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Pierpont EI, Isaia AR, McCoy E, Brown SJ, Gupta AO, Eisengart JB. Neurocognitive and mental health impact of adrenoleukodystrophy across the lifespan: Insights for the era of newborn screening. J Inherit Metab Dis 2023; 46:174-193. [PMID: 36527290 PMCID: PMC10030096 DOI: 10.1002/jimd.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
X-linked adrenoleukodystrophy (ALD) is a rare inherited neurological disorder that poses considerable challenges for clinical management throughout the lifespan. Although males are generally more severely affected than females, the time course and presentation of clinical symptoms are otherwise difficult to predict. Opportunities to improve outcomes for individuals with ALD are rapidly expanding due to the introduction of newborn screening programs for this condition and an evolving treatment landscape. The aim of this comprehensive review is to synthesize current knowledge regarding the neurocognitive and mental health effects of ALD. This review provides investigators and clinicians with context to improve case conceptualization, inform prognostic counseling, and optimize neuropsychological and mental health care for patients and their families. Results highlight key predictive factors and brain-behavior relationships associated with the diverse manifestations of ALD. The review also discusses considerations for endpoints within clinical trials and identifies gaps to address in future research.
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Affiliation(s)
| | - Ashley R. Isaia
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Erin McCoy
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sarah J. Brown
- Health Sciences Library, University of Minnesota, Minneapolis, Minnesota
| | - Ashish O. Gupta
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Julie B. Eisengart
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Is there a choice when a sibling is ill? Experiences of children and adolescents who donated stem cells to a sibling. Eur J Oncol Nurs 2022; 58:102147. [DOI: 10.1016/j.ejon.2022.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
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Rubeis G, Steger F. Saving whom? The ethical challenges of harvesting tissue from savior siblings. Eur J Haematol 2019; 103:478-482. [PMID: 31418923 DOI: 10.1111/ejh.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE STUDY To discuss the ethical challenges for the therapeutic team when dealing with a young savior sibling as a potential tissue donor. BASIC PROCEDURES Savior siblings are children that are created to serve a sibling as a donor of umbilical cord blood, bone marrow, or peripheral blood from which hematopoietic stem cells are derived. These cells are used for hematopoietic stem cell therapy, which is the only curative treatment for certain hemoglobinopathies. We used a case including a 19-year-old thalassemia patient and his two and a half year old sister from our practice as ethics consultants. Our methodological basis is the principlism approach by Beauchamp and Childress, consisting of four principles: autonomy, non-maleficence, beneficence, and justice. MAIN FINDINGS We found that the main conflict arises between the autonomy of the savior sibling as well as the non-maleficence regarding her and the beneficence of the thalassemia patient. PRINCIPAL CONCLUSIONS Decision-making is complex when decisions within the family are concerned, especially when non-competent young children are involved. The therapeutic team does not only have to recognize the principal vulnerability of children but also the different scales of vulnerability depending on their age.
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Affiliation(s)
- Giovanni Rubeis
- Institute of History and Ethics of Medicine, Heidelberg University, Heidelberg, Germany
| | - Florian Steger
- Institute of History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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4
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Pilot Study of Educational Interventions for Pediatric Hematopoietic Stem Cell Sibling Donors to Increase Knowledge of Donation and Transplantation Procedures. ACTA ACUST UNITED AC 2019; 1. [PMID: 33225301 DOI: 10.1097/or9.0000000000000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Siblings are frequently identified as a tissue match for patients with malignant and nonmalignant diseases and are selected to donate hematopoietic stem cells (HSC). Research on preparing siblings donors for stem cell donation is limited. Even after donation procedures are explained, siblings have been found to have difficulty understanding the information and may experience anxiety, particularly amongst younger donors. No prospective studies examining educational tools and transplant knowledge in sibling stem cell donors are currently available. This pilot study assessed donor comprehension of HSC donation procedures and compared knowledge prior to and post an educational intervention. Methods Assessment of baseline knowledge regarding HSC donation was assessed before and after the consent/information meeting with the medical team. Donors were then stratified into 2 groups by age. Donors aged 10 to 15 played an adapted version of the therapeutic game ShopTalk and donors aged 16 to 25 were provided a workbook designed for sibling stem cell donors. Assessment of knowledge was repeated 24 hours after the intervention. Results Participants included 17 siblings of pediatric transplant recipients, ages 10-25. Mean knowledge scores increased from 59.6% to 68.8% following the meeting with the medical provider and further increased to 88.5% after an educational intervention. Results suggest that education that provides information via a game or workbook increases knowledge in sibling donors. Conclusion Limited interactive educational material on stem cell donation is available for pediatric HSC donors. Additional visual and/or interactive information for sibling donors may increase knowledge and perhaps comfort with the donation process, beyond that which is provided by the medical teams. Providing detailed information about donation and discussion of procedures should be tailored to the individual learning style and supplemented with additional visual information.
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Wiener L, Hoag JA, Pelletier W, Shah NN, Shaw BE, Pulsipher MA, Bruce J, Bader P, Willasch AM, Dalissier A, Guilcher G, Anthias C, Confer DL, Sees JA, Logan B, Switzer GE. Transplant center practices for psychosocial assessment and management of pediatric hematopoietic stem cell donors. Bone Marrow Transplant 2019; 54:1780-1788. [PMID: 30971776 DOI: 10.1038/s41409-019-0515-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/31/2023]
Abstract
Understanding the potential emotional and psychological risks of pediatric sibling HSC donation is an area of research that remains in its infancy. A cross-sectional survey was distributed electronically to directors at all CIBMTR and EBMT centers to describe current transplant center practices for obtaining assent, preparation for the physical/emotional experiences of donation, and monitoring the post-donation well-being of pediatric donors (<18 years of age). Respondents were 45/91 (49%) and 66/144 (46%) of CIBMTR and EBMT centers, respectively. Although 78% of centers reported having a mechanism in place to ensure donor free assent, centers also reported only limited assessment of psychosocial suitability to manage the emotional risks of donation. More than half of centers reported no psychosocial follow-up assessment post-donation. Few centers have policies in place to address donor psychological needs. Future investigations should include medical and psychosocial outcomes following full integration of comprehensive psychosocial screening and surveillance of pediatric donors.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health Bethesda, Bethesda, MD, USA
| | - Jennifer A Hoag
- Medical College of Wisconsin, Department of Pediatrics, Division of Hematology, Oncology and Blood and Marrow Transplant, Milwaukee, WI, USA
| | - Wendy Pelletier
- Pediatric Hematology/Oncology/Blood & Marrow Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health Bethesda, Bethesda, MD, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jessica Bruce
- Departments of Medicine, Psychiatry, Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andre M Willasch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Arnaud Dalissier
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Gregory Guilcher
- Pediatric Hematology/Oncology/Blood & Marrow Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada.,Departments of Oncology and Paediatrics, University of Calgary, Calgary, AB, Canada
| | - Chloe Anthias
- Anthony Nolan Research Institute, Anthony Nolan Trust, London, UK.,Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Dennis L Confer
- National Marrow Donor Program/Be The Match®, Minneapolis, MN, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Brent Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Galen E Switzer
- Departments of Medicine, Psychiatry, Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Then SN, Kerridge IH, Marks M. Children as haematopoietic stem cell donors: ethically challenging and legally complex. Med J Aust 2018; 208:334-337. [PMID: 29716509 DOI: 10.5694/mja17.00758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/05/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Shih-Ning Then
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW
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Kakourou G, Vrettou C, Moutafi M, Traeger-Synodinos J. Pre-implantation HLA matching: The production of a Saviour Child. Best Pract Res Clin Obstet Gynaecol 2017; 44:76-89. [DOI: 10.1016/j.bpobgyn.2017.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/09/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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8
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Parent versus child donor perceptions of the bone marrow donation experience. Bone Marrow Transplant 2017. [PMID: 28650449 DOI: 10.1038/bmt.2017.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F, Kent EE, Jacobsen PB, Lee SJ, Hsieh MM, Denzen EM, Syrjala KL. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report. Biol Blood Marrow Transplant 2017; 23:538-551. [PMID: 27660168 PMCID: PMC5346334 DOI: 10.1016/j.bbmt.2016.09.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022]
Abstract
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.
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Affiliation(s)
- Margaret Bevans
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - D Kathryn Tierney
- Division of Primary, Preventive and Community Medicine, Stanford University, Stanford, California
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina, Durham, North Carolina
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan & Department of Psychology, Eastern Michigan University, Ann Arbor, Michigan
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Paul B Jacobsen
- Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Ellen M Denzen
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Switzer GE, Bruce J, Kiefer DM, Kobusingye H, Drexler R, Besser RM, Confer DL, Horowitz MM, King RJ, Shaw BE, van Walraven SM, Wiener L, Packman W, Varni JW, Pulsipher MA. Health-Related Quality of Life among Pediatric Hematopoietic Stem Cell Donors. J Pediatr 2016; 178:164-170.e1. [PMID: 27522440 PMCID: PMC5085860 DOI: 10.1016/j.jpeds.2016.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine health-related quality of life (HRQoL) among sibling pediatric hematopoietic stem cell donors from predonation through 1 year postdonation, to compare donor-reported HRQoL scores with proxy-reports by parents/guardians and those of healthy norms, and to identify predonation factors (including donor age) potentially associated with postdonation HRQoL, to better understand the physical and psychosocial effects of pediatric hematopoietic stem cell donation. STUDY DESIGN A random sample of 105 pediatric donors from US centers and a parent/guardian were interviewed by telephone predonation and 4 weeks and 1 year postdonation. The interview included sociodemographic, psychosocial, and HRQoL items. A sample of healthy controls matched to donors by age, gender, and race/ethnicity was generated. RESULTS Key findings included (1) approximately 20% of donors at each time point had very poor HRQoL; (2) child self-reported HRQoL was significantly lower than parent proxy-reported HRQoL at all 3 time points and significantly lower than that of norms at predonation and 4 weeks postdonation; and (3) younger children were at particular risk of poor HRQoL. CONCLUSIONS Additional research to identify the specific sources of poorer HRQoL among at-risk donors (eg, the donation experience vs having a chronically ill sibling) and the reasons that parents may be overestimating HRQoL in their donor children is critical and should lead to interventions and policy changes that ensure positive experiences for these minor donors.
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Affiliation(s)
- Galen E. Switzer
- Departments of Medicine, University of Pittsburgh, Pittsburgh, PA,Psychiatry, University of Pittsburgh, Pittsburgh, PA,Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jessica Bruce
- Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Deidre M. Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - RaeAnne M. Besser
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Dennis L. Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Mary M. Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Roberta J. King
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E. Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Suzanna M. van Walraven
- Sanquin Blood Supply, Department of Donor Services, Amsterdam, The Netherlands,Willem Alexander Children's Hospital, Department for Pediatric Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Wendy Packman
- Department of Psychology, Palo Alto University, Palo Alto, CA
| | - James W. Varni
- Department of Pediatrics, Texas A&M University, College Station, TX,Department of Landscape Architecture and Urban Planning, Center for Health Systems and Design, Texas A&M University, College Station, TX
| | - Michael A. Pulsipher
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA
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Hutt D, Nehari M, Munitz-Shenkar D, Alkalay Y, Toren A, Bielorai B. Hematopoietic stem cell donation: psychological perspectives of pediatric sibling donors and their parents. Bone Marrow Transplant 2015; 50:1337-42. [DOI: 10.1038/bmt.2015.152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/30/2015] [Accepted: 05/14/2015] [Indexed: 12/14/2022]
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12
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Christian BJ. Rebirth and renewal through research--new evidence and strategies for improving the quality of pediatric nursing care. J Pediatr Nurs 2013; 28:305-8. [PMID: 23537490 DOI: 10.1016/j.pedn.2013.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Becky J Christian
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA.
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