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, AB, Canada
| | - M Khu
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, AB, Canada
| | - K Reynolds
- Long Term Survivor Clinic, Alberta Children's Hospital, AB, Canada; and
| | - G M T Guilcher
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, AB, Canada.,Alberta Children's Hospital Research Institute, AB, Canada
| | - F S M Schulte
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, AB, Canada.,Alberta Children's Hospital Research Institute, AB, Canada.,Long Term Survivor Clinic, Alberta Children's Hospital, AB, Canada; and.,Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, AB, Canada
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Rangarajan HG, Abu-Arja R, Pai V, Guilcher GMT, Soni S. Outcomes of Unrelated Donor Stem Cell Transplantion with Post-Transplant Cyclophosphamide for Graft-versus-Host Disease Prophylaxis in Patients with Severe Sickle Cell Disease. Biol Blood Marrow Transplant 2017; 24:413-417. [PMID: 29061531 DOI: 10.1016/j.bbmt.2017.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/02/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
Abstract
Unrelated donor (URD) hematopoietic cell transplantation (HCT) in children with sickle cell disease (SCD) is associated with a high incidence of rejection and graft-versus-host disease (GVHD). We report on the first 4 patients with severe SCD who underwent URD HCT using a novel myeloablative and immunosuppressive regimen composed of busulfan, fludarabine, and antithymocyte globulin with a single dose of post-transplant cyclophosphamide along with tacrolimus and mycophenolate mofetil for GVHD prophylaxis. Three patients engrafted and remain disease-free after a median follow-up period of 2.5 years. One patient had primary graft failure attributed to low stem cell content of the graft. Of interest, none of the engrafted patients developed acute or chronic GVHD. This preparative regimen along with the use of post-transplant cyclophosphamide offers a promising approach for unrelated donor transplants in patients with SCD and needs further corroboration in larger number of patients.
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Affiliation(s)
- Hemalatha G Rangarajan
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Rolla Abu-Arja
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Vinita Pai
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory M T Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Departments of Oncology and Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Sandeep Soni
- Division of Stem Cell Transplant and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
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Moules NJ, Estefan A, Laing CM, Schulte F, Guilcher GMT, Field JC, Strother D. "A Tribe Apart": Sexuality and Cancer in Adolescence. J Pediatr Oncol Nurs 2017; 34:295-308. [PMID: 28615000 DOI: 10.1177/1043454217697669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This qualitative study employed hermeneutic phenomenology and narrative inquiry to examine the topic of sexuality and adolescents with cancer from the perspectives of survivors who had experienced cancer as adolescents. This investigation examined the potentially sensitive, disquieting, and often taboo issue of sexuality in the interest of optimizing wellness in young people, and, ultimately, in the health of adults. Understanding the adolescent body as a sensitive, sexual, and developing self can enrich our understanding of adolescent cancer and promote best health care and practices, examining ways that we might mitigate the long-term effects of arrested or delayed development of sexual identity. In this article, we discuss phase 1 of the study, which used hermeneutics as the method of inquiry. Findings included a general experience of adolescents having a sense of "losing themselves" while at the same time finding themselves in a new light. Other findings include the connection between sexuality, self, and identity; the unique "tribe" of adolescents with cancer; the necessity for sexuality to take a backseat to cancer; the changing mirror images from self and others; sexuality and fertility; and, ultimately, that sexuality is a relational experience.
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Affiliation(s)
| | | | | | - Fiona Schulte
- 1 University of Calgary, Calgary, Alberta, Canada.,2 Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- 1 University of Calgary, Calgary, Alberta, Canada.,2 Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Douglas Strother
- 1 University of Calgary, Calgary, Alberta, Canada.,2 Alberta Children's Hospital, Calgary, Alberta, Canada
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Guilcher GMT. Can Preconsent Eliminate Some Barriers to Clinical Trial Enrollment of Children With Sickle Cell Disease in Crisis? Pediatr Blood Cancer 2016; 63:1511-2. [PMID: 27189802 DOI: 10.1002/pbc.26057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/16/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Gregory M T Guilcher
- Departments of Oncology and Paediatrics, Section of Oncology and Paediatrics, University of Calgary, Calgary, Canada
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Affiliation(s)
- Gregory M T Guilcher
- Section of Pediatric Oncology/BMT, Alberta Children's Hospital; Departments of Oncology and Pediatrics, University of Calgary, Calgary, Alberta, Canada
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40
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Chow EJ, Anderson L, Baker KS, Bhatia S, Guilcher GMT, Huang JT, Pelletier W, Perkins JL, Rivard LS, Schechter T, Shah AJ, Wilson KD, Wong K, Grewal SS, Armenian SH, Meacham LR, Mulrooney DA, Castellino SM. Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report. Biol Blood Marrow Transplant 2016; 22:782-95. [PMID: 26802323 DOI: 10.1016/j.bbmt.2016.01.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [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: 11/18/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies, solid tumors, and, increasingly, nonmalignant diseases. Given improvements in care, there are a growing number of long-term survivors of pediatric HCT. Compared with childhood cancer survivors who did not undergo transplantation, HCT survivors have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pretransplantation treatment exposures and organ dysfunction, the transplantation conditioning regimen, and any post-transplantation graft-versus-host disease (GVHD). In response, the Children's Oncology Group (COG) has created long-term follow-up guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those who were treated with HCT. Guideline task forces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other health care professionals, and patient advocates systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided herein is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those who underwent transplantation for nonmalignant diseases, and those with a history of chronic GVHD.
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Affiliation(s)
- Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington.
| | - Lynnette Anderson
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Scott Baker
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory M T Guilcher
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer T Huang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Pelletier
- Departments of Oncology and Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Joanna L Perkins
- Department of Cancer and Blood Disorders, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Linda S Rivard
- Department of Pediatric Hematology Oncology, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Tal Schechter
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ami J Shah
- Division of Stem Cell Transplant and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | - Karla D Wilson
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Kenneth Wong
- Department of Radiation Oncology, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California
| | - Satkiran S Grewal
- Department of Pediatrics, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts
| | - Saro H Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Lillian R Meacham
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sharon M Castellino
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Burke MJ, Verneris MR, Le Rademacher J, He W, Abdel-Azim H, Abraham AA, Auletta JJ, Ayas M, Brown VI, Cairo MS, Chan KW, Diaz Perez MA, Dvorak CC, Egeler RM, Eldjerou L, Frangoul H, Guilcher GMT, Hayashi RJ, Ibrahim A, Kasow KA, Leung WH, Olsson RF, Pulsipher MA, Shah N, Shah NN, Thiel E, Talano JA, Kitko CL. Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research. Biol Blood Marrow Transplant 2015; 21:2154-2159. [PMID: 26327632 DOI: 10.1016/j.bbmt.2015.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
Survival for children with relapsed T cell acute lymphoblastic leukemia (T-ALL) is poor when treated with chemotherapy alone, and outcomes after allogeneic hematopoietic cell transplantation (HCT) is not well described. Two hundred twenty-nine children with T-ALL in second complete remission (CR2) received an HCT after myeloablative conditioning between 2000 and 2011 and were reported to the Center for International Blood and Marrow Transplant Research. Median age was 10 years (range, 2 to 18). Donor source was umbilical cord blood (26%), matched sibling bone marrow (38%), or unrelated bone marrow/peripheral blood (36%). Acute (grades II to IV) and chronic graft-versus-host disease occurred in, respectively, 35% (95% confidence interval [CI], 27% to 45%) and 26% (95% CI, 20% to 33%) of patients. Transplant-related mortality at day 100 and 3-year relapse rates were 13% (95% CI, 9% to 18%) and 30% (95% CI, 24% to 37%), respectively. Three-year overall survival and disease-free survival rates were 48% (95% CI, 41% to 55%) and 46% (95% CI, 39% to 52%), respectively. In multivariate analysis, patients with bone marrow relapse, with or without concurrent extramedullary relapse before HCT, were most likely to relapse (hazard ratio, 3.94; P = .005) as compared with isolated extramedullary disease. In conclusion, HCT for pediatric T-ALL in CR2 demonstrates reasonable and durable outcomes, and consideration for HCT is warranted.
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Affiliation(s)
- Michael J Burke
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI.
| | | | - Jennifer Le Rademacher
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Wensheng He
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Allistair A Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Jeffery J Auletta
- Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Valerie I Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA
| | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Ka Wah Chan
- Department of Pediatrics, Texas Transplant Institute, San Antonio, TX
| | - Miguel A Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Christopher C Dvorak
- Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA
| | - R Maarten Egeler
- Department of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Lamis Eldjerou
- Department of Pediatrics, University of Florida, Gainsville, FL
| | - Haydar Frangoul
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Gregory M T Guilcher
- Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, AB, Canada
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ahmed Ibrahim
- Department of Hematology/Oncology, Makassed General Hospital, Beiruit, Lebanon
| | - Kimberly A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wing H Leung
- Division of Bone Marrow Transplantation, St. Jude Children's Research Hospital, Memphis, TN
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Michael A Pulsipher
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Niketa Shah
- Division of Hematology/Oncology, Department of Pediatrics, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, AZ
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NIH), Bethesda, MD
| | - Elizabeth Thiel
- CIBMTR(®) (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Carrie L Kitko
- Stem Cell Transplant Program, Department of Pediatrics, Vanderbilt University, Nashville, TN
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Pelletier W, Schulte F, Guilcher GMT. Pediatric hematopoietic stem cell donors: need for longitudinal medical and psychosocial surveillance. Pediatr Blood Cancer 2015; 62:737-8. [PMID: 25641913 DOI: 10.1002/pbc.25375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/05/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Wendy Pelletier
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Alberta, Canada
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Abstract
Since the first use of umbilical cord blood (UCB) as a medical therapy, the number of UCB banks worldwide has grown. Public UCB banks offer the option of altruistic donation, whereas private banks allow a product to be stored for the exclusive use of the paying client. With many more UCB products banked privately than publicly in countries such as the USA, hybrid models blending aspects of public and private banking have been proposed. One such bank is in operation in the UK. In this paper we review the hybrid UCB model and conclude that it offers limited benefit to the general public. Furthermore, compared with private banking, this model provides few advantages and potential disadvantages to private clients.
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Affiliation(s)
- Gregory M T Guilcher
- Section of Hematology/Oncology/Transplant, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wurz A, Chamorro-Vina C, Guilcher GMT, Schulte F, Culos-Reed SN. The feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients. Pediatr Blood Cancer 2014; 61:1828-34. [PMID: 24938424 DOI: 10.1002/pbc.25096] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Received: 03/20/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Increasing rates of survival present a new set of psychosocial and physical challenges for children undergoing treatment for cancer. Physical activity (PA) has been shown to be a safe and effective strategy to mitigate the significant burden of cancer and its treatments, with yoga increasingly gaining recognition as a gentle alternative. The purpose of this study was to determine the feasibility and benefits of a 12-week community-based yoga intervention on health-related quality of life (HRQL), select physical fitness outcomes and PA levels (PAL). PROCEDURE Eight pediatric cancer out-patients (4 male; 4 female; Mage = 11.88, SD = 4.26) participated in the 12-week intervention consisting of supervised yoga sessions 2 times/week. Participants (patients and parent proxies) completed measures assessing HRQL, physical fitness and PAL at baseline and post-intervention. RESULTS Rates of recruitment, retention, attendance and adverse events indicated the program was feasible. Wilcoxon Signed Rank tests indicated significant improvements for patient (P = 0.02) and parent reported HRQL (P = 0.03), functional mobility (P = 0.01), hamstring flexibility (left, P = 0.01 and right P = 0.02), and total PAL (P = 0.02) pre to post intervention. CONCLUSION This 12-week community-based yoga intervention was feasible and provides preliminary evidence for the benefits of yoga on HRQL, physical fitness and PAL in pediatric cancer out-patients. In a population where sedentary behavior and the associated co-morbidities are a growing concern, these results promote the continued exploration of yoga programming.
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Affiliation(s)
- Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Effinger KE, Migliorati CA, Hudson MM, McMullen KP, Kaste SC, Ruble K, Guilcher GMT, Shah AJ, Castellino SM. Oral and dental late effects in survivors of childhood cancer: a Children's Oncology Group report. Support Care Cancer 2014; 22:2009-19. [PMID: 24781353 PMCID: PMC4118932 DOI: 10.1007/s00520-014-2260-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/16/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children's Oncology Group. METHODS An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network "Categories of Consensus" system. RESULTS The Children's Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment. CONCLUSIONS Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.
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Affiliation(s)
- Karen E Effinger
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Stanford University, 1000 Welch Rd, Suite 300, Palo Alto, CA, 94304, USA,
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Miettunen PM, Lafay-Cousin L, Guilcher GMT, Nettel-Aguirre A, Moorjani V. Widespread osteonecrosis in children with leukemia revealed by whole-body MRI. Clin Orthop Relat Res 2012; 470:3587-95. [PMID: 23008023 PMCID: PMC3492614 DOI: 10.1007/s11999-012-2579-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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: 01/25/2012] [Accepted: 08/21/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Confirmation of early long-bone epiphyseal osteonecrosis in pediatric patients with leukemia allows for medical and surgical intervention before articular surface collapse. MRI detects early osteonecrosis, but multiple focused MR images are required to capture all lesions. QUESTIONS/PURPOSES We determined whether whole-body MRI (WB-MRI) could (1) assist in diagnosing long-bone epiphyseal and other osteonecroses, (2) characterize articular surface involvement, and (3) detect preferential sites for osteonecrosis. PATIENTS AND METHODS We retrospectively reviewed prospectively collected data on all 11 pediatric patients newly diagnosed with leukemia who had musculoskeletal pain develop that persisted 4 weeks or more during leukemia treatment. All were screened for osteonecrosis by WB-MRI, which consisted of a one-time scan of the entire body. Osteonecrosis was defined as circumscribed lesions with a distinct rim of low signal intensity in the normally high-intensity marrow on T1-weighted images and high signal intensity in the normally low-intensity marrow on short-tau inversion recovery images. RESULTS WB-MRI confirmed osteonecrosis in nine of 11 patients. All patients had multisite lesions; eight had long-bone epiphyseal lesions, which comprised 66 of 129 (51%) of all lesions. Osteonecrosis involving greater than 50% of the epiphyseal surface was present in 57% of distal femoral and proximal tibial lesions. All humeral and femoral head lesions involved more than 1/3 of the medial surface volume but were asymptomatic. No articular collapse was present. All osteonecrotic lesions were more common in the lower extremities. CONCLUSIONS WB-MRI confirmed early epiphyseal osteonecrosis, with quantification of articular surface involvement. Lower limbs were preferentially affected, but asymptomatic humeral head osteonecrosis was present in five of nine patients. LEVEL OF EVIDENCE Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paivi Maria Miettunen
- Division of Pediatric Rheumatology, Department of Pediatrics, Alberta Children’s Hospital and University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8 Canada
| | - Lucie Lafay-Cousin
- Division of Pediatric Oncology, Department of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB Canada
| | - Gregory M. T. Guilcher
- Division of Pediatric Oncology, Department of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, AB Canada
| | - Alberto Nettel-Aguirre
- Departments of Pediatrics and Community Health Sciences, Alberta Children’s Hospital and University of Calgary, Calgary, AB Canada
| | - Vijay Moorjani
- Department of Diagnostic Imaging, Alberta Children’s Hospital and University of Calgary, Calgary, AB Canada
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Chamorro-Viña C, Guilcher GMT, Khan FM, Mazil K, Schulte F, Wurz A, Williamson T, Reimer RA, Culos-Reed SN. EXERCISE in pediatric autologous stem cell transplant patients: a randomized controlled trial protocol. BMC Cancer 2012; 12:401. [PMID: 22963378 PMCID: PMC3503655 DOI: 10.1186/1471-2407-12-401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 12/18/2022] Open
Abstract
Background Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases. However, this therapy is associated with high mortality rates and numerous negative side-effects. The recovery of the immune system is a special concern and plays a key role in the success of this treatment. In healthy populations it is known that exercise plays an important role in immune system regulation, but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant. The primary objective of this randomized-controlled trial (RCT) is to study the effect of an exercise program (in- and outpatient) on immune cell recovery in patients undergoing an autologous stem cell transplantation. The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life, physical fitness, and the acquisition of a sedentary lifestyle. Methods This RCT has received approval from The Conjoint Health Research Ethics Board (CHREB) of the University of Calgary (Ethics ID # E-24476). Twenty-four participants treated for a malignancy with autologous stem cell transplant (5 to 18 years) in the Alberta Children’s Hospital will be randomly assigned to an exercise or control group. The exercise group will participate in a two-phase exercise intervention (in- and outpatient) from hospitalization until 10 weeks after discharge. The exercise program includes strength, flexibility and aerobic exercise. During the inpatient phase this program will be performed 5 times/week and will be supervised. The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device. The control group will follow the standard protocol without any specific exercise program. A range of outcomes, including quantitative and functional recovery of immune system, cytokine levels in serum, natural killer (NK) cells and their subset recovery and function, and gene expression of activating and inhibitory NK cell receptors, body composition, nutrition, quality of life, fatigue, health-related fitness assessment and physical activity levels will be examined, providing the most comprehensive assessment to date. Discussion We expect to find improvements in immunological recovery and quality of life, and decreased acquisition of sedentary behavior and fitness deconditioning. The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes. Trial registration Gov identification # NCT01666015
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48
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Abstract
Pediatric bone marrow transplantation (BMT) for various diseases can lead to endocrine system dysfunction owing to preparative regimens involving chemotherapy and radiation therapy. We assessed the prevalence of post-BMT endocrine complications in children treated at the Alberta Children's Hospital (ACH) from 1991 to 2001. Time of onset of endocrine dysfunction, underlying disease processes, chemotherapy, radiation therapy and age at BMT were characterized. Subjects of <18 years of age at the time of allogeneic or autologous BMT for whom 1-year follow-up through the ACH and a chart were available for review were included in the study. Subjects with a pre-existing endocrine condition were excluded. Of the 194 pediatric BMT procedures performed at the ACH between January 1, 1991 and December 31, 2001, 150 complete charts were available for review. Sixty five subjects received follow-up care at other centers and were excluded. Therefore, a total of 85 subjects were included in the review. The prevalence of endocrine complications identified was: primary hypothyroidism 1.2%, compensated hypothyroidism 7.0%, hyperthyroidism 2.4%, hypergonadotrophic hypogonadism 22.4%, abnormal bone density 2.4%, and secondary diabetes mellitus 1.2%. These findings emphasize the need to screen for endocrine system dysfunction, particularly hypergonadotrophic hypogonadism, in children who have undergone BMT. Children need long-term follow-up so that endocrine complications can be diagnosed and treated promptly.
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Affiliation(s)
- Josephine Ho
- Division of Endocrinology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta T3B 6A8, Canada.
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Abstract
BACKGROUND Major advances have been made in the treatment of childhood cancer; however, survivors of childhood cancer are at increased risk for morbidity and mortality. There is little literature regarding available long-term follow-up programs for survivors of childhood cancer. PROCEDURE In March 2007, 16 surveys were sent to pediatric hematology/oncology programs across Canada to determine what programs were available for survivors of childhood cancer, and the nature of such programs. RESULTS Of 15 participating centers, 13 (87%) have multi-disciplinary programs for the long-term follow-up of pediatric cancer survivors. Research databases were documented in 9/15 (60%) of centers to document late effects. Dedicated programs for adult survivors of childhood cancer were established in 8/15 (53%) of centers. Access to subspecialty care for survivors was rated as quite good. Concerns were raised by many participants about patients being lost to follow-up. Respondents indicated that primary care physicians appear to be under-represented within dedicated long-term follow-up programs. CONCLUSION Long-term follow-up programs for survivors of childhood cancer are available in 87% of Canadian pediatric oncology centers. While programs reported good access to care for childhood survivors, many adult survivors of childhood cancer have more limited timely access to services and patients are often lost to follow-up. New models of care incorporating primary care physicians are necessary due to growing numbers of survivors.
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Affiliation(s)
- G M T Guilcher
- Division of Pediatric Hematology, University of Calgary, Calgary, Canada.
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Guilcher GMT, Gardiner JA, Wadsworth LD, Dix DB. Retinal hemorrhages requiring vitrectomy in a patient with hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2008; 51:145. [PMID: 18322924 DOI: 10.1002/pbc.21542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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