Review of chronic graft-versus-host disease in children after allogeneic stem cell transplantation: nursing perspective

A bibliometric analysis of global publications on graft-versus-host disease research

BACKGROUND

Graft-versus-host disease (GVHD) is a fatal complication of hematopoietic stem cell transplantation and is an enormous burden on the patient economy and related health systems. Nevertheless, only a few bibliometric studies have examined the direction of research and the major findings within the field.

METHODS

Statistical and visualization bibliometric analysis was performed in April 2021. Our research data were retrieved from the Web of Science using an advanced search strategy. We then used bibliometric analysis to determine the current general research direction and trend of publications and established the most prolific and distinguished authors, institutions, countries, funding agencies, and keywords in GVHD research. We employed VOSviewer (Leiden University, Leiden, Netherlands), Microsoft Excel (Microsoft, Redmond, State of Washington), and GunnMap (https://lert.co.nz/map/) to retrieve, integrate, and visualize the results.

RESULTS

Overall, 15,378 publications from 500 journals were extracted from the Institute for Scientific Information (ISI) Web of Science Core Collection database based on our analysis, of which the United States and the Fred Hutchinson Cancer Research Center were the most prolific countries and institutions, respectively. Moreover, we identified future research trends and the current status of GVHD research based on the top 10 most cited articles. Finally, influential authors' analysis demonstrated that Blazar, BR were both the most productive and most cited among all authors.

CONCLUSION

Our study provides an exhaustive and objective overview of the current status of GVHD research. This information would be highly beneficial to anyone seeking information on GVHD and would serve as a reference guide for researchers aiming to conduct further GVHD research.

Quality of Life After Hematopoietic Stem Cell Transplantation in Pediatric Survivors: Comparison With Healthy Controls and Risk Factors

BACKGROUND

Hematopoietic stem cell transplantation has prolonged life for children with life-threatening diseases. Quality of life is an essential outcome for evaluating the long-term effects of transplantation.

OBJECTIVE

The aims of this study were to compare the quality of life of children posttransplantation to that of healthy peers and explore the variables associated with the quality of life of posttransplant children.

METHODS

A cross-sectional study was conducted with 43 pediatric transplantation survivors and 43 age- and sex-matched healthy peers.

RESULTS

The mean age of the transplant group was 12.06 years. The mean time since transplant was 3.73 years. After covariate adjustment, there was no difference between posttransplant and healthy children in each domain and overall quality of life, except for physical functioning where the posttransplant children had lower scores than did the healthy group. Chronic graft-versus-host disease was found to be the primary factor associated with poor posttransplant overall quality of life and emotional and social functioning. Sociodemographic variables, symptom distress, and caregiver depression were not correlated with posttransplant quality of life.

CONCLUSIONS

The quality of life of pediatric transplantation survivors was comparable to that of healthy peers.

IMPLICATIONS FOR PRACTICE

The finding that children after transplant may achieve quality of life similar to their healthy peers is important information for parents to consider as they consider treatment options. For those sick children who cannot regularly attend school, their emotional and social functioning should be closely monitored.

Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging

Osteonecrosis after hematopoietic SCT (HCT) has seldom been addressed in pediatric populations. At our institution, since January 2002, children undergoing allogeneic HCT (alloHCT) receive yearly follow-up magnetic resonance imaging (MR) of hips and knees. To estimate the prevalence, longitudinal changes and associated risk factors for osteonecrosis after alloHCT, we reviewed MRs for children who underwent single alloHCT during the study period. We analyzed 149 of 344 patients who had post-HCT MR imaging performed (84 males; median age 11 years (range, 0.5-21 years)), median follow-up time was 32.6 months (range, 2.8-97.2 months). In all, 44 (29.5%) developed osteonecrosis of hips and/or knees; of those, 20 (45%) had at least 30% epiphyseal involvement. In 23 (52%), osteonecrosis lesions were identified in the first and in 43 (98%) by the third yearly scan. Knees were more frequently involved than hips; severity of osteonecrosis was greater in hips. Those who had pre-alloHCT osteonecrosis, two patients' hips and six patients' knees resolved completely; three patients' osteonecrosis lesions regressed after alloHCT. On risk factor analysis, age at time of alloHCT (P=0.051) and osteonecrosis identified by MRs before alloHCT (P=0.001) were the primary risk factors. This analysis shows that preventive strategies for osteonecrosis in this population should focus on measures to minimize risk factors before alloHCT.

Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging

Osteonecrosis after hematopoietic stem cell transplantation (HCT) has seldom been addressed in pediatric populations. At our institution, since January 2002, children undergoing allogeneic HCT (alloHCT) receive yearly follow-up magnetic resonance imaging (MR) of hips and knees. To estimate the prevalence, longitudinal changes and associated risk factors for osteonecrosis after alloHCT, we reviewed MRs for children who underwent single alloHCT during the study period. We analyzed 149 of 344 patients who had post HCT MRI imaging performed [84 males; median age11 years (range, 0.5–21years)], median follow-up time was 32.6 months (range, 2.8–97.2 months). Forty-four (29.5%) developed osteonecrosis of hips and/or knees; of those, 20 (45%) had at least 30% epiphyseal involvement. In 23 (52%) osteonecrosis lesions were identified in the first, and 43 (98%) by the third yearly scan. Knees were more frequently involved than hips; severity of osteonecrosis was greater in hips. Those who had pre-alloHCT osteonecrosis, two patients’ hips and six patients’ knees resolved completely; three patients’ osteonecrosis lesions regressed after alloHCT. On risk factor analysis, age at time of alloHCT (p=0.051) and osteonecrosis identified by MRs before alloHCT (p=0.001) were the primary risk factors. This analysis shows that preventive strategies for osteonecrosis in this population should focus on measures to minimize risk factors before alloHCT.