1
|
Abraham NS, Mishra S, Bhatnagar S, Kumar L, Sharma A, Garg R, Bharati SJ, Gupta N, Kumar V. Quality of life and symptom burden in hematological cancer patients receiving hematopoietic stem cell transplantation: an observational study at Regional Cancer Centre, India. Support Care Cancer 2024; 32:274. [PMID: 38587678 DOI: 10.1007/s00520-024-08481-8] [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: 07/13/2023] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Hematopoietic stem cell transplant (HSCT) is an intense form of treatment, resulting in major symptom burden but can prove curative. The quality of life (QOL) is a major endpoint for these patients as the survival rate in them has improved over time. The aim of the study is to assess the QOL and symptom burden of hematological malignancy patients at admission to hospital for HSCT, at 1 month and at 3 months following HSCT. METHODS This prospective observational study was done on hematological malignancy patients who were admitted for HSCT in a regional cancer center. The study subjects were assessed by the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT Scale), Edmonton Symptom Assessment Scale-revised (r-ESAS), and Depression, Anxiety and Stress Scale-21 Items (DASS-21) at the time of hospital admission for transplantation, on day 30 (~ 1 month) and day100 (~ 3 months) of transplantation. RESULTS A total of 68 patients were included in this study. FACT-BMT scores have decreased from baseline (F0) to the first follow-up (F1) and then increased in the third follow-up (F2). The maximum r-ESAS mean score was for tiredness among all other symptoms at F0 as well as at F1 and at F2. The DASS 21 scores for depression, anxiety, and stress were maximum during F1 and minimum during F2. CONCLUSION Symptom burden is maximum during the first month of BMT, which improves later and QOL becomes improved with time.
Collapse
Affiliation(s)
- Neethu Susan Abraham
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029.
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| | - Lalit Kumar
- Department of Medical Oncology, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
| |
Collapse
|
2
|
Fraint E, Abdel-Azim H, Bhatt NS, Broglie L, Chattha A, Kohorst M, Ktena YP, Lee MA, Long S, Qayed M, Sharma A, Stefanski H, Vatsayan A, Wray L, Hamadani M, Carpenter PA. Evaluation of Children with Malignancies for Blood and Marrow Transplantation: A Report from the ASTCT Committee on Practice Guidelines. Transplant Cell Ther 2023; 29:293-301. [PMID: 36775202 DOI: 10.1016/j.jtct.2023.02.003] [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: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Evaluation of a candidate for hematopoietic cell transplantation (HCT) is a complex process with substantial intercenter variability. Although literature providing guidance for evaluating the eligibility of adults is well established, similar guidance for children is lacking. To address gaps between adult recommendations and the specific needs of children, we convened a panel of pediatric HCT experts from a wide geographic range of American Society of Transplantation and Cellular Therapy (ASTCT) member institutions to offer recommendations for pediatric-focused pre-HCT evaluation. In this report from the ASTCT Committee on Practice Guidelines, we present a practical framework for evaluating children with malignancies who are candidates for HCT. We also highlight key differences from adults and emphasize areas of unmet need that require additional research to delineate best practices.
Collapse
Affiliation(s)
- Ellen Fraint
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York.
| | - Hisham Abdel-Azim
- Loma Linda University School of Medicine, Cancer Center, Children's Hospital and Medical Center, Loma Linda, California
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Larisa Broglie
- Medical College of Wisconsin, Department of Pediatrics, Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Milwaukee, Wisconsin
| | - Asma Chattha
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mira Kohorst
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yiouli P Ktena
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michelle A Lee
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York
| | - Susie Long
- University of Minnesota Masonic Children's Hospital, MHealth Fairview Acute Care Pharmacy Services, Minneapolis, Minnesota
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Anant Vatsayan
- Children's National Medical Center, Washington, District of Columbia
| | - Lisa Wray
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| |
Collapse
|
3
|
Di Francesco G, Cieri F, Esposito R, Sciarra P, Ballarini V, Di Ianni M, Santarone S. Fatigue as Mediator Factor in PTSD-Symptoms after Allogeneic Hematopoietic Stem Cell Transplantation. J Clin Med 2023; 12:jcm12082756. [PMID: 37109093 PMCID: PMC10144210 DOI: 10.3390/jcm12082756] [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: 02/01/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a valid treatment for hematological oncological or metabolic diseases. Despite its therapeutic efficacy, it is an aggressive treatment that impacts negatively on quality of life (QoL) and may result in Post-Traumatic Stress Disorder (PTSD) symptoms. The aim of this study is to explore rates and risk factors for PTSD symptoms, and fatigue in post-HSCT patients with hematological malignancies. METHODS A total of 123 patients after HSCT were evaluated for PTSD symptoms, QoL and fatigue. PTSD symptoms were assessed with the Impact of Event Scale- Revised (IES-R), QoL was measured with Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) and fatigue symptoms were assessed with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). RESULTS A total of 58.54% of the sample developed PTSD symptoms after transplant. Patients with PTSD symptoms reported significantly lower QoL total scores and significantly higher fatigue than those without PTSD symptoms (p < 0.001). The SEM analysis showed that worse QoL and fatigue affected PTSD symptomatology along different pathways. Fatigue was found as a major influencing factor of PTSD symptoms directly (β = 0.31 **), while QoL only through the mediation of fatigue at a lesser extent. (β = 0.33 *). CONCLUSIONS Our findings indicate that QoL is a concurrent causative factor to the development of PTSD symptomatology through the mediating role of fatigue. Innovative interventions before transplantation to prevent PTSD symptoms should be investigated to improve survival and QoL in patients.
Collapse
Affiliation(s)
- Giulia Di Francesco
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Filippo Cieri
- Department of Neurology, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA
| | - Roberto Esposito
- Clinica Diagnostica Titano (Bianalisi), 47891 Falciano, San Marino
- Azienda Sanitaria Territoriale (AST1), 61121 Pesaro, Italy
| | - Pierpaola Sciarra
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Valeria Ballarini
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Mauro Di Ianni
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Stella Santarone
- Bone Marrow Transplant Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| |
Collapse
|
4
|
Felicetti F, Gatti F, Faraci D, Rosso D, Zavattaro M, Fortunati N, Marinelli L, Leone S, Gill J, Dionisi-Vici M, Dellacasa C, Busca A, Giaccone L, Arvat E, Bruno B, Brignardello E. Impact of allogeneic stem cell transplantation on thyroid function. J Endocrinol Invest 2023:10.1007/s40618-023-02039-x. [PMID: 36884196 DOI: 10.1007/s40618-023-02039-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors. METHODS One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated. RESULTS After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%. CONCLUSIONS About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.
Collapse
Affiliation(s)
- F Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy.
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - F Gatti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - D Faraci
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - D Rosso
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - M Zavattaro
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
- Division of Endocrinology, University Hospital "Maggiore della Carità", Novara, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
| | - S Leone
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - J Gill
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - M Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - C Dellacasa
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Busca
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Giaccone
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Arvat
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - B Bruno
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
| |
Collapse
|
5
|
Long-term survivors demonstrate superior quality of life after haploidentical stem cell transplantation to matched sibling donor transplantation. J Transl Med 2022; 20:596. [DOI: 10.1186/s12967-022-03803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
It has been well-documented that haplo-identical hematopoietic stem cell transplantation (HID-HSCT) can provide outcomes comparable to conventional matched sibling donor (MSD) HSCT, however, little is known about the effects on quality of life (QoL) in long-term survivors. This study is to investigate the differences in longitudinal performance of QoL between HID and MSD HSCT using a comprehensive assessment system.
Methods
This prospective study enrolled consecutive patients who had received allogenic-HSCT (allo-HSCT) between January 2018 and December 2019 in our center. All patients were informed to complete QoL questionnaires including the Mos 36-Item Short-Form Health Survey (SF-36) and the Functional Assessment of Cancer Therapy Bone Marrow Transplant (FACT-BMT, version 4), using an online applet, before transplantation and at scheduled time points after transplantation. The linear mixed-effects model was used to analyze the variation trend of different dimensions of both SF-36 and FACT-BMT with different follow-up times.
Results
Of the 425 participants, recipients of HID and MSD who survived more than 1 year (n = 230) were included in the final analysis of QoL (median age [range]: 36, [15, 66]). The 3 year overall survival (OS) of HID and MSD was 82.42% and 86.46%, respectively. QoL was assessed using both SF-36 and FACT-BMT and there was longitudinal recovery with clinical significance in the cohort. Compared to MSD-HSCT patients, HID-HSCT recipients demonstrated superior QoL performance in some subscales describing physical and mental wellness. Specifically, the difference in physical performance is more remarkable using FACT-BMT whereas that in mental wellness is more significant using SF36. In the subsequent stratified analysis, patients with a history of aGVHD or CMV reactivation demonstrated inferior QoL.
Conclusions
Long-term survivors of HID HSCT achieved better QoL in some sub-scales compared to MSD HSCT. In addition, SF-36 and FACT-BMT demonstrated different performance thus combination of both improved capacity of the evaluation system.
Collapse
|
6
|
Karnofsky performance status and visual analogue scale scores are simple indicators for quality of life in long-term AYA survivors who received allogeneic hematopoietic stem cells transplantation in childhood. Int J Hematol 2022; 116:787-797. [PMID: 36056987 DOI: 10.1007/s12185-022-03426-5] [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: 04/02/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to investigate Karnofsky performance status (KPS) scores and visual analogue scale (VAS) scores to explain which domains in the standardized self-reported quality of life (QOL) are instrumental for long-term hematopoietic stem cell transplantation (HSCT) survivors. We conducted a nationwide cross-sectional questionnaire study on 221 survivors with allogeneic-HSCT in 28 pediatric centers. Patient-reported QOL was assessed at a single time point using the 36-item Short-Form Survey (SF-36), the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and VAS scores. KPS scores were significantly correlated with both physical and role component summary scores of the SF-36, while the VAS provided by the patient (VASpt) was significantly correlated with the mental component summary score of the SF-36 and many subscales of the FACT-BMT. The VAS provided by the participants' attending physician (VASdoc) was correlated well with KPS scores. A VASpt score more than 40% lower than KPS scores suggested mental health problems. In conclusion, KPS scores might be considered as an indicator for physical and role/social components and VASpt score as an indicator for mental components and HSCT-specific QOL.
Collapse
|
7
|
The effect of hematopoietic stem cell transplantation on fertility and strategies for improvement. Bone Marrow Transplant 2022; 57:1649-1656. [PMID: 36038764 DOI: 10.1038/s41409-022-01792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/30/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
Ovarian dysfunction is an important consequence of hematopoietic stem cell transplantation (HCT). Premature ovarian failure and infertility can severely impact the quality of life for the increasing number of female long-term survivors of HCT. Here, we review the impact of HCT on ovarian function, post-transplant fertility and birth outcomes, and the contemporaneous strategies to preserve fertility for these patients.
Collapse
|
8
|
Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2022; 57:1150-1163. [PMID: 35523848 DOI: 10.1038/s41409-022-01591-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
Collapse
Affiliation(s)
- Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Burns
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Pinki Prasad
- Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, Department of Pediatrics, New Orleans, LA, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, NC, USA
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Flatau
- Association of Cancer Online Resources, Association of Cancer Online Resources, Austin, TX, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, FL, USA
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, PA, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/ Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John A Snowden
- The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | | |
Collapse
|
9
|
Feasibility of ovarian stimulation for fertility preservation during and after blinatumomab treatment for Ph-negative B-cell acute lymphoblastic leukemia. Int J Hematol 2022; 116:453-458. [DOI: 10.1007/s12185-022-03323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
|
10
|
El-Jawahri A. What else do I need to worry about when treating graft-versus-host disease? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:655-661. [PMID: 34889363 PMCID: PMC8791094 DOI: 10.1182/hematology.2021000302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Graft-versus-host disease (GVHD) is the main cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant survivors. Patients with acute and chronic GVHD often endure substantial symptom burden and quality of life (QOL) and functional impairments. Living with GVHD affects multiple domains of patient-reported QOL, physical functioning, and psychological well-being. Patients describe living with GVHD as a life-altering "full-time job" requiring unique knowledge, personal growth, and resilient coping strategies. Managing the supportive care needs of patients living with GVHD must include (1) monitoring of patient-reported QOL and symptom burden; (2) routine screening for psychological distress and implementing therapeutic strategies to treat depression, anxiety, and posttraumatic stress symptoms; (3) a systematic review of care needs by a multidisciplinary team experienced in managing transplant-related complications and organ-specific GVHD symptoms; and (4) ensuring optimal prevention and management of infection complications in this highly immunocompromised population. Improving the QOL in patients with GVHD requires a multidisciplinary approach with emphasis on aggressive symptom management, psychological coping, and promoting physical activity and rehabilitation in this population living with immense prognostic uncertainty and struggling to adapt to this difficult and unpredictable illness.
Collapse
Affiliation(s)
- Areej El-Jawahri
- Correspondence Areej El-Jawahri, Hematology-Oncology, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA 02114; e-mail:
| |
Collapse
|
11
|
Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Transplant Cell Ther 2021; 28:335.e1-335.e17. [PMID: 34757220 DOI: 10.1016/j.jtct.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. OBJECTIVE Here, we provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. STUDY DESIGN We utilized systematic review methodology to summarize incidence, risk factors, screening, prevention and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research. RESULTS Most of the evidence regarding male GvHD is still based on limited data, precluding strong therapeutic recommendations. We therefore recommend to systematically screen for male genital GvHD regularly and report it to large registries to allow for a better understanding. Future research should also address treatment since little published evidence is available to date. Male-specific endocrine consequences of HCT include hypogonadism which may also affect bone health. Since the evidence is scarce, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, which warrants offering sperm preservation in all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, hence the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent than in the general population; however, subsequent malignancies in general seem to be more prevalent in males than females, and special attention should be given to skin and oral mucosa. CONCLUSION Male-specific late effects, probably more under-reported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplant physicians and specialists from other involved disciplines. Future research should be directed towards better data collection on male-specific late effects and on studies about the interrelationship between these late effects, to allow the development of evidence based effective management practices.
Collapse
|
12
|
Stolze J, Boor M, Hazenberg MD, Brand HS, Raber-Durlacher JE, Laheij AMGA. Oral health-related quality of life of patients with oral chronic graft-versus-host disease. Support Care Cancer 2021; 29:6353-6360. [PMID: 33884507 PMCID: PMC8464572 DOI: 10.1007/s00520-021-06197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/01/2021] [Indexed: 12/26/2022]
Abstract
Purpose Symptoms of oral chronic graft-versus-host-disease (cGVHD) may significantly affect the oral health–related quality of life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD and to examine whether oral cGVHD symptoms, mucosal cGVHD, and salivary gland function correlated with OHRQoL. Methods Patients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms, and OHRQoL was assessed by the NIH OMS, NIH OSS, and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined and categorized into “hyposalivation,” “normal salivary flow,” and “hypersalivation.” Results Of 56 included patients, 80% had mild, moderate, or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow, and hypersalivation reported equal levels of OHRQoL. Conclusion Results demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL.
Collapse
Affiliation(s)
- Juliette Stolze
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
- Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marlou Boor
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
| | - Mette D Hazenberg
- Department of Hematology Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands
- Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, The Netherlands.
- Department of Preventive Dentistry, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
13
|
Wolff D, Herzberg PY, Herrmann A, Pavletic SZ, Heussner P, Mumm F, Höfer C, Hilgendorf I, Hemmati PG, Holler E, Greinix H, Mitchell SA. Post-transplant multimorbidity index and quality of life in patients with chronic graft-versus-host disease-results from a joint evaluation of a prospective German multicenter validation trial and a cohort from the National Institutes of Health. Bone Marrow Transplant 2020; 56:243-256. [PMID: 32737446 PMCID: PMC8376641 DOI: 10.1038/s41409-020-01017-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022]
Abstract
Comorbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT) impairs quality of life (QoL), physical functioning, and survival. We developed a new standardized measure to capture comorbidity after transplantation, the Post-transplant Multimorbidity Index (PTMI) in a cohort of 50 long term survivors. We subsequently evaluated the content validity and impact on survival and QoL within a multicenter trial, including 208 patients (pts) after alloHSCT, who were prospectively evaluated applying the FACT-BMT, the Human Activity Profile (HAP), the SF-36 v.2, PTMI and the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). The most prevalent comorbidities were compensated arterial hypertension (28.4%), ambulatory infections (25.5%), iron overload (23%), mild renal function impairment (20%), and osteoporosis (13%). Applying the PTMI 13% of patients had no comorbidity, while 37.1% had 1–3 comorbidities, 27.4% had 4–6 comorbidities, and 13.5% had > 6 comorbidities. Chronic graft-versus-host disease (cGvHD) was significantly associated with the PTMI, while age and prior acute GvHD were not. In contrast, the HCT-CI was not associated with the presence of cGvHD. cGvHD was significantly associated with depression (r = 0.16), neurological disease (r = 0.21), osteoporosis (r = 0.18) and nonmelanoma skin cancer (r = 0.26). The PTMI demonstrated strong measurement properties and compared to the HCT-CI captured a wider range of comorbidities associated with cGvHD.
Collapse
Affiliation(s)
- Daniel Wolff
- Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany.
| | - Philipp Y Herzberg
- Faculty of Humanities and Social Sciences, Personality Psychology and Psychological Assessment, Helmut Schmidt University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Anne Herrmann
- Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany
| | - Steven Z Pavletic
- Immune Deficiency Cellular Therapy Program, Center of Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Pia Heussner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Friederike Mumm
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christina Höfer
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Philipp G Hemmati
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow Klinikum Charité-University Hospital Berlin, Berlin, Germany
| | - Ernst Holler
- Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany
| | | | - Sandra A Mitchell
- Outcomes Research Branch, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
14
|
Lung transplantation for graft-versus-host disease after allogeneic stem cell transplantation: A report of two cases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:543-546. [PMID: 32953221 DOI: 10.5606/tgkdc.dergisi.2020.19009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
Allogeneic peripheral stem cell transplantation is an effective treatment of malignant and non-malignant hematological diseases. However, it is associated with several complications, such as graft-versus-host disease, and also various complications involving different organ systems. Late-onset non-infectious lung complication is one of them. This pathology may also affect the different anatomical regions in the lung as parenchymas, bronchi, or vessels and may manifest with different clinical presentations. Lung transplantation can be an effective treatment in patients with pulmonary complications after allogeneic stem cell transplantation and also in patients who do not respond to treatment adequately and with a limited life expectancy. Herein, we report two rare cases who underwent lung transplantation after allogeneic stem cell transplantation.
Collapse
|
15
|
Bourlon C, Riviello-Goya S, Acosta-Medina AA, Caballero-Landinez RE, Manrique-Rubio A, Teran-De-la-Sancha K, Gulias-Herrero A, Bourlon MT. Outcomes and Challenges of Reproductive Health in Hematopoietic Stem Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:2127-2131. [PMID: 32659435 DOI: 10.1016/j.bbmt.2020.07.007] [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: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022]
Abstract
Long-term therapy-related reproductive health side effects impact the quality of life of hematopoietic stem cell transplantation (HSCT) survivors. In this study, we evaluated the prevalence of gonadal dysfunction (GD) pre- and post-HSCT, analyzed factors associated with GD, and explored rates of fertility assessment (FA) and fertility preservation (FP) in a resource-limited setting. FA and outcomes of patients age ≤45 years undergoing HSCT between June 2000 and May 2018 were collected retrospectively. We included 213 patients with a median age of 26 years. Pre-HSCT FA was performed in 71.8%, with a GD rate of 17%. The rate of GD was not different between the sexes (females, 19.5% versus males, 16.1%; P = .616) and was only associated with increasing age. The rate of cryopreservation in the cohort was 3.3%. Almost one-half (47.7%) of post-HSCT patients completed FA and evidenced an increase in GD rate to 48.9%. Comparing pre-HSCT and post-HSCT GD rates, women had a significant increase (19.5% versus 81.4%; P < .001), whereas men did not (16.1% versus 20.4%; P = .76). These results were confirmed by a multiple imputation analysis accounting for missing data. Female sex, pre-HSCT cytotoxic therapy, myeloablative conditioning, and germ cell tumor (GCT) diagnosis were associated with post-HSCT GD. Reproductive health preservation can be positively impacted when FA and FP are prioritized at the initial diagnosis in HSCT candidates, particularly in women of older age and men with a diagnosis of GCT. The low FP success observed urges implementation of strategies that favor accessibility and improve quality of life of HSCT survivors in low- and middle-income countries.
Collapse
Affiliation(s)
- Christianne Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Santiago Riviello-Goya
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aldo A Acosta-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosa E Caballero-Landinez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Alfonso Gulias-Herrero
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria T Bourlon
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
16
|
Randomized controlled study of ECP with methoxsalen as first-line treatment of patients with moderate to severe cGVHD. Blood Adv 2020; 3:2218-2229. [PMID: 31332045 DOI: 10.1182/bloodadvances.2019000145] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022] Open
Abstract
The investigation of extracorporeal photopheresis (ECP) plus standard of care (SoC) (SoC+ECP) in chronic graft-versus-host disease (cGVHD) within prospective, randomized clinical studies is limited, despite its frequent clinical use. This phase 1/pilot study was the first randomized, prospective study to investigate ECP use as first-line therapy in cGVHD, based on the 2015 National Institutes of Health (NIH) consensus criteria for diagnosis and response assessment. Adult patients with new-onset (≤3 years of hematopoietic stem cell transplantation) moderate or severe cGVHD were randomized 1:1 to 26 weeks of SoC+ECP vs SoC (corticosteroids and cyclosporine A/tacrolimus) between 2011 and 2015. The primary endpoint was overall response rate (ORR), defined as complete or partial response, at week 28 in the intention-to-treat population (ITT). Other outcomes included quality of life (QoL) measures and safety. Sixty patients were randomized; ITT included 53 patients (SoC+ECP: 29; SoC: 24). Week 28 ORR was 74.1% (SoC+ECP) and 60.9% (SoC). Investigator-assessed ORR was 56.0% (SoC+ECP) and 66.7% (SoC). Patients treated with SoC experienced a decline in QoL over the 28-week study period; QoL remained unchanged in SoC+ECP patients. Most frequent treatment-emergent adverse events (TEAEs) in SoC+ECP patients were hypertension (31.0%), cough (20.7%), dyspnea (17.2%), and fatigue (17.2%). Seventeen patients (SoC+ECP: 8; SoC: 9) experienced 35 serious adverse events (SAEs). No TEAEs or SAEs were considered related to the ECP instrument or methoxsalen. The encouraging short-term results of this study could inform the design of subsequent studies. This trial was registered at www.clinicaltrials.gov as #NCT01380535.
Collapse
|
17
|
Liu L, Zhang Y, Jiao W, Zhou H, Wang Q, Jin S, Cai Y, Zhao L, Shangguan X, Liu Z, Xu J, Lei M, Yan X, Miao M, Wu D. Comparison of efficacy and health-related quality of life of first-line haploidentical hematopoietic stem cell transplantation with unrelated cord blood infusion and first-line immunosuppressive therapy for acquired severe aplastic anemia. Leukemia 2020; 34:3359-3369. [PMID: 32591644 DOI: 10.1038/s41375-020-0933-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
We retrospectively compared the efficacy and health-related quality of life (HRQoL) of (1) first-line haploidentical hematopoietic stem cell transplantation (haplo-HSCT, n = 146) combined with unrelated cord blood (UCB) infusion and (2) first-line immunosuppressive therapy (IST, n = 219) in acquired severe aplastic anemia (SAA) patients. At 6 months post treatment, 90.30% patients in the haplo-HSCT group and 18.78% patients in the IST group achieved normal blood routine (P < 0.0001). The time required to discontinue red blood cells and platelets transfusion in the IST group were longer than in the haplo-HSCT group (P < 0.0001). The estimated overall survival at 4 years was similar (80.1 ± 3.5% vs. 80.1 ± 3.0%, P = 0.726); the estimated failure-free survival (FFS) at 4 years was 77.8 ± 3.7% in the haplo-HSCT group and 48.0 ± 3.6% in the IST group (P < 0.0001). Patients treated with haplo-HSCT scored significantly better in the HRQoL than treated with IST (P < 0.0001). In the multivariate analysis, first-line haplo-HSCT was the favorable factor for FFS and HRQoL (P < 0.0001). These results suggest that first-line haplo-HSCT combined with UCB infusion might provide a better chance of success and HRQoL than first-line IST for SAA patients.
Collapse
Affiliation(s)
- Limin Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Yanming Zhang
- Department of Hematology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
| | - Wenjing Jiao
- Department of Hematology, Xian Yang Central Hospital, Xianyang, Shanxi Province, China
| | - Huifen Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Qingyuan Wang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Song Jin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China
| | - Yifeng Cai
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Liyun Zhao
- Department of Hematology, People Hospital of Xingtai, Xingtai, Hebei Province, China
| | - Xiaohui Shangguan
- Department of Hematology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian Province, China
| | - Zefa Liu
- Department of Hematology, People Hospital of Xinghua, Xinghua, Jiangsu Province, China
| | - Jinge Xu
- The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Meiqing Lei
- Department of Hematology in Haikou Municipal People's Hospital, Affiliated Haikou Hospital Xiangya School of Medicine Central South University, Haikou, Hainan Province, China
| | - Xiaoyun Yan
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Miao Miao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China.
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, China.
| |
Collapse
|
18
|
Outcomes of haploidentical vs matched sibling transplantation for acute myeloid leukemia in first complete remission. Blood Adv 2020; 3:1826-1836. [PMID: 31201170 DOI: 10.1182/bloodadvances.2019000050] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 11/20/2022] Open
Abstract
HLA-haploidentical hematopoietic cell transplantation (Haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) has improved donor availability. However, a matched sibling donor (MSD) is still considered the optimal donor. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes after Haplo-HCT vs MSD in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Data from 1205 adult CR1 AML patients (2008-2015) were analyzed. A total of 336 patients underwent PT-Cy-based Haplo-HCT and 869 underwent MSD using calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis. The Haplo-HCT group included more reduced-intensity conditioning (65% vs 30%) and bone marrow grafts (62% vs 7%), consistent with current practice. In multivariable analysis, Haplo-HCT and MSD groups were not different with regard to overall survival (P = .15), leukemia-free survival (P = .50), nonrelapse mortality (P = .16), relapse (P = .90), or grade II-IV acute GVHD (P = .98). However, the Haplo-HCT group had a significantly lower rate of chronic GVHD (hazard ratio, 0.38; 95% confidence interval, 0.30-0.48; P < .001). Results of subgroup analyses by conditioning intensity and graft source suggested that the reduced incidence of chronic GVHD in Haplo-HCT is not limited to a specific graft source or conditioning intensity. Center effect and minimal residual disease-donor type interaction were not predictors of outcome. Our results indicate a lower rate of chronic GVHD after PT-Cy-based Haplo-HCT vs MSD using calcineurin inhibitor-based GVHD prophylaxis, but similar other outcomes, in patients with AML in CR1. Haplo-HCT is a viable alternative to MSD in these patients.
Collapse
|
19
|
Fatigue predicts impaired social adjustment in survivors of allogeneic hematopoietic cell transplantation (HCT). Support Care Cancer 2018; 27:1355-1363. [PMID: 30136024 DOI: 10.1007/s00520-018-4411-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study is to examine social adjustment to illness and to identify factors related to social adjustment in allogeneic hematopoietic cell transplantation (HCT) survivors. METHODS Cross-sectional data were drawn from a longitudinal study of patients ≥ 3 years after their first HCT. The five subscales of the Psychosocial Adjustment to Illness Scale (PAIS) that reflect social adjustment, specifically vocational environment (VE); domestic environment (DE); sexual relationships (SEX); extended family relationships (ER); and social environment (SE) were examined in this analysis. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measured cancer-related fatigue. RESULTS Subjects (N = 171) were a median of 5.19 years from HCT (range 3-16). The most impaired dimension of social adjustment was ER with 38% of participants reaching clinically relevant (score ≥ 62) levels of social maladjustment. Unmarried and unemployed participants had lower levels of social adjustment in VE (p < .001 and p < .001, respectively) and DE (p = .004 and p = .006, respectively). Survivors with some college had poorer SEX adjustment than those with less or more education (p < .005). Hispanics reported lower adjustment with respect to ER adjustment (p = .002). Participants with higher fatigue had poorer adjustment in all five dimensions (p < .001). CONCLUSIONS Although the majority of survivors are well adjusted, subgroups may experience significant poor social adjustment. Specifically, survivors with fatigue are at risk to experience lower levels of social adjustment. Development of effective rehabilitation strategies to improve affected areas of social health is warranted, and all HCT survivors should be screened periodically for social maladjustment and provided with resources and referrals.
Collapse
|
20
|
Lipof JJ, Loh KP, O'Dwyer K, Liesveld JL. Allogeneic Hematopoietic Cell Transplantation for Older Adults with Acute Myeloid Leukemia. Cancers (Basel) 2018; 10:cancers10060179. [PMID: 29866998 PMCID: PMC6025016 DOI: 10.3390/cancers10060179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia (AML) is a disease that affects adults aged 65 years and above, and survival in this population is poor. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for these patients but is underutilized due to frequent comorbidities and perceived higher risk of treatment-related mortality and non-relapse mortality. Increasing data supports the utility of allo-HCT in fit older patients after intensive chemotherapy resulting in improvement of outcomes. With the development of reduced intensity and non-myeloablative conditioning regimens that are associated with lower rates of treatment-related toxicity and mortality, this has allowed more older patients with AML to receive allo-HCT. In this review, we provide some guidance on appropriate selection of older patients as transplant candidates, benefits and risks associated with allo-HCT, conditioning regimen choice, and stem cell transplant sources as they relate to the conduct of stem cell transplantation in older patients.
Collapse
Affiliation(s)
- Jodi J Lipof
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Kristen O'Dwyer
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Jane L Liesveld
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| |
Collapse
|
21
|
Stickney Ferguson S, Randall J, Dabney J, Kalbacker ME, Boyle N, Thao V, Murphy EA, Denzen EM. Perceived Workforce Challenges among Clinical Social Workers in Hematopoietic Cell Transplantation Programs. Biol Blood Marrow Transplant 2017; 24:1063-1068. [PMID: 29288820 DOI: 10.1016/j.bbmt.2017.12.793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
Abstract
Clinical social workers are psychosocial care experts who provide interventions that aim to address the emotional, relational, financial, and logistical challenges that arise throughout the hematopoietic cell transplantation (HCT) treatment and recovery process. Interventions that contribute to better patient outcomes can include cognitive behavioral therapy and counseling for adaptation to illness, family planning for 24/7 caregiver availability and strategies to support patient activities of daily living, instruction on guided imagery and relaxation techniques for symptom management and to decrease anxiety, psychoeducation on the treatment trajectory, and linkage with financial resources. A Social Work Workforce Group (SWG) was established through the System Capacity Initiative, led by the National Marrow Donor Program/Be The Match, to characterize the current social work workforce capacity and challenges. The SWG conducted a web-based survey of HCT clinical social workers in the United States. The response rate was 57% (n = 90), representing 76 transplant centers. Survey results indicated that the clinical social worker role and scope of practice varies significantly between centers; less than half of respondents reported that their clinical social work expertise was used to its fullest potential. With an estimated 3-fold increase in HCT patient volume by 2020, the need for specialized psychosocial health services will increase. The SWG makes recommendations to build capacity for the psychosocial care of HCT patients and to more fully integrate the social worker as a core member of the HCT team. The SWG created a Blood and Marrow Transplant (BMT) Clinical Social Worker role description that can be used by transplant centers to educate healthcare professionals, benchmark utilization of clinical social workers, and improve comprehensive psychosocial health programs.
Collapse
Affiliation(s)
- Stacy Stickney Ferguson
- Patient and Health Professional Services, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Jill Randall
- Kent School of Social Work, University of Louisville, Louisville, Kentucky
| | - Jane Dabney
- The Blood and Marrow Transplant Program, Taussig Cancer Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Marion E Kalbacker
- Pediatric Blood and Marrow Transplant Program, Duke University Medical Center, Durham, North Carolina
| | - Nancy Boyle
- Center for Hematologic Malignancy, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Viengneesee Thao
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth A Murphy
- Patient and Health Professional Services, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ellen M Denzen
- Patient and Health Professional Services, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| |
Collapse
|
22
|
O'Sullivan ML, Shelby RA, Dorfman CS, Kelleher SA, Fisher HM, Rowe Nichols KA, Keefe FJ, Sung AD, Somers TJ. The effect of pre-transplant pain and chronic disease self-efficacy on quality of life domains in the year following hematopoietic stem cell transplantation. Support Care Cancer 2017; 26:1243-1252. [PMID: 29124418 DOI: 10.1007/s00520-017-3947-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Pain is common for hematopoietic stem cell transplant (HSCT) patients and may be experienced pre-transplant, acutely post-transplant, and for months or years following transplant. HSCT patients with persistent pain may be at risk for poor quality of life following transplant; however, the impact of pre-transplant pain on quality of life post-transplant is not well understood. Self-efficacy for chronic disease management is associated with quality of life among cancer patients and may impact quality of life for HSCT patients. The primary aim was to examine the effect of pre-transplant pain and self-efficacy on quality of life domains in the year following transplant. METHODS One hundred sixty-six HSCT patients completed questionnaires providing information on pain, self-efficacy, and quality of life prior to transplant, at discharge, and 3-, 6-, and 12-months post-transplant as part of a longitudinal, observational study. Linear mixed modeling examined the trajectories of these variables and the effect of pre-transplant pain and self-efficacy on post-transplant quality of life. RESULTS Pain and social and emotional quality of life remained stable in the year following transplant while self-efficacy and physical and functional quality of life improved. Pre-transplant pain was significantly related to lower physical well-being post-transplant. Lower pre-transplant self-efficacy was related to lower quality of life across all domains post-transplant. CONCLUSION Above and beyond the effect of pre-transplant pain, self-efficacy for managing chronic disease is important in understanding quality of life following transplant. Identifying patients with pain and/or low self-efficacy pre-transplant may allow for early intervention with self-management strategies.
Collapse
Affiliation(s)
- Madeline L O'Sullivan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Hannah M Fisher
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, USA
| | - Krista A Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, 2400 Pratt St., Suite 9000, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, 2400 Pratt St., Suite 9000, Durham, NC, 27710, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main St., Suite 340, Durham, NC, 27705, USA.
| |
Collapse
|
23
|
Cima LN, Colita A, Fica S. Perspectives on the co-treatment with GnRHa in female patients undergoing hematopoietic stem cell transplantation. Endocr Connect 2017; 6:R162-R170. [PMID: 28947558 PMCID: PMC5655684 DOI: 10.1530/ec-17-0246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 11/08/2022]
Abstract
Outcomes after hematopoietic stem cell transplantation (HSCT) for patients with both malignant and nonmalignant diseases have improved significantly in recent years. However, the endocrine system is highly susceptible to damage by the high-dose chemotherapy and/or irradiation used in the conditioning regimen before HSCT. Ovarian failure and subsequent infertility are frequent complications that long-term HSCT survivors and their partners face with a negative impact on their QoL. Several meta-analyses of randomized clinical trials showed that gonadotropin-releasing hormone agonist (GnRHa) administration in advance of starting standard chemotherapy decreases the risk of gonadal dysfunction and infertility in cancer patients, but GnRHa use for ovarian protection in HSCT patients is not fully determined. In this review, we are discussing the potential preservation of ovarian function and fertility in pubertal girls/premenopausal women who undergo HSCT using GnRHa in parallel with conditioning chemotherapy, focusing on the current data available and making some special remarks regarding the use of GnRHa.
Collapse
Affiliation(s)
| | - Anca Colita
- Carol Davila University of Medicine and PharmacyBucharest, Romania
- Hematology DepartmentFundeni Hospital, Bucharest, Romania
| | - Simona Fica
- Carol Davila University of Medicine and PharmacyBucharest, Romania
- Endocrine DepartmentElias Hospital, Bucharest, Romania
| |
Collapse
|
24
|
Abstract
Sexual dysfunction is a common concern for many patients with cancer after treatment. Hormonal changes as a result of cancer-directed therapy can affect both male and female sexual health. This has the potential to significantly impact patients' quality of life, but is underreported and undertreated in the oncology setting. This review discusses commonly reported sexual issues and the role that hormonal changes play in this dysfunction. Although medical and psychosocial intervention strategies exist, there is a clear need for further research to formally develop programming that can assist people whose sexual health has been impacted by cancer treatment.
Collapse
Affiliation(s)
- Eric S Zhou
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Natasha N Frederick
- Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Sharon L Bober
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Sexual Health Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| |
Collapse
|
25
|
Slováček L, Slováčková B, Jebavý L, Pavlík V. Quality of Life in Adult Patients Treated with Peripheral Blood Progenitor Cell Transplantation: the Effect of Selected Psychosocial, Demographics and Health Aspects on Quality of Life: a Retrospective Analysis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017. [DOI: 10.14712/18059694.2017.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aim: this retrospective study analyses the effect of selected psychosocial, demographics and health aspects on quality of life (QoL) in adult patients treated with peripheral blood progenitor cell transplantation (PBPCT). Patients and Methods: The total number of respondents treated with PBPCT between the years 2001–2003 was 95. The return rate of QoL questionnaires was 72.1 % (71 respondents). There were 100 % ratable QoL questionnaire. The average age of all respondents was 55.5 years old. The Czech version of an international generic European Quality of Life Questionnaire – Version EQ-5D was used. The effect of selected aspects on QoL of patients was determined by analysis of variance. The QoL questionnaires were evaluated with descriptive analysis. Results: The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score – QoL dimensions, EQ-5D VAS – subjective health condition) on age, increasing number of associated diseases, religion and type of disease. The effect of other aspects on QoL was not proven statistically significant. The QoL in adult patients treated with PBPCT declines with increasing age and with the increasing number of associated diseases. People of faith have a higher level of QoL than non-believers. Patients with multiple myeloma treated with PBPCT have the most low QoL. Conclusion: The global QoL in an adult patients treated with PBPCT is on a good level.
Collapse
|
26
|
Solomon SR, Sizemore C, Zhang X, Ridgeway M, Solh M, Morris LE, Holland HK, Bashey A. Current Graft-versus-Host Disease–Free, Relapse-Free Survival: A Dynamic Endpoint to Better Define Efficacy after Allogenic Transplant. Biol Blood Marrow Transplant 2017; 23:1208-1214. [DOI: 10.1016/j.bbmt.2017.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
|
27
|
PROSE Treatment for Ocular Chronic Graft-Versus-Host Disease as a Clinical Network Expands. Eye Contact Lens 2017; 42:262-6. [PMID: 26448446 DOI: 10.1097/icl.0000000000000186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Keratoconjunctivitis sicca occurs in 40% to 90% of patients with ocular chronic graft-versus-host disease (cGVHD). Ocular symptoms can have profound effects in both the visual function and quality of life of patients with GVHD. We report the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in patients with cGVHD as a clinical network expands. METHODS We queried the BostonSight PROSE manufacturing database from January 2002 to December 2011. Patients treated for ocular cGVHD were reported by age, gender, year, and network site where the treatment was undertaken. The baseline and six-month follow-up scores of visual function using a standardized validated instrument, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), were evaluated for a period in 2006 and again in 2010 after network expansion had occurred. RESULTS A total of 407 patients with a male:female ratio of 226:181, mean age was 51 years with ocular cGVHD underwent PROSE treatment from January 2002 to December 2011. By 2011, 67% of all cases were treated at network clinics. Baseline characteristics of patients treated throughout the network in 2010 were similar to that of 2006 and 2010 cohorts from the main center. There was a significant improvement of 41 points (P<0.001) in composite NEI VFQ score among patients treated across the network in 2010, similar to the improvement of 30 points (P<0.001) seen among the patients treated at the main center in 2010. There was a trend toward lower baseline self-reported general health status (SRGHS) and VFQ scores among patients treated at network clinics, suggesting that expansion of the network allows treatment of sicker patients (lower general health status) or those more severely affected by ocular cGVHD. CONCLUSIONS PROSE treatment of ocular cGVHD has increased in the last decade with the establishment of BostonSight network clinics across the United States. Patients treated at network clinics showed similar levels of baseline visual function and SRGHS, and achieved a similar high level of improvement in visual function as those treated at the main center. Patient-reported measures of functional status are useful in evaluating treatment options for patients with cGVHD. PROSE treatment has significant positive impact on the visual function of patients with ocular cGVHD regardless of whether the patient is treated at the main center or at a network site.
Collapse
|
28
|
Inamoto Y, Lee SJ. Late effects of blood and marrow transplantation. Haematologica 2017; 102:614-625. [PMID: 28232372 PMCID: PMC5395102 DOI: 10.3324/haematol.2016.150250] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
Hematopoietic cell transplantation is a curative treatment for a variety of hematologic diseases. Advances in transplantation technology have reduced early transplant-related mortality and expanded application of transplantation to older patients and to a wider variety of diseases. Management of late effects after transplantation is increasingly important for a growing number of long-term survivors that is estimated to be half a million worldwide. Many studies have shown that transplant survivors suffer from significant late effects that adversely affect morbidity, mortality, working status and quality of life. Late effects include diseases of the cardiovascular, pulmonary, and endocrine systems, dysfunction of the thyroid gland, gonads, liver and kidneys, infertility, iron overload, bone diseases, infection, solid cancer, and neuropsychological effects. The leading causes of late mortality include recurrent malignancy, lung diseases, infection, secondary cancers and chronic graft-versus-host disease. The aim of this review is to facilitate better care of adult transplant survivors by summarizing accumulated evidence, new insights, and practical information about individual late effects. Further research is needed to understand the biology of late effects allowing better prevention and treatment strategies to be developed.
Collapse
Affiliation(s)
- Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
29
|
Decision analysis of allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome stratified according to the revised International Prognostic Scoring System. Leukemia 2017; 31:2449-2457. [PMID: 28321120 DOI: 10.1038/leu.2017.88] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/03/2017] [Accepted: 03/03/2017] [Indexed: 12/14/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Crucial questions in clinical decision-making include the definition of optimal timing of the procedure and the benefit of cytoreduction before transplant in high-risk patients. We carried out a decision analysis on 1728 MDS who received supportive care, transplantation or hypomethylating agents (HMAs). Risk assessment was based on the revised International Prognostic Scoring System (IPSS-R). We used a continuous-time multistate Markov model to describe the natural history of disease and evaluate the effect of different treatment policies on survival. Life expectancy increased when transplantation was delayed from the initial stages to intermediate IPSS-R risk (gain-of-life expectancy 5.3, 4.7 and 2.8 years for patients aged ⩽55, 60 and 65 years, respectively), and then decreased for higher risks. Modeling decision analysis on IPSS-R versus original IPSS changed transplantation policy in 29% of patients, resulting in a 2-year gain in life expectancy. In advanced stages, HMAs given before transplant is associated with a 2-year gain-of-life expectancy, especially in older patients. These results provide a preliminary evidence to maximize the effectiveness of allo-SCT in MDS.
Collapse
|
30
|
Perić Z, Desnica L, Duraković N, Ostojić A, Pulanić D, Serventi-Seiwerth R, Prenc E, Basak G, Vrhovac R, Pavletic SZ, Nemet D. Which questionnaires should we use to evaluate quality of life in patients with chronic graft-vs-host disease? Croat Med J 2016; 57:6-15. [PMID: 26935610 PMCID: PMC4800326 DOI: 10.3325/cmj.2016.57.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim To investigate the ability of two standard quality of life (QOL) questionnaires – The Short Form (36-item) Health Survey (SF-36) and The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ C30) to evaluate QOL in patients with chronic graft-vs-host disease (cGVHD) graded according to National Institutes of Health (NIH) consensus criteria. Methods In this cross-sectional study, QOL was assessed in patients who underwent allogeneic stem cell transplantation (allo-SCT) at the University Hospital Centre Zagreb and were alive and in complete remission for more than one year after allo-SCT. Results The study included 58 patients, 38 patients with cGVHD and 20 controls, patients without cGVHD. Patients with cGVHD scored according to the NIH criteria had significantly lower scores of global health status and lower QOL on all SF-36 subscales and most of QLQ C30 functional subscales (P < 0.050 for all comparisons). Furthermore, patients with active cGVHD had significantly lower QOL scores than patients with inactive cGVHD, and this difference was most evident in physical functioning subscale of SF-36 (P = 0.0007) and social functioning subscale of QLQ C30 (P = 0.009). Conclusion cGVHD scored according to the NIH criteria is correlated with patient-reported QOL, particularly in the physical domains as detected by SF-36. QLQ C30 questionnaire adds more information on social functioning and should be used as a valuable tool in the evaluation of social domains in cGVHD patients.
Collapse
Affiliation(s)
- Zinaida Perić
- Zinaida Perić, Department of Internal Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ditz D, Rabanus R, Schulz C, Wolff D, Holler B, Holler E, Hildebrandt GC. The lung function score and its components as predictors of overall survival and chronic graft-vs-host disease after allogeneic stem cell transplantation. Croat Med J 2016; 57:16-28. [PMID: 26935611 PMCID: PMC4800331 DOI: 10.3325/cmj.2016.57.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim To retrospectively assess if the modified lung function score (LFS) and/or its components, forced expiratory volume within the first second (FEV1) and diffusion capacity for carbon monoxide corrected for hemoglobin level (cDLCO), predict overall survival (OS) and chronic graft-vs-host-disease (cGvHD). Methods We evaluated 241 patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the University of Regensburg Transplant Center between June 1998 and July 2005 in relation to their LFS, FEV1 and cDLCO, before and after HSCT. Results Decreased OS after allo-HSCT was related to decreased pre-transplantation values of FEV1<60% (P = 0.040), cDLCO<50% of predicted value (P = 0.025), and LFS≥III (P = 0.037). It was also related to decreased FEV1 at 3 and 12 months after HSCT (P < 0.001 and P = 0.001, respectively) and increased LFS at 3 and 12 months after HSCT (P = 0.028 and P = 0.002, respectively), but not to changes of cDLCO. A higher incidence of cGvHD was related to decreased FEV1 at 6, 12, and 18 months (P = 0.069, P = 0.054, and P = 0.009, respectively) and increased LFS at 12 months (P = 0.002), but not to changes in cDLCO. Conclusions OS was related to both LFS and FEV1, but cGvHD had a stronger relation to FEV1 than to cDLCO or LFS. FEV1 alone offered more information on the outcome after allo-HSCT than LFS or cDLCO, suggesting limited value of LFS for the patients’ assessment after allo-HSCT.
Collapse
Affiliation(s)
- Diana Ditz
- Diana Ditz, Department of Internal Medicine III, University of Regensburg Medical Center, Franz-Josef-Strauss Allee 11, D-93053 Regensburg, Germany,
| | | | | | | | | | | | | |
Collapse
|
32
|
Nuss SL, Wilson ME. Health-Related Quality of Life Following Hematopoietic Stem Cell Transplant During Childhood. J Pediatr Oncol Nurs 2016; 24:106-15. [PMID: 17332424 DOI: 10.1177/1043454206296033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to examine the self-reported and parent-reported health-related quality of life (HRQoL) of children (age < 19 years) who received a hematopoietic (bone marrow, cord blood, or peripheral blood) stem cell transplant (SCT) at the University of Nebraska Medical Center (UNMC). A total of 35 families participated: 31 SCT recipients, 35 mothers, and 28 fathers. Mean scores were 73.6 child, 71.2 mothers, and 76.2 fathers (range of 0-100, with high scores indicating better HRQoL). No significant overall HRQoL difference between parent and child were reported. Mothers reported significantly lower physical functioning (F 2,23 = 3.509, P = .041) compared to child (P = .041) and fathers (P = .025). Older age at time of transplant was associated with higher procedural anxiety according to child (r = .498, P = .005) and mothers (r = .466, P = .008). Older age at time of transplant was associated with less worry according to fathers (r = -.589, P = .002). Overall, SCT recipients and their parents report moderately high HRQoL.
Collapse
|
33
|
Chiodi S, Spinelli S, Bruzzi P, Anserini P, Di Grazia C, Bacigalupo A. Menstrual patterns, fertility and main pregnancy outcomes after allogeneic haematopoietic stem cell transplantation. J OBSTET GYNAECOL 2016; 36:783-788. [PMID: 27153290 DOI: 10.3109/01443615.2016.1154508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Two-hundred and sixty-nine females aged ≤42 and undergoing an allogeneic stem cell transplant were retrospectively studied to assess the effect of age, conditioning regimen and chronic graft-versus-host disease (cGVHD) on resumption of stable menstrual cyclicity. Overall, a stable menstrual cyclicity was observed in 22% of cases. The cumulative probability of menses resumption was significantly age and conditioning regimen related. A statistically significant inverse correlation between cGVHD severity and menses resumption was observed only in univariate analysis. In patients with residual ovarian function, infertility was found in 43% and early menopause in 45%. An increased incidence of prematurity and low birth weight (LBW) was observed among the single spontaneous pregnancies. Follicle-stimulating hormone (FSH) and 17 beta-oestradiol levels were found to be inadequate to detect both early signs of menses resumption and menstrual stability. Our study confirms the crucial role of full dose total body irradiation (TBI) and age on menses recovery and fertility after haematopoietic stem cell transplantation (HSCT). The impact of severe cGVHD remains unclear.
Collapse
Affiliation(s)
- Sandra Chiodi
- a Hematology Department , IRCCS San Martino-IST , Genoa, Italy
| | | | - Paolo Bruzzi
- b Clinical Epidemiology, IRCCS San Martino-IST , Genoa, Italy , and
| | - Paola Anserini
- c Physiopathology of Reproduction Unit, IRCCS San Martino-IST , Genoa , Italy
| | | | | |
Collapse
|
34
|
Konuma T, Kato S, Oiwa-Monna M, Ishii H, Tojo A, Takahashi S. Comparison of graft-versus-host disease-free, relapse-free survival of transplantation using matched sibling donor, matched unrelated donor or unrelated cord blood after myeloablative conditioning for adult patients with hematological malignancies. Leuk Lymphoma 2016; 57:2126-32. [DOI: 10.3109/10428194.2015.1122784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
Fiuza-Luces C, Simpson RJ, Ramírez M, Lucia A, Berger NA. Physical function and quality of life in patients with chronic GvHD: a summary of preclinical and clinical studies and a call for exercise intervention trials in patients. Bone Marrow Transplant 2015; 51:13-26. [PMID: 26367233 DOI: 10.1038/bmt.2015.195] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/23/2015] [Accepted: 07/15/2015] [Indexed: 01/12/2023]
Abstract
Allogeneic hematopoietic stem cell transplant, to reconstitute the hematopoietic and immune status of patients undergoing myeloablative therapy for hematologic disorders, has been of great benefit in minimizing or eradicating disease and extending survival. Patients who undergo allogeneic hematopoietic stem cell transplant (allo-HSCT) are subject to many comorbidities among which the most significant, affecting quality of life (QoL) and survival, are acute GvHD (aGvHD) and chronic GvHD (cGvHD), resulting from donor lymphocytes reacting to and damaging host tissues. Physical activity and exercise have clearly been shown, in both children and adults, to enhance fitness, improve symptomatology and QoL, reduce disease progression and extend survival for many diseases including malignancies. In some cases, vigorous exercise has been shown to be equal to or more effective than pharmacologic therapy. This review addresses how cGvHD affects patients' physical function and physical domain of QoL, and the potential benefits of exercise interventions along with recommendations for relevant research and evaluation targeted at incorporating this strategy as soon as possible after allo-HSCT and ideally, as soon as possible upon diagnosis of the condition leading to allo-HSCT.
Collapse
Affiliation(s)
- C Fiuza-Luces
- Institute of Health Carlos III and Mitochondrial and Neuromuscular Diseases Laboratory, Hospital Universitario 12 de Octubre Research Institute (i+12), Madrid, Spain
| | - R J Simpson
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - M Ramírez
- Pediatric Hematology & Oncology, Hospital Niño Jesus, Madrid, Spain
| | - A Lucia
- Departamento de Biomedicina, Universidad Europea and Research Institute (i+12), Polideportivo, Villaviciosa de Odón, Madrid, Spain
| | - N A Berger
- Center for Science, Health and Society, Department of Medicine, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
36
|
Solomon SR, Sizemore CA, Ridgeway M, Zhang X, Smith J, Brown S, Holland HK, Morris LE, Bashey A. Corticosteroid-Free Primary Treatment of Chronic Extensive Graft-versus-Host Disease Incorporating Rituximab. Biol Blood Marrow Transplant 2015; 21:1576-82. [DOI: 10.1016/j.bbmt.2015.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/27/2015] [Indexed: 11/17/2022]
|
37
|
Cantú-Rodríguez OG, Sánchez-Cárdenas M, Treviño-Montemayor OR, Gutiérrez-Aguirre CH, Tarín-Arzaga L, Jaime-Pérez JC, Gómez-Almaguer D. Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy. PSYCHOL HEALTH MED 2015; 21:10-9. [PMID: 26125120 DOI: 10.1080/13548506.2015.1054843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.
Collapse
Affiliation(s)
- Olga Graciela Cantú-Rodríguez
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Mónica Sánchez-Cárdenas
- b Department of Internal Medicine , Hospital Universitario, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Oscar Rubén Treviño-Montemayor
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - Luz Tarín-Arzaga
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - José Carlos Jaime-Pérez
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| | - David Gómez-Almaguer
- a Hematology Service , Hospital Universitario, Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn. Colonia Mitras Centro, C.P. 64460 Monterrey , Mexico
| |
Collapse
|
38
|
Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia. Bone Marrow Transplant 2015; 50:1241-9. [PMID: 26076127 DOI: 10.1038/bmt.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 01/13/2023]
Abstract
When discussing treatment options for patients with acute leukemia, it is important to acknowledge the impact of allogeneic hematopoietic cell transplantation (allo-HCT) or chemotherapy on quality of life (QOL). We performed a cross-sectional questionnaire study that administered SF-36, FACT-Leukemia and EuroQOL5D to 524 acute leukemia survivors, to compare patient-reported QOL between chemotherapy and allo-HCT, and to elucidate predictors of QOL. Patients who received chemotherapy alone had a better physical QOL than those who received allo-HCT. On the other hand, the allo-HCT group reported a better mental QOL. In the comparison of QOL in the allo-HCT patients according to the presence of GVHD at survey, patients who had GVHD symptoms experienced statistically and clinically significantly worse QOL than those who did not. In the allo-HCT patients without GVHD, the physical QOL was comparable to that in the chemotherapy patients, and they experienced significantly better mental and general QOL than the chemotherapy patients. GVHD and immunosuppressive drugs at survey were strongly associated with worse QOL after allo-HCT. In the chemotherapy group, a shorter time between treatment completion and survey was significantly associated with worse QOL. Further evaluation of QOL by a longitudinal assessment with quantitative and qualitative analyses are warranted.
Collapse
|
39
|
Carpenter PA, Kitko CL, Elad S, Flowers MED, Gea-Banacloche JC, Halter JP, Hoodin F, Johnston L, Lawitschka A, McDonald GB, Opipari AW, Savani BN, Schultz KR, Smith SR, Syrjala KL, Treister N, Vogelsang GB, Williams KM, Pavletic SZ, Martin PJ, Lee SJ, Couriel DR. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant 2015; 21:1167-87. [PMID: 25838185 DOI: 10.1016/j.bbmt.2015.03.024] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.
Collapse
Affiliation(s)
- Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juan C Gea-Banacloche
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Laura Johnston
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University, Vienna, Austria
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony W Opipari
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and University of BC, Vancouver, British Columbia
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| |
Collapse
|
40
|
Tackett AP, Peugh JL, Wu YP, Pai AL. Parent Medication Barriers Scale (PMBS): A preliminary investigation of factor structures with hematopoietic stem cell transplant recipients. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2014.979917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
41
|
Health-related quality of life in patients who develop bronchiolitis obliterans syndrome following allo-SCT. Bone Marrow Transplant 2014; 50:289-95. [PMID: 25419692 DOI: 10.1038/bmt.2014.264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 11/12/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) remains an important complication following allo-SCT. The development of this condition portends a higher morbidity and mortality but the effect on heath-related quality of life (HRQL) is unknown. The aim of this study was to determine whether the development of BOS impacted HRQL compared with patients without BOS. This Institutional Review Board-approved prospective study analyzed 126 patients who underwent allo-SCT at our institution. Patients were administered three HRQL survey tools (SF-36, European Organization for Research and Treatment of Cancer QLQ-c30 and St George Respiratory Questionnaire (SGRQ)) before transplant and then again at 6 months, 1 year and 2 years after transplant. Patients were analyzed in three groups determined by highest chronic GVHD (cGVHD) severity and BOS status. Overall, our study group had improving HRQL after transplant when measured over time, measured by the SF-36 with stable HRQL, when measured by the SGRQ total score and QLQ-c30. Patients that developed BOS had significantly worse HRQL scores measured by the SGRQ and the SF-36 physical composite score. This difference was not explained by the severity of cGVHD that patients with BOS developed.
Collapse
|
42
|
Impact of an incentive-based mobility program, "Motivated and Moving," on physiologic and quality of life outcomes in a stem cell transplant population. Cancer Nurs 2014; 37:345-54. [PMID: 24067357 DOI: 10.1097/ncc.0b013e3182a40db2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Research suggests that patients experience increased fatigue, reduced physical activity, and diminished quality of life (QOL) after hematopoietic stem cell transplantation (HSCT). Structured exercise during hospitalization has been shown to maintain or improve fatigue. Incentive-based interventions have not been tested to encourage physical activity maintenance. OBJECTIVES The study's aim was to evaluate the effect of participation in an incentive-based mobility program on fatigue, physical conditioning, performance status, and QOL in individuals undergoing allogeneic HSCT. We hypothesized that program participation would affect these variables and that time spent engaged in physical activity would correlate with improved outcomes. METHODS A 1-group repeated-measures design used the Brief Fatigue Inventory, 6-minute walk test, and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale to assess study variables. Repeated-measures models assessed the effect of participation time on these variables. RESULTS Individuals with higher participation (minutes) significantly increased 6-minute walk test scores throughout hospitalization but had no significant changes in Brief Fatigue Inventory and Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale scores. Fatigue and QOL decreased over hospitalization but improved by discharge. Subjects who demonstrated higher participation averaged fewer hospital days (R = 1.65; P = .005). CONCLUSIONS This study is unique in examining the impact of an incentive-based mobility program, participation in which may decrease length of hospital stay for HSCT patients. Randomized trials are needed to further validate these findings and assess additional variables that can influence outcomes. IMPLICATIONS FOR PRACTICE An incentive-based mobility program during hospitalization for HSCT has the potential to minimize fatigue and stabilize, if not improve, QOL.
Collapse
|
43
|
El-Jawahri A, Pidala J, Inamoto Y, Chai X, Khera N, Wood WA, Cutler C, Arora M, Carpenter PA, Palmer J, Flowers M, Weisdorf D, Pavletic S, Jaglowski S, Jagasia M, Lee SJ, Chen YB. Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1341-8. [PMID: 24813171 PMCID: PMC4127362 DOI: 10.1016/j.bbmt.2014.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/01/2014] [Indexed: 11/22/2022]
Abstract
Although older patients undergoing allogeneic hematopoietic stem cell transplantation (HCT) may experience higher morbidity, the impact of chronic graft-versus-host disease (GVHD) on quality of life (QOL) and survival outcomes for older compared with younger patients is currently unknown. We utilized data of patients with moderate or severe chronic GVHD (N = 522, 1661 follow-up visits, a total of 2183 visits) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between age group (adolescent and young adult, "AYA," 18 to 40 years; "middle-aged," 41 to 59 years; and "older," ≥ 60 years) and QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]), physical functioning (Human Activity Profile [HAP]), functional status (2-minute walk test [2MWT]), nonrelapse mortality, and overall survival. Because of multiple testing, P values < .01 were considered significant. This study included 115 (22%) AYA, 279 (53%) middle-aged, and 128 (25%) older patients with moderate (58%) or severe (42%) chronic GVHD. Despite more physical limitations in older patients as measured by worse functional status (shorter 2MWT [P < .001] and lower HAP scores [P < .001]) relative to AYA and middle-aged patients, older patients reported better QOL (FACT-BMT, P = .004) compared with middle-aged patients and similar to AYA patients (P = .99). Nonrelapse mortality and overall survival were similar between the age groups. Therefore, despite higher physical and functional limitations, older patients who are selected to undergo HSCT and survive long enough to develop moderate or severe chronic GVHD have preserved QOL and similar overall survival and nonrelapse mortality when compared with younger patients. Therefore, we did not find evidence that older age is associated with worse outcomes in patients with moderate or severe chronic GVHD.
Collapse
Affiliation(s)
- Areej El-Jawahri
- Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yoshi Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - William A Wood
- Linenberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Corey Cutler
- Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mukta Arora
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jeanne Palmer
- Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Steven Pavletic
- National Cancer Institute, National Institutes of Health Center for Cancer Research, Bethesda, Maryland
| | - Samantha Jaglowski
- Division of Hematology-Oncology, Ohio State University Medical Center, Columbus, Ohio
| | - Madan Jagasia
- Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yi-Bin Chen
- Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Fiuza-Luces C, Soares-Miranda L, González-Murillo A, Palacio JM, Colmenero I, Casco F, Melén GJ, Delmiro A, Morán M, Ramírez M, Lucia A. Exercise benefits in chronic graft versus host disease: a murine model study. Med Sci Sports Exerc 2014; 45:1703-11. [PMID: 23954992 DOI: 10.1249/mss.0b013e31828fa004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Chronic graft versus host disease (cGVHD) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation that generates considerable morbidity and compromises the physical capacity of patients. We determined the effects of an exercise training program performed after allogeneic hematopoietic stem cell transplantation on clinical and biological variables in a minor histocompatibility antigen-driven murine model of cGVHD treated with cyclosporine A. METHODS Recipient BALB/C female mice (age 8 wk) received bone marrow cells and splenocytes from donor B10.D2 male mice and were randomly assigned to an exercise (n = 11) or control group (n = 12). For approximately 11 wk after transplant, the exercise group completed a moderate-intensity treadmill program. Variables assessed were clinical severity scores, survival, physical fitness, cytokine profile, immune cell reconstitution, molecular markers of muscle exercise adaptations, and histological scores in affected tissues. RESULTS Exercise training increased survival (P = 0.011), diminished total clinical severity scores (P = 0.002), improved physical fitness (P = 0.030), and reduced blood IL-4 and tumor necrosis factor α levels (P = 0.03), while increasing circulating B220 (P = 0.008) and CD4 lymphocytes (P = 0.043). CONCLUSIONS A moderate-intensity exercise program that mimics widely accepted public health recommendations for physical activity in human adults was well tolerated and positive effects on survival as well as on clinical and biological indicators of cGVHD.
Collapse
Affiliation(s)
- Carmen Fiuza-Luces
- School of Doctorate Studies and Research, European University of Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD. Bone Marrow Transplant 2014; 49:704-8. [PMID: 24566709 DOI: 10.1038/bmt.2014.21] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/02/2014] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients' quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P=0.012 and 3.4 compared with 6.9, P=0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD.
Collapse
|
46
|
Mo XD, Jiang Q, Xu LP, Liu DH, Liu KY, Jiang B, Jiang H, Chen H, Chen YH, Zhang XH, Han W, Wang Y, Huang XJ. Health-related quality of life of patients with newly diagnosed chronic myeloid leukemia treated with allogeneic hematopoietic SCT versus imatinib. Bone Marrow Transplant 2014; 49:576-80. [PMID: 24442252 DOI: 10.1038/bmt.2013.232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/09/2022]
Abstract
To evaluate and compare the health-related quality of life (HRQOL) of patients with newly diagnosed CML in the first chronic phase (CML-CP1) receiving HLA-identical sibling donor (ISD) hematopoietic SCT (HSCT) or imatinib, a cross-sectional study that was part of a prospective cohort study at the Institute of Hematology, Peking University was performed. A total of 222 patients including 126 and 96 in the imatinib and ISD HSCT groups, respectively, were enrolled. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey. The ISD HSCT group functioned significantly better on the role-physical functioning and mental health subscales, as well as the mental component summary (MCS) than the imatinib group. HRQOL was generally comparable to groups in the young population. Multivariate analysis showed that white blood cell count ≥ 30 × 10(9)/L and plts count ≥ 450 × 10(9)/L were the major adverse factors affecting HRQOL in long-term survivors. Imatinib therapy was also an adverse factor affecting the MCS (odds ratio=1.7, P=0.032). Thus, long-term CML-CP1 survivors receiving ISD HSCT can attain desirable HRQOL comparable to or better than that of patients receiving imatinib.
Collapse
Affiliation(s)
- X-D Mo
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Q Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - L-P Xu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - D-H Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - K-Y Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - B Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-H Zhang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - W Han
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y Wang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-J Huang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| |
Collapse
|
47
|
Clinical guide to fertility preservation in hematopoietic cell transplant recipients. Bone Marrow Transplant 2014; 49:477-84. [PMID: 24419521 DOI: 10.1038/bmt.2013.211] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 11/08/2022]
Abstract
With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.
Collapse
|
48
|
Bishop MM, Wingard JR. Thriving after hematopoietic stem cell transplant: a focus on positive changes in quality of life. Expert Rev Pharmacoecon Outcomes Res 2014; 4:111-23. [DOI: 10.1586/14737167.4.1.111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
49
|
Kapucu S, Karacan Y. Physiological problems in patients undergoing autologous and allogeneic hematopoietic stem cell transplantation. Asia Pac J Oncol Nurs 2014; 1:50-54. [PMID: 27981083 PMCID: PMC5123448 DOI: 10.4103/2347-5625.135821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Stem cell transplantation is usually performed in an effort to extend the patient's life span and to improve their quality of life. This study was conducted to determine the postoperative physiological effects experienced by patients who had undergone autologous and allogeneic stem cell transplantation. METHODS The research is a descriptive study conducted with a sample of 60 patients at Stem Cell Transplantation Units in Ankara. Percentile calculation and chi-square tests were used to evaluate the data. RESULTS When a comparison was made between patients who had undergone allogeneic Hematopoietic stem cell transplantation (HSCT) and those who had undergone autologous HSCT, results indicated that problems occurred more often for the allogeneic HSCT patients. The problems included: Digestion (94.3%), dermatological (76.7%), cardiac and respiratory (66.7%), neurological (66.7%), eye (56.7%), infections (26.7%) and Graft Versus Host Disease (5 patients). Furthermore, the problems with pain (50%), numbness and tingling (40%), and speech disorders (3 patients) were observed more often in autologous BMT patients. CONCLUSION Autologous and allogeneic patients experienced most of physical problems due to they receive high doses of chemotherapy. Therefore, it is recommended that an interdisciplinary support team approach should be usedtohelp reduce and manage the problems that may arise during patient care.
Collapse
Affiliation(s)
- Sevgisun Kapucu
- Department of Internal Diseases Nursing, Hacettepe University, Faculty of Nursing, Ankara, Turkey
| | - Yasemin Karacan
- Department of Hematology, MN Uludag University, Goruklu, Bursa, Turkey
| |
Collapse
|
50
|
Ovayolu O, Ovayolu N, Kaplan E, Pehlivan M, Karadag G. Symptoms and Quality of Life: Before and after stem cell transplantation in cancer. Pak J Med Sci 2013; 29:803-8. [PMID: 24353632 PMCID: PMC3809283 DOI: 10.12669/pjms.293.3290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/21/2012] [Accepted: 04/15/2013] [Indexed: 11/15/2022] Open
Abstract
Objective: This study was conducted thinking that it was extremely important in terms of the disease and treatment to assess the symptoms that may be encountered before and after a stem cell transplantation and quality of life. Methodology: A prospective longitudinal design was used.The study was completed in two years on 82 patients who underwent transplantation at the bone marrow transplantation unit. Data were collected using a questionnaire, the Edmonton Symptom Assessment Scale, and the Short Form-36 quality of life scale. Results: It was observed that the patients had low mean scores of physical and mental quality of life both before and after transplantation; there was an increase in the mean scores of all the symptoms and primarily of fatigue after the stem cell transplantation as compared to before it; and the mean scores of physical and mental quality of life further declined (p<0.05). Conclusion: Quality of life of patients who underwent stem cell transplantation is adversely affected in the periods immediately before and after transplantation. Patients’ quality of life worsens as the severity of symptoms experienced by patients increases.
Collapse
Affiliation(s)
- Ozlem Ovayolu
- Ozlem Ovayolu, RN, PhD, Gaziantep University, Faculty of Health Science, Gaziantep, Turkey.
| | - Nimet Ovayolu
- Nimet Ovayolu, RN, PhD, Associate Professor, Gaziantep University, Faculty of Health Science, Gaziantep, Turkey.
| | - Emine Kaplan
- Emine Kaplan, Research Assistant, Adiyaman University, School of Health, Adiyaman, Turkey.
| | - Mustafa Pehlivan
- Mustafa Pehlivan, MD, Associate Professor, Department of Hematology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Gulendam Karadag
- Gulendam Karadag, RN, PhD,Gaziantep University, Faculty of Health Science, Gaziantep, Turkey.
| |
Collapse
|