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Ruan J, Cheng H, Liu Q, Xu F, Kwok WYY, Luo D, Qian Y, Cheung DST, Li H, Yeung WF. Survivorship Experiences of Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Systematic Review. Cancer Nurs 2024:00002820-990000000-00271. [PMID: 39016254 DOI: 10.1097/ncc.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND The number of allogeneic hematopoietic stem cell transplantation (allo-HSCT) survivors is increasing globally. Although qualitative studies in this population are reported, clear understanding of how allo-HSCT survivors experience survivorship is lacking. OBJECTIVE This study aimed to identify, appraise, and synthesize evidence from qualitative research on survivorship experience among allo-HSCT survivors. METHODS A qualitative systematic review was conducted. A literature search of 9 databases and OpenGrey, Google Scholar, and Google was performed from inception to February 2023. Two reviewers independently screened and assessed the eligibility of each study. Descriptive information was extracted from the studies by one reviewer and checked by another. Findings were extracted and analyzed using thematic synthesis. RESULTS Seventeen articles were included. Four themes and 12 subthemes regarding allo-HSCT survivors' experiences emerged: (1) recovery as being a longer process than they thought (influenced by long-term physical symptoms, disturbed by survivorship uncertainty); (2) experiencing a restricted survivorship life (shrunken social world, forced dietary limitations, centered around hospitals); (3) suffering from stigma and discrimination (perceived as a burden, seen differently by others, difficulties establishing and maintaining romantic relationships and marriage, limited opportunities in work); and (4) realizing something positive obtained during survivorship (enriched survivorship self-management skills, enhanced personal growth, developed positive relationships). CONCLUSIONS The findings reveal the challenges, needs, and growth that allo-HSCT survivors experienced during survivorship. Some understudied areas were identified, which warrant further exploration. IMPLICATIONS FOR PRACTICE Targeted survivor-centered care should be provided to allo-HSCT survivors, and interventions to resolve issues experienced during survivorship should be developed.
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Affiliation(s)
- Jiayin Ruan
- Author Affiliations: School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region (Mss Ruan and Liu, Drs Cheng and Yeung, and Mr Kwok); Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (Ms Xu); School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu (Dr Luo); Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang (Ms Qian); School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region (Dr Cheung); and Hematology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang (Ms Li), People's Republic of China
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Suga M, Fuji S, Tada Y, Tsutsumi K, Kida S, Shibata K, Nakata R, Shingai Y, Yuda S, Yokota T, Ishikawa J. A single-institution pre-post comparison of subcutaneous immunoglobulin replacement therapy in allogeneic haematopoietic cell transplantation recipients. Br J Haematol 2024; 204:260-267. [PMID: 37963427 DOI: 10.1111/bjh.19203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
Immunoglobulin replacement therapy (IgRT) reduces the risk of infection in hypogammaglobulinaemia secondary to chronic lymphocytic leukaemia and multiple myeloma. However, the benefit of IgRT, especially subcutaneous IgRT (ScIgRT), has not been assessed in hypogammaglobulinaemia after allogeneic haematopoietic cell transplantation (allo-HCT). We performed a pre-post comparison of the clinical impact of ScIgRT after allo-HCT in a retrospective analysis of 209 patients who underwent allogeneic HCT at our institution from 2011 to 2019. Since ScIgRT became available at our institution in April 2017, we categorized patients treated from January 2011 to March 2017 as the Pre-ScIgRT group (n = 118) and those treated from April 2017 to December 2019 as the Post-ScIgRT group (n = 91). The 2-year overall survival rate was 65% in the Pre-ScIgRT group and 81% in the Post-ScIgRT group (p = 0.02). The cumulative incidence (CI) of non-relapse mortality at 2 years was 18% and 7% (p = 0.02). There were 78 infectious events in 44 patients in the Pre-ScIgRT group and 28 such events in 19 patients in the Post-ScIgRT group. The CI of the documented infection during the observation period was between 38% and 21% (p = 0.01). Our study suggests that ScIgRT may reduce infection rates and improve prognosis after allo-HCT.
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Affiliation(s)
- Makiko Suga
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuma Tada
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhito Tsutsumi
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuhei Kida
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kumi Shibata
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryo Nakata
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhiro Shingai
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Sayako Yuda
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Takafumi Yokota
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
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Liu Y, Liu Y, Chen X, Jia Y. Clinical characteristics and mortality risk factors of mixed bacterial infections in hematopoietic stem cell transplantation recipients. Front Cell Infect Microbiol 2023; 13:1223824. [PMID: 37790911 PMCID: PMC10543755 DOI: 10.3389/fcimb.2023.1223824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Background and objective Mixed bacterial infections (MBI) is one of the complications after hematopoietic stem cell transplantation (HSCT) and increases the risk of patient death. However, there are few reports specifically on this topic. The purpose of this study was to investigate the clinical characteristics and mortality risk factors of MBI in HSCT recipients. Methods The electronic medical records of patients undergoing HSCT were collected. The epidemiological features and antibiotic resistance of patients with and without MBI were compared. Logistic regression and Cox regression were used to identify the risk factors for MBI acquisition and death. R language was used to construct a prediction model for the overall survival of HSCT recipients with MBI. Results The cumulative incidence of MBI was 6.3% and the mortality was 48.8%. Time interval from diagnosis to transplantation > 180 days (HR=2.059, 95% CI 1.042-4.069, P=0.038) and ICU admission after transplantation (HR=2.271, 95% CI 1.053-4.898, P=0.036) were independent risk factors for MBI acquisition. Engraftment period > 20 days (HR=2.273, 95% CI 1.028-5.027, P=0.043), continuous renal replacement therapy (HR=5.755, 95% CI 1.691-19.589, P=0.005) and septic shock (HR=4.308, 95% CI 2.085-8.901, P=0.000) were independent risk factors associated with mortality. Conclusions MBI has become a serious problem that cannot be ignored after HSCT. It is urgent for clinicians to pay high attention to it and formulate reasonable monitoring and treatment plans to improve the prognosis of patients.
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Affiliation(s)
- Yanfeng Liu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Liu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuefeng Chen
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yan Jia
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Lin Y, Li S, Mo C, Liu H, Bi J, Xu S, Jia B, Liu C, Liu Z. Oral microbial changes and oral disease management before and after the treatment of hematological malignancies: a narrative review. Clin Oral Investig 2023; 27:4083-4106. [PMID: 37071220 DOI: 10.1007/s00784-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Patients with hematological malignancies have dynamic changes in oral microbial communities before and after treatment. This narrative review describes the changes in oral microbial composition and diversity, and discusses an oral microbe-oriented strategy for oral disease management. MATERIALS AND METHODS A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1980 and 2022. Any articles on the changes in oral microbial communities in patients with hematological malignancies and their effects on disease progression and prognosis were included. RESULTS Oral sample detection and oral microbial sequencing analysis of patients with hematological malignancies showed a correlation between changes in oral microbial composition and diversity and disease progression and prognosis. The possible pathogenic mechanism of oral microbial disorders is the impairment of mucosal barrier function and microbial translocation. Probiotic strategies, antibiotic strategies, and professional oral care strategies targeting the oral microbiota can effectively reduce the risk of oral complications and the grade of severity in patients with hematological malignancies. CLINICAL RELEVANCE This review provides dentists and hematologists with a comprehensive understanding of the host-microbe associated with hematologic malignancies and oral disease management advice.
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Affiliation(s)
- Yunhe Lin
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Siwei Li
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chuzi Mo
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Hongyu Liu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jiaming Bi
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bo Jia
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chengxia Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Bhatti H, Batbileg E, De S, Friedman G, Antony S. Acute Colonic Perforation with Septic Shock Secondary to Disseminated Histoplasmosis in an Autologous Bone Marrow Transplant Recipient. Infect Drug Resist 2023; 16:3029-3034. [PMID: 37215300 PMCID: PMC10199683 DOI: 10.2147/idr.s402228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Histoplasma capsulatum is an opportunistic pathogen which can lead to a wide variety of clinical presentations in the immunocompromised host. Post-transplant histoplasmosis in hematopoietic cell transplant recipients is exceedingly rare, with an incidence of <1%. We present a case of acute caecal perforation resulting from disseminated histoplasmosis in a patient who had undergone autologous bone marrow transplant for plasma cell dyscrasia. This is a 71-year-old patient who initially presented due to progressive weakness associated with shortness of breath.
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Affiliation(s)
- Harsimrandeep Bhatti
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Enkhbileg Batbileg
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Srijisnu De
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Glen Friedman
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Suresh Antony
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
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Ladbury C, Armenian S, Bosworth A, He T, Wong FL, Dandapani S, Han C, Liu A, Al Malki M, Rosenthal J, Stein A, Wong J. Risk of Subsequent Malignant Neoplasms Following Hematopoietic Stem Cell Transplantation with Total Body Irradiation or Total Marrow Irradiation: Insights from Early Follow-Up. Transplant Cell Ther 2022; 28:860.e1-860.e6. [PMID: 36167306 DOI: 10.1016/j.jtct.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Total marrow irradiation (TMI) is an alternative to total body irradiation (TBI) as a component of the conditioning regimen for hematopoietic cell transplantation (HCT), offering the ability to deliver more targeted doses and facilitating organ-sparing. The organ-sparing effect of TMI is theorized to decrease the risk of complications associated with radiation, including subsequent malignant neoplasms (SMNs), while allowing for dosage escalation to improve oncologic outcomes. The purpose of this study was to compare SMNs rates among patients treated with TBI- or TMI-based conditioning regimens. We hypothesized that TMI would yield a rate of SMNs comparable to, if not lower than, TBI. A retrospective matched-pair analysis of patients who underwent allogeneic HCT and received either TBI- or TMI-based conditioning regimens to a total dose of 12 to 20 Gy was performed. A total of 171 patients received TMI-based conditioning and 171 received TBI-based conditioning, matched based on age, sex, diagnosis, and length of follow-up. SMNs were identified from an established long-term follow-up protocol, our institutional cancer registry, and the California Cancer Registry. There were no significant differences in patient and clinical characteristics between the TMI and TBI cohorts except for clinical response status at transplantation and radiation dose. As expected, patients in the TMI received higher radiation doses (median dose, 16.0 Gy for the TMI cohort versus 13.2 Gy for the TBI cohort; P < .001). The median follow-up for both cohorts was 2.0 years (range, .5 to 12.3 years). There was no significant difference in the risk of developing SMNs between the 2 cohorts (P = .81). A total of 9 patients (5.3%) conditioned with TBI and 10 patients (5.8%) conditioned with TMI developed SMNs, at a median of 3.3 years and 1.7 years following HCT, respectively. Excluding nonmelanoma skin cancers and noninvasive neoplasms, 2 patients in the TBI cohort developed SMNs (both melanomas), and 1 patient in the TMI cohort developed an SMN (colon cancer). No patients developed a subsequent hematologic malignancy. TMI-based conditioning is not associated with a significant difference in the risk of developing SMNs compared with TBI-based conditioning during early post-HCT follow-up. Future studies with longer follow-up may be needed to further characterize the risk of SMNs associated with TMI-based conditioning regimens compared with TBI-based regimens.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Saro Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Alysia Bosworth
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Tianhui He
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Savita Dandapani
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Monzr Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joseph Rosenthal
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Anthony Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jeffrey Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
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Trama A, Vener C, Lasalvia P, Bernasconi A. Late Mortality, Subsequent Malignant Neoplasms and Hospitalisations in Long-Term Survivors of Adolescent and Young Adult Hematological Cancers. Front Oncol 2022; 12:823115. [PMID: 35280767 PMCID: PMC8913709 DOI: 10.3389/fonc.2022.823115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Increased success in the treatment of hematological cancers contributed to the increase of 5-year survival for most adolescent and young adults (AYAs) with these tumours. However, as 5-year survival increased, it became clear that AYA long-term survivors were at increased risk for severe late effects. Moreover, limited information on long-term cancer impact is available for AYAs, since most studies focused on children and adolescents. We aimed to assess various long-term outcomes on AYA survivors of hematological cancers. Methods We selected patients diagnosed with a first primary hematological cancer between 1997 and 2006, in the Italian nationwide population-based cohort of AYA cancer survivors (i.e. alive at least 5 years after cancer diagnosis). Long-term outcomes of interest were: second malignant neoplasms (SMNs), hospitalizations and overall mortality. We calculated standardized incidence ratios (SIRs), standardized hospitalization rate ratios (SHRs) and standardized mortality rate ratios (SMRs). To study morbidity patterns over time, we modeled observed incidence rates by fitting flexible parametric models for nonlinear patterns and we used linear regression for linear patterns. Results The study cohort included 5,042 AYA hematological cancer survivors of which 1,237 and 3,805 had a leukaemia and lymphoma diagnosis, respectively. AYA survivors were at substantially increased risk for SMN (SIR=2.1; 95%CI=1.7; 2.6), hospitalisation (SHR=1.5; 95%CI=1.5; 1.6), and mortality (SMR=1.4; 95%CI=1.2; 1.6) with differences between leukaemia and lymphoma survivors. The highest excess risks of hospitalisations were for infectious diseases, respiratory diseases, and diseases of blood and blood-forming organs. The morbidity pattern differs over time by morbidity type. Conclusions Our results support the need for strict follow-up plans for survivors, and call for further study to better personalised follow-up plans for AYA cancer survivors.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Vener
- Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| | - Paolo Lasalvia
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,*Correspondence: Alice Bernasconi,
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