Expanding Indications for Stem Cell Transplantation

Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center

BACKGROUND

Bone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality.

OBJECTIVES

This study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT.

METHODS

This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED.

RESULTS

Our study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015).

CONCLUSION

In our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.

Nursing interventions in autologous stem cell transplantation for autoimmune diseases

AIMS

To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases.

DESIGN

This is a retrospective, cross-sectional study.

METHODS

This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis.

RESULTS

There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group.

CONCLUSION

Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions.

IMPACT

Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.

L-Lysine-modified Fe3O4 nanoparticles for magnetic cell labeling

The efficiency of magnetic labeling with L-Lys-modified Fe₃O₄ magnetic nanoparticles (MNPs) and the stability of magnetization of rat adipose-derived mesenchymal stem cells, lineage-negative (Lin(-)) hematopoietic progenitor cells from mouse bone marrow and human leukemia K562 cells were studied. For this purpose, covalent modification of MNPs with 3-aminopropylsilane and N-di-Fmoc-L-lysine followed by removal of N-protecting groups was carried out. Since the degree of hydroxylation of the surface of the starting nanoparticles plays a crucial role in the silanization reaction and the possibility of obtaining stable colloidal solutions. In present work we for the first time performed a comparative qualitative and quantitative evaluation of the number of adsorbed water molecules and hydroxyl groups on the surface of chemically and physically obtained Fe₃O₄ MNPs using comprehensive FTIR spectroscopy and thermogravimetric analysis. The results obtained can be further used for magnetic labeling of cells in experiments in vitro and in vivo.

Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation

There are limited data available regarding effectiveness of exercise training in children undergoing hematopoietic stem cell transplantation (HSCT). We aimed to investigate effects of multimodal exercise program on clinical status and patient-reported outcomes including pain, fatigue, depression, and quality of life (QOL) level of children and their parents' QOL level. Twenty-six children undergoing HSCT participated in this study. Clinical status, pain, fatigue, depression, and QOL level of children were assessed three times: before HSCT, at discharge, and one month later. For intervention group (IG, n = 15), multimodal exercise program was performed five days a week, throughout hospitalization and children were advised to continue exercise program at home. For control group (CG, n = 11), being active as much as possible was advised. The number of painful day and pain intensity was significantly lower in IG than in CG during hospitalization (p < .05). Depression level decreased in IG at the time points (p ˂ .05); however, there was no significantly difference between groups. The QOL level was higher in IG than CG only at control measurements (p ˂ .05). In addition, QOL level of the parents decreased in both groups (p ˂ .05). There was no statistically difference between groups in terms of other clinical variables. The multimodal supervised exercise program has positive effects on children's pain and QOL level. Exercise program was also well tolerated by children during hospitalization. In addition, QOL levels of the parents were also negatively affected during hospitalization, and interventions aiming to increase QOL level of the parents should be considered.

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

PURPOSE

To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation.

METHODS

Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search.

RESULTS

Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I₂ 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I₂ 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I₂ 24%).

CONCLUSIONS

Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Transfusion challenges in hematology oncology and hematopoietic stem cell transplant - Literature review and local experience

Transfusion medicine plays a vital role in the supportive care of patients receiving therapy for hematology, oncology and hematopoietic stem cell transplants (HSCT). With advances in therapy with more intensive chemotherapy or radiotherapy, patients usually develop cytopenias and need frequent transfusion support with packed red blood cells, granulocyte transfusion or platelets to support them until they recover from the effect of therapy. HSCT poses unique challenges for transfusion medicine, since transplant recipients may require substantial transfusion support due to cytopenias associated with toxic medications, decreased marrow reserve, infection or their malignancy. Transfusion support has many complications, mainly immune mediated and infectious complications. Jehovah's Witness patients deny transfusions of blood products as a therapeutic option and, consequently, management of their disease with chemotherapy and stem cell transplant after myeloablative therapy is quite challenging. This review describes the challenges of transfusion support in managing hemato-oncology and stem cell transplant patients and highlights a local experience in transplanting two Jehovah's Witness patients.

Investigation of the Effects of an Exercise Program on Physical Functions and Activities of Daily Life in Pediatric Hematopoietic Stem Cell Transplantation

BACKGROUND

The aim of this study was to determine the effectiveness of an implemented exercise program for children throughout the hematopoietic stem cell transplantation (HSCT) process.

PROCEDURE

Twenty-two children aged between 3 and 17, who were earlier selected for HSCT, were divided into two groups-intervention and control. Children's physical function, functional performance, and activities of daily life (ADL) were assessed before HSCT, at discharge, and 1 month later. The exercise program, which consisted of strengthening, endurance, stretching, and relaxation exercises, was implemented to the intervention group for 5 days a week throughout hospitalization; and these exercises were given as home program at discharge.

RESULTS

The results of the supervised exercise program during hospitalization showed that the children's physical function and functional performance increased statistically significantly in the intervention group (P < 0.05) and decreased statistically significantly in the control group (P < 0.05). For the ADL, no difference was found between the two groups (P ˃ 0.05).

CONCLUSIONS

The present study determined that the exercise program had positive effects throughout the HSCT process, but these effects did not continue during the follow-up period. Exercise programs implemented by physiotherapists are important for children undergoing HSCT, and after transplantation it is necessary to continue supervised exercise program during follow-up.

Gender differences in health-related quality of life, physical function and psychological status among patients in the early phase following allogeneic haematopoietic stem cell transplantation

OBJECTIVE

The aim of this study was to examine gender differences in quality of life (QOL), physical function and psychological status before and in the early phase after allogeneic haematopoietic stem cell transplantation (allo-HSCT).

METHODS

One hundred patients (66 men, 34 women) who underwent allo-HSCT between July 2007 and June 2011 at Hyogo College of Medicine Hospital were included in this study. Patients were evaluated for health-related QOL using the Medical Outcome Study 36-item Short Form Health Survey; exercise capacity was measured with the 6-min walk test, hand grip strength and knee extensor strength. Fatigue and psychological status were measured by the Piper Fatigue Scale and Hospital Anxiety and Depression Scale, respectively.

RESULTS

Women had significantly lower scores for physical function and general health on health-related QOL tests compared with men (p < 0.01). No difference between genders was found in decline of physical function. In women, exercise capacity was strongly associated with QOL (p < 0.01). In men, depression and anxiety were closely related to QOL (p < 0.01).

CONCLUSIONS

Gender-appropriate rehabilitation in allo-HSCT patients is important. Women may need more endurance exercises and training for activities of daily life. Men may need rehabilitation including a psychological approach.

Effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study

OBJECTIVE

The objective of this study was to evaluate the effect of salivary stimulation therapies on the salivary flow, oral mucositis, and salivary cytokine levels in patients receiving allogeneic hematopoietic stem cell transplantation.

STUDY DESIGN

Thirty-five eligible patients were randomized into 4 groups: control, mechanical sialogogue, transcutaneous electrical nerve stimulation (TENS) sialogogue, and combined mechanical/electrical sialogogue. Saliva was collected from patients before transplantation and at days 3, 7, and 14 after transplantation. The volume was measured and salivary cytokines were assessed using enzyme-linked immunosorbent assay.

RESULTS

By day 14, resting and stimulated salivary flow levels were diminished. Resting salivary flow rates decreased the most in the control and mechanical groups. In contrast, TENS alone or in combination with mechanical stimulatory therapy benefited the patients. TENS-treated patients showed increase in resting salivary flow. Also, the groups treated with TENS had fewer patients affected by grades 3 and 4 mucositis, and less mucositis was associated with better patient survival (P = .027).

CONCLUSIONS

TENS-associated salivary stimulation therapies minimized the reduction of salivary flow and prevented severe chemotherapy-induced oral mucositis.