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Jantunen E, Hämäläinen S, Pulkki K, Juutilainen A. Novel biomarkers to identify complicated course of febrile neutropenia in hematological patients receiving intensive chemotherapy. Eur J Haematol 2024. [PMID: 38961525 DOI: 10.1111/ejh.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
Febrile neutropenia (FN) is a common consequence of intensive chemotherapy in hematological patients. More than 90% of the patients with acute myeloid leukemia (AML) develop FN, and 5%-10% of them die from subsequent sepsis. FN is very common also in autologous stem cell transplant recipients, but the risk of death is lower than in AML patients. In this review, we discuss biomarkers that have been evaluated for diagnostic and prognostic purposes in hematological patients with FN. In general, novel biomarkers have provided little benefit over traditional inflammatory biomarkers, such as C-reactive protein and procalcitonin. The utility of most biomarkers in hematological patients with FN has been evaluated in only a few small studies. Although some of them appear promising, much more data is needed before they can be implemented in the clinical evaluation of FN patients. Currently, close patient follow-up is key to detect complicated course of FN and the need for further interventions such as intensive care unit admission. Scoring systems such as q-SOFA (Quick Sequential Organ Failure Assessment) or NEWS (National Early Warning Sign) combined with traditional and/or novel biomarkers may provide added value in the clinical evaluation of FN patients.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Sari Hämäläinen
- Department of Medicine, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Kari Pulkki
- Diagnostic Center, Helsinki University Hospital and Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
- Institute of Clinical Medicine/Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
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2
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de Jong MME, Fokkema C, Papazian N, Czeti Á, Appelman MK, Vermeulen M, van Heusden T, Hoogenboezem RM, van Beek G, Tahri S, Sanders MA, van de Woestijne PC, Gay F, Moreau P, Büttner-Herold M, Bruns H, van Duin M, Broijl A, Sonneveld P, Cupedo T. An IL-1β-driven neutrophil-stromal cell axis fosters a BAFF-rich protumor microenvironment in individuals with multiple myeloma. Nat Immunol 2024; 25:820-833. [PMID: 38600356 DOI: 10.1038/s41590-024-01808-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
Human bone marrow permanently harbors high numbers of neutrophils, and a tumor-supportive bias of these cells could significantly impact bone marrow-confined malignancies. In individuals with multiple myeloma, the bone marrow is characterized by inflammatory stromal cells with the potential to influence neutrophils. We investigated myeloma-associated alterations in human marrow neutrophils and the impact of stromal inflammation on neutrophil function. Mature neutrophils in myeloma marrow are activated and tumor supportive and transcribe increased levels of IL1B and myeloma cell survival factor TNFSF13B (BAFF). Interactions with inflammatory stromal cells induce neutrophil activation, including BAFF secretion, in a STAT3-dependent manner, and once activated, neutrophils gain the ability to reciprocally induce stromal activation. After first-line myeloid-depleting antimyeloma treatment, human bone marrow retains residual stromal inflammation, and newly formed neutrophils are reactivated. Combined, we identify a neutrophil-stromal cell feed-forward loop driving tumor-supportive inflammation that persists after treatment and warrants novel strategies to target both stromal and immune microenvironments in multiple myeloma.
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Affiliation(s)
- Madelon M E de Jong
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Cathelijne Fokkema
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Natalie Papazian
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Ágnes Czeti
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Marjolein K Appelman
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Michael Vermeulen
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Teddie van Heusden
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Remco M Hoogenboezem
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Gregory van Beek
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Sabrin Tahri
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Mathijs A Sanders
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | | | - Francesca Gay
- Clinical Trial Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Philippe Moreau
- Department of Hematology, Nantes University Hospital Hotel-Dieu, Nantes, France
| | - Maike Büttner-Herold
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Heiko Bruns
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mark van Duin
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Annemiek Broijl
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.
| | - Tom Cupedo
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.
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Garcés-Carrasco AM, Santacatalina-Roig E, Carretero-Márquez C, Chover-Sierra E, Martínez-Sabater A, Balaguer-López E. Post-Transplant Complications in Patients Undergoing Autologous Hematopoietic Cell Transplantation (HCT)-A Comparative Analysis of Home Care versus Hospitalized Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:44. [PMID: 38256305 PMCID: PMC10821161 DOI: 10.3390/medicina60010044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The increase in indications for hematopoietic cell transplants (HCTs) has led to the development of new care options after said transplant, such as home care after transplantation, which improves the patients' quality of life. The main purpose of this research is to analyze the differences in the appearance of post-transplant complications between patients having underwent autologous HCT with at-home post-transplant modalities and those under in-hospital post-transplant care. Materials and Methods: An observational, analytical, longitudinal, and retrospective study of cases and controls. All transplanted people in the domiciliary model since 2020 are included as cases (20 subjects). For each case, two controls (40 subjects) are proposed among patients who received an autologous transplant in a hospital in the last five years with a similar demographic and pathological base profile in each case. Results: No significant differences were found between cases and controls, except for the Karnofsky value, which was higher in people receiving home treatment (91.7% vs. 87.74%; p = 0.05). The average number of days of the process post-transplantation was more significant at home (processing days 22.4 ± 2.6; post-transplantation days of 16.4 ± 2.08 versus 21.21 ± 4.18, with a mean of 15.51 ± 3.96 days post-transplant (days of the process p = 0.022; days post-transplant p = 0.002)). There is a more significant presence of neutropenic fever, mucositis, and positive blood cultures in the post-transplant patients who remain in the hospital. In contrast, the patients receiving home care post-transplantation undergo significantly more weight loss. Regarding the odds ratio of the appearance of adverse events, in the hospital setting, it is up to 8.5 times more likely to encounter neutropenic fever, 4.63 times more likely for mucositis, and 6.65 times more likely for the presence of pathogens in blood cultures. Conclusions: The home care modality in the post-transplant phase does not show an inferiority in conditions in the management and safety of the patient concerning the appearance of adverse events. However, more significant weight loss is detected in patients at home, and an increased risk of episodes of neutropenic fever, mucositis, and positive blood cultures for patients in hospital settings.
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Affiliation(s)
- Ana María Garcés-Carrasco
- Oncology and Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain (E.S.-R.)
| | - Enric Santacatalina-Roig
- Oncology and Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain (E.S.-R.)
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (E.C.-S.); (E.B.-L.)
| | - Carlos Carretero-Márquez
- Oncology and Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain (E.S.-R.)
| | - Elena Chover-Sierra
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (E.C.-S.); (E.B.-L.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
- Internal Medicine Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Antonio Martínez-Sabater
- Oncology and Hematology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain (E.S.-R.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 Valencia, Spain
- Grupo Asociado de Investigación en Cuidados (INCLIVA, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Evelin Balaguer-López
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 Valencia, Spain; (E.C.-S.); (E.B.-L.)
- Internal Medicine Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
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Sezgin MG, Bektas H. A retrospective study of treatment and outcomes of patients with lymphoma undergoing hematopoietic stem cell transplantation: A single-center experience. Transpl Immunol 2023; 79:101855. [PMID: 37201796 DOI: 10.1016/j.trim.2023.101855] [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: 02/07/2023] [Revised: 04/10/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Early evaluation of symptoms and taking appropriate preventive measures can improve outcomes for patients with lymphoma undergoing hematopoietic stem cell transplantation (HSCT). This study aimed to examine the treatment and outcomes of patients with lymphoma undergoing HSCT. METHODS Patients with lymphoma undergoing SCT at a university hospital between 15.06.2018 and 15.06.2020, were selected for a retrospective study. The medical treatments of patients were obtained from the records on the Hospital Information Management System (HIMS) database. The study was reported following the STROBE checklist. RESULTS Sixty-four patients were analyzed. The mean age of the patients was 48.25 ± 16.93 (p = 0.76). Although relapse developed in 26 (40.6%) patients with lymphoma, remission was achieved in 38 (59.4%) patients. The incidence of skin graft-versus-host disease (GVHD) symptoms in patients with relapse [14(53.8%)] was found to be significantly higher than in patients in remission [4(10.5%)] (p < 0.001). The most common symptoms seen in patients undergoing HSCT were oral mucositis (78.1%), febrile neutropenia (68.8%), and anemia (56.3%). In the treatments applied after SCT, the administration of antifungal (p = 0.033), analgesic (p = 0.001), and anticoagulant (p = 0.008) treatments to the patients who were in remission compared with the relapsed patients was significant. Less courses (OR: 0.446; 95% CI: 0.22-0.907; p = 0.026), analgesic therapy (OR:6.22; 95% CI: 1.61-24.027; p = 0.008), and anticoagulant treatment (OR:7.13; %) 95 CI: 1.374-37.1; p = 0.019) were found to increase the risk of relapse. Because of the increase in the number of cures in SCT, the incidence of diarrhea (p = 0.016) and GIS GVHD (p = 0.022) was high. It was determined that the hospitalization period was shorter in patients with febrile neutropenia (p = 0.021), thrombocytopenia/bleeding (p = 0.031), and secretion (p = 0.036) symptoms. CONCLUSIONS Patients experienced severe symptoms such as oral mucositis, febrile neutropenia, and anemia due to HSCT, and necessary treatment was applied for the symptoms. Further clinical studies must determine the symptoms and patient outcomes associated with SCT. It is predicted that patients will benefit from regular follow-up of their symptoms and planning of appropriate evidence-based nursing interventions and that this will improve the quality of care to be offered to them and increase their life span.
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Affiliation(s)
- Merve Gozde Sezgin
- Akdeniz University Faculty of Nursing, Department of Internal Medicine Nursing, Antalya, Turkey.
| | - Hicran Bektas
- Akdeniz University Faculty of Nursing, Department of Internal Medicine Nursing, Antalya, Turkey.
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5
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Duarte GDC, Butler A, Atkinson G, Badami K, Wei W. A critical assessment of dose effects of post-thaw CD34 on autologous stem cell transplantation treatment of haematological malignancies. EJHAEM 2023; 4:419-427. [PMID: 37206253 PMCID: PMC10188507 DOI: 10.1002/jha2.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 05/21/2023]
Abstract
A consensus threshold of pre-cryopreservation CD34-positive cells (CD34s) has been used as the minimum dose to initiate autologous stem cell transplantation (ASCT). Advances in cryopreservation posed a debate whether post-thaw CD34s might be a superior surrogate instead. We addressed the debate in this retrospective study of 217 adult ASCTs in five different haematological malignancies treated at a single centre. We showed that post-thaw CD34s was highly correlated with pre-cryopreservation CD34s (r = 0.97) and explained ∼2.2% (p = 0.003) of the variation of the post-thaw total nucleated cell viability that however had no power to predict engraftment outcomes. After stratifying the ASCT cases into four dose groups based on post-thaw CD34s reinfused, stepwise multivariate regression analyses detected significant effects in dose group and interactions with diseases for neutrophil and platelet recovery respectively. The significant dose effects and interactions were triggered by two technical outliers in the low dose group, and disappeared in the repeated regressions after exclusion of the outliers where disease and age were the significant predictors remained. Our data clearly support the validity of the consensus threshold in ASCT applications but also highlight neglected conditions where monitoring post-thaw CD34s and clinical attributes are valuable.
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Affiliation(s)
| | - Andrew Butler
- Haematology DepartmentChristchurch HospitalChristchurchNew Zealand
| | | | | | - Wen‐Hua Wei
- New Zealand Blood ServiceChristchurchNew Zealand
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
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6
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Singhal S, Saadeh SS, Durani U, Kansagra A, Alkhateeb HB, Shah MV, Mangaonkar A, Kenderian S, Hashmi S, Patnaik MV, Litzow MR, Hogan WJ. Allogeneic Hematopoietic Stem Cell Transplantation in the Outpatient Setting: The Mayo Clinic Experience. Transplant Cell Ther 2023; 29:183.e1-183.e6. [PMID: 36584940 DOI: 10.1016/j.jtct.2022.12.016] [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: 06/18/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Hematopoietic stem cell transplantations (HSCT) are intensive and potentially curative modalities available for a variety of hematological diseases. Although alloHSCTs are typically performed in an inpatient setting, there has been increasing interest in moving them to the outpatient setting. AlloHSCTs are associated with a median length of hospital stay of 30 days. AlloHSCTs in the inpatient setting may increase patient exposure to nosocomial infections, drug-resistant organisms, rapid deconditioning with time spent in hospital beds, and loss of muscle mass. In this study, we aim to share outcomes of 856 consecutive alloHSCTs done in our institute over the past 2 decades. This is a single-center retrospective chart review encompassing 856 patients who underwent outpatient alloHSCTs between 2000 and 2017. Reduced-intensity conditioning, stem cell infusion, and much of the immediate follow-up in the early alloHSCT period was performed on an outpatient basis with daily evaluation, laboratory assessment, and intervention as needed. Rate of non-routine hospital admission was our primary outcome of interest. We also looked at various secondary outcomes, including causes of admission, median length of stay, and in-hospital mortality rate. Data analysis was performed using STATA statistical software Version 15. Descriptive statistics were used to summarize baseline demographic data and outcomes. Logistic regression modeling was used to identify predictors of hospital admission. We observed that about one third of our cohort never required admission to the hospital throughout the first 100 days after HSCT. Among those admitted, 6.6% experienced a direct admission to the intensive care unit, and the overall in hospital mortality was low at 5%. Furthermore, the median length of stay was noted to be decreased at 6 days compared to a median reported 30 days in existing literature. Overall, we observed favorable safety profile and outcomes with outpatient management of HSCTs.
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Affiliation(s)
- Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Salwa S Saadeh
- Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Urshila Durani
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Ankit Kansagra
- Department of Internal Medicine, UT Southwestern Medical Center, Texas
| | | | - Mithun V Shah
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Saad Kenderian
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Shahrukh Hashmi
- Department of Hematology, Mayo Clinic, Rochester, Minnesota; Department of Hematology/Oncology, Sheikh Shakhbout Medical City/ Mayo Clinic, Abu Dhabi
| | | | - Mark R Litzow
- Department of Hematology, Mayo Clinic, Rochester, Minnesota
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Maranzano M, Mead M. The role of transplantation in Hodgkin lymphoma. Front Oncol 2023; 12:1054314. [PMID: 36776370 PMCID: PMC9908991 DOI: 10.3389/fonc.2022.1054314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
Despite the success of frontline anthracycline-based chemotherapy for classical Hodgkin Lymphoma (cHL), approximately 15% of patients do not achieve an adequate response and require further therapy. For transplant-eligible patients, additional treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) provides a durable response in 50% of patients. The most refractory patients, including those requiring multiple lines of therapy to achieve a response or those relapsing after an autoHCT, may achieve long-term survival with allogeneic hematopoietic stem cell transplant (alloHCT). Contemporary salvage regimens used as a bridge to transplant have expanded to include not only non-cross resistant chemotherapy, but also brentuximab vedotin (BV) and checkpoint inhibitors (CPI). As the management of relapsed/refractory (R/R) cHL evolves with the introduction of novel agents, so too does the role of transplantation. The paradigm of chemosensitivity as a predictor for autoHCT efficacy is being challenged by favorable post- autoHCT outcomes in heavily pre-treated CPI-exposed patients. Contemporary supportive care measures, validated comorbidity assessments, and an increased donor pool with haploidentical donors have broadened the application of transplantation to an increasingly older and diverse patient population. Despite the introduction of increasingly effective treatment options for R/R cHL, transplantation continues to play an important role in the management of these patients. In this review, we explore the impact of salvage therapy on autoHCT, conditioning regimens, maintenance therapy and the diminishing role of alloHCT for patients with cHL.
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Affiliation(s)
| | - Monica Mead
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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8
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Grosso D, Leiby B, Wilde L, Carabasi M, Filicko-O'Hara J, O'Hara W, Wagner JL, Mateja G, Alpdogan O, Binder A, Kasner M, Keiffer G, Klumpp T, Martinez UO, Palmisiano N, Porcu P, Gergis U, Flomenberg N. A Prospective, Randomized Trial Examining the Use of G-CSF Versus No G-CSF in Patients Post-Autologous Transplantation. Transplant Cell Ther 2022; 28:831.e1-831.e7. [PMID: 36167307 DOI: 10.1016/j.jtct.2022.09.012] [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: 06/06/2022] [Revised: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Contemporary, prospective data regarding the impact of granulocyte-colony stimulating factor (G-CSF) on outcomes after autologous hematopoietic stem cell transplantation (Auto-HSCT) in an era when stem cell grafts are more qualitatively robust are limited. Recent retrospective analyses have not supported a beneficial effect of post-transplantation G-CSF use on major outcomes after Auto-HSCT leading to strategies to delay or eliminate the use of G-CSF altogether in this context. To test the hypothesis that the infusion of consistently higher doses of stem cells (defined as ≥4 × 106/kg) in Auto-HSCT will obviate the need for post-transplantation G-CSF. If so, the impact of withholding G-CSF will be noninferior to the use of G-CSF in terms of length of stay (LOS). The specific objectives were to conduct a prospective, randomized clinical trial primarily examining the impact of post-transplantation G-CSF on LOS, and secondarily on engraftment, infectious complications, antibiotic usage, and incidence of engraftment syndrome after Auto-HSCT in patients receiving versus not receiving G-CSF after Auto-HSCT. Patients with multiple myeloma or non-Hodgkin lymphoma (NHL) who underwent Pegfilgrastim plus Plerixafor-primed stem cell collection followed by Auto-HSCT were randomized to the G-CSF group (receive G-CSF starting at day 3 after Auto-HSCT) or the no G-CSF group (G-CSF withheld after Auto-HSCT). Seventy patients per arm were planned to demonstrate the primary endpoint of noninferiority in LOS between the G-CSF and the no G-CSF groups. Patient outcomes in the two groups were followed up and compared after Auto-HSCT, and an interim analysis for futility was planned when accrual reached 50%.The primary finding of this study was that despite only a 2-day longer median absolute neutrophil count (ANC) recovery in the no G-CSF arm (median 11 versus 13 days; P = .001), LOS was 4 days longer in patients not treated with G-CSF (median 11 days versus 15 days; P = .001). G-CSF use was associated with more robust incremental daily increases in ANC once recovered (P = .001), fewer days of febrile neutropenia (P = .001), and fewer days on antibiotics (P = .001), potentially contributing to this disproportionate finding. Inferiority in LOS in the no G-CSF group was demonstrated on the interim analysis, and the study was closed at the half-way point. There were no significant group differences in platelet recovery, documented infections, hospital readmissions, or overall survival at 1 year. Engraftment syndrome occurred in 54.3% of patients and was not related to G-CSF use. These results suggest that the increased LOS associated with the omission of G-CSF is largely due to concerns regarding the potential for infection in patients without a stable, recovered ANC in a hospital setting. Engraftment syndrome represented a significant source of febrile neutropenia further contributing to patient safety concerns and requires strategies to decrease its incidence. Infectious complications and death were not affected by the omission of G-CSF supporting a carefully monitored outpatient approach to Auto-HSCT in which white blood cell growth factor is eliminated or given as needed for documented infection. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Dolores Grosso
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Carabasi
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanne Filicko-O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John L Wagner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Mateja
- Office of Clinical Research, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Onder Alpdogan
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Margaret Kasner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Keiffer
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Klumpp
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ubaldo Outschoorn Martinez
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neil Palmisiano
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pierluigi Porcu
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Usama Gergis
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neal Flomenberg
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
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9
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Carcò D, Castorina P, Guardo P, Iachelli V, Pace T, Scirè P, Stanco R, Markovic U, Milone GA, Galbo F, Moschetti G, Martorana E. Combination of Interleukin-6, C-Reactive Protein and Procalcitonin Values as Predictive Index of Sepsis in Course of Fever Episode in Adult Haematological Patients: Observational and Statistical Study. J Clin Med 2022; 11:jcm11226800. [PMID: 36431277 PMCID: PMC9694618 DOI: 10.3390/jcm11226800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Haematological patients represent a vulnerable population to opportunistic infections, mainly due to the disease itself and chemotherapy-induced neutropenia. The level of immune suppression strongly increases the importance of timely antibiotic treatment in order to prevent sepsis-related mortality. During the initial fever episode, serum biomarkers are usually used to estimate the probability of blood stream infection prior to the results of microbial diagnosis. A new serum biomarker combination study on a febrile haematological population, including C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT), is proposed in order to improve their predictive accuracy. In our prospective study, CRP, IL-6 and PCT were evaluated in 34 immunosuppressed haematological patients immediately after the onset of 51 fever episodes, either during the course of standard chemotherapy or high-dose chemotherapy and autologous stem cell transplant. The fever episodes were divided into documented infections and fever alone. Receiver operating characteristic analysis (ROC) was performed for each biomarker and a combination of all three biomarkers (multiROC) to define a new predictive index. Significant differences were evidenced between the two groups (documented infection and no infection) for both PCT and IL-6 (p = 0.03 and p = 0.035, respectively), but none for CRP (p = 0.1). The composite parameter is more reliable than any single biomarker alone, with an area under the curve (AUC) of 79% and with high sensitivity and specificity. IL-6 gave the closest response compared to the composite index. Composite parameters of serum biomarkers could be used for an early diagnosis of infection at fever onset in haematological patients.
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Affiliation(s)
- Daniela Carcò
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
- Correspondence: (D.C.); (E.M.)
| | - Paolo Castorina
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
- Istituto Nazionale Fisica Nucleare, 95125 Catania, Italy
- Faculty of Mathematics and Physics, Charles University, 121 16 Prague, Czech Republic
| | - Paola Guardo
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | | | - Tecla Pace
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | - Paola Scirè
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | - Rosaria Stanco
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | - Uros Markovic
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy
| | | | - Federica Galbo
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | | | - Emanuele Martorana
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
- Correspondence: (D.C.); (E.M.)
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10
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Gómez-Almaguer D, Gómez-De León A, Colunga-Pedraza PR, Cantú-Rodríguez OG, Gutierrez-Aguirre CH, Ruíz-Arguelles G. Outpatient allogeneic hematopoietic stem-cell transplantation: a review. Ther Adv Hematol 2022; 13:20406207221080739. [PMID: 35237396 PMCID: PMC8882949 DOI: 10.1177/20406207221080739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is usually performed in
well-equipped units inside a hospital. The cost of this in-hospital transplant
is usually very high; therefore, this procedure is more difficult to perform in
low- and middle-income countries. Autologous outpatient HSCT is now a common
procedure; however, outpatient allogeneic transplants are more complicated. Only
a few centers in the world have incorporated outpatient HSCT. This transplant
requires special adaptation, like a day hospital, careful selection of patients,
oral medications, and the patient must live relatively close to the hospital.
The results until now suggest that this outpatient transplant is factible and
similar to inpatient HSCT. The objective was to review and describe the
different methods and results following an outpatient allogeneic-HSCT
strategy.
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Affiliation(s)
- David Gómez-Almaguer
- Hematology Service, Facultad de Medicina y Hospital Universitario ‘Dr. Jose Eleuterio Gonzalez’, Universidad Autónoma de Nuevo León, Francisco I. Madero Ave., Mitras Centro, Monterrey 64460, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Perla R. Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Olga G. Cantú-Rodríguez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - César Homero Gutierrez-Aguirre
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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11
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Gatwood KS, Dholaria BR, Lucena M, Baer B, Savani BN, Oluwole OO. Chimeric antigen receptor T-cell therapy: Challenges and framework of outpatient administration. EJHAEM 2022; 3:54-60. [PMID: 35844300 PMCID: PMC9176074 DOI: 10.1002/jha2.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 05/14/2023]
Abstract
Adoptive cellular therapy has made a landmark change within the treatment paradigm of several hematologic malignancies, and novel cellular therapy products, such as chimeric antigen receptor T-cell therapy (CART), have demonstrated impressive efficacy and produced durable responses. However, the CART treatment process is associated with significant toxicities, healthcare resource utilization, and financial burden. Most of these therapies have been administered in the inpatient setting due to their toxicity profile. Improved toxicity management strategies and a better understanding of cellular therapy processes are now established. Therefore, efforts to transition CART to the outpatient setting are warranted with the potential to translate into enhanced patient quality of life and cost savings. A successful launch of outpatient CART requires several components including a multidisciplinary cellular therapy team and an outpatient center with appropriate clinical space and personnel. Telemedicine should be incorporated for closer monitoring. Additionally, clear criteria for admission upon clinical decompensation, a pathway for prompt inpatient transition, and clear toxicity management guidelines should be implemented. Effective education about cellular therapy and toxicity management is imperative, especially for the Emergency Department and Intensive Care Unit teams. Here, we have outlined the various logistical and clinical considerations required for the care of CART patients, which will aid centers to establish an outpatient CART program.
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Affiliation(s)
- Katie S. Gatwood
- Department of PharmacyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Bhagirathbhai R. Dholaria
- Division of Hematology‐OncologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Brittney Baer
- Department of NursingClinical Trials OfficeVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Bipin N. Savani
- Division of Hematology‐OncologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Hematology‐OncologyDepartment of MedicineTennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Olalekan O. Oluwole
- Division of Hematology‐OncologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
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12
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Verma N, Haji-Abolhassani I, Ganesh S, Vera-Aguilera J, Paludo J, Heitz R, Markovic SN, Kulig K, Ghoreyshi A. A Novel Wearable Device for Continuous Temperature Monitoring & Fever Detection. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2021; 9:2700407. [PMID: 34765323 PMCID: PMC8577572 DOI: 10.1109/jtehm.2021.3098127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/18/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022]
Abstract
Objective: Continuous temperature monitoring in high-risk patients can enable healthcare providers to remotely track patients' temperatures, promptly detect fevers and timely intervene to improve clinical outcomes. We evaluated if a novel wearable, continuous temperature monitor (Verily Patch) can reliably estimate body temperature and early detect fevers in an outpatient setting in patients at a high risk of febrile neutropenia (FN) who recently underwent chemotherapy and autologous stem cell transplantation (ASCT). Methods: 86 patients at a high risk for FN were prospectively enrolled at Mayo Clinic, MN. Patients wore the device in their axilla region for 7 days post ASCT and recorded self-measured oral temperatures every 3 hours. Patients were also followed using clinical standard-of-care procedures with daily oral temperature assessment. The clinic- and patient-assessed oral temperatures were used to develop and evaluate Verily Patch's body temperature and early fever detection algorithms using a K-fold cross-validation approach. Results: The Verily Patch reliably measured body temperatures with an error of 0.35 ± 0.88°F in comparison to clinic- and patient-assessed oral temperatures. The sensitivity and specificity of the patch in detecting clinic-assessed fever episodes was 90.2% and 87.8%. The patch detected 14.3 times the number of clinic-assessed fever episodes with a median lead time of 4.3 hours. Conclusion: Patient self-monitoring of temperature and fever incidents suffers from low accuracy and is impractical for extended periods of time. Continuous temperature monitoring by a wearable device (such as Verily Patch) has the potential to overcome these challenges resulting in better patient clinical outcomes and more cost-effective care.
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Affiliation(s)
- Nishant Verma
- Verily Life Sciences South San Francisco CA 94080 USA
| | | | - Suhas Ganesh
- Verily Life Sciences South San Francisco CA 94080 USA
| | | | - Jonas Paludo
- Division of HematologyMayo Clinic Rochester MN 55905 USA
| | - Roxana Heitz
- Verily Life Sciences South San Francisco CA 94080 USA
| | | | - Kimary Kulig
- Verily Life Sciences South San Francisco CA 94080 USA
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13
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Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs. PLoS One 2021; 16:e0254135. [PMID: 34383780 PMCID: PMC8360565 DOI: 10.1371/journal.pone.0254135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Abstract
The number of Hematopoietic Stem Cell Transplantations has risen in the past 20 years. The practice of outpatient Hematopoietic Stem Cell Transplantation programs is increasing in an attempt to improve the quality of patient care and reduce the demand for hospital admission. A systematic review of 29 comparative studies between in-hospital and outpatient treatment of Hematopoietic Stem Cell Transplantation, with no restriction by outpatient regime was conducted. This study aims to analyse the current evidence on the effects of the outpatient model on patient-centred outcomes, comparing both in-hospital and outpatient models for autologous and allogeneic HSCT using the Triple Aim framework: health outcomes, costs and experience of care. We found evidence on improved health outcomes and quality of life, on enhanced safety and effectiveness and on reduced overall costs and hospital stays, with similar results on overall survival rates comparing both models for autologous and allogeneic patients. We also found that the outpatient Hematopoietic Stem Cell Transplantation is a safe practice as well as less costly, it requires fewer days of hospital stay both for autologous and allogeneic transplantations. Under a situation of an increasing number of transplants, rising healthcare costs and shortages of hospital capacity, incorporating outpatient models could improve the quality of care for people requiring Hematopoietic Stem Cell Transplantation programs.
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14
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Tsai CK, Yeh CM, Hong YC, Chen PM, Liu JH, Gau JP, Liu CJ. The influence of high-efficiency particulate air filtration on mortality among multiple myeloma patients receiving autologous stem cell transplantation. Sci Rep 2021; 11:11789. [PMID: 34083620 PMCID: PMC8175695 DOI: 10.1038/s41598-021-91135-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) continues to be the standard treatment for transplant-eligible multiple myeloma (MM) patients. A portion of MM patients received ASCT in an isolation room with high-efficiency particulate air (HEPA) filtration. The effectiveness of the HEPA filtration on reducing treatment-related mortality (TRM) is controversial. We enrolled patients with newly diagnosed MM in Taiwan between 2000 and 2017. The primary endpoint of the study was TRM, which was defined as death within 100 days after ASCT. A total of 961 MM patients received ASCT. Of them, 480 patients (49.9%) received ASCT in an isolation room with HEPA filtration (HEPA group). The median overall survival from ASCT was 7.52 years for the HEPA group and 5.88 years for the remaining patients (non-HEPA group) (p = 0.370). The 100-day mortality rate was 1.5% and 1.0% for the HEPA and non-HEPA groups, respectively. In the multivariate analysis, the 100-day mortality had no difference between the HEPA and non-HEPA groups (adjusted hazard ratio 1.65, 95% CI 0.52-5.23). The median cost for ASCT inpatient care was $13,777.6 and $6527.6 for the HEPA and non-HEPA groups, respectively (p < 0.001). Although half of MM patients in Taiwan received ASCT in HEPA room, it didn't affect 100-day mortality.
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Affiliation(s)
- Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Cheng Hsin General Hospital, Taipei, Taiwan.,Chong Hin Loon Cancer and Biotherapy Research Center, and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan. .,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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15
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Martino M, Pitino A, Tripepi G, Paviglianiti A, Russo L, Cusumano G, Rossetti A, Provenzano PF, Porto G, Meliambro N, Gallo S, Porcino D, Romeo V, Gangemi T, D'Arrigo G, Imbalzano L, Console G, Gori M. The Burden in Caregivers of Multiple Myeloma Patients Undergoing Outpatient Autologous Stem-Cell Transplantation Compared to Inpatient Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e402-e409. [PMID: 33288484 DOI: 10.1016/j.clml.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The application of different models of autologous stem-cell transplantation (ASCT) in multiple myeloma has demonstrated the feasibility and safety of outpatient-based programs of care. Although several systematic reviews have evaluated the burden of caregivers, only a few studies have included outpatient ASCT. PATIENTS AND METHODS The feelings of lack of family support, daily activities, and general health were compared between caregivers of 2 groups of patients with multiple myeloma who underwent inpatient (n = 71) or outpatient (n = 25) ASCT. RESULTS The 3 features did not significantly differ between the 2 study groups at baseline, before, and 3 months after ASCT. Multivariate modeling showed that the baseline values were significantly related to the changes in study outcomes independent of patient and caregiver characteristics. Other correlates were caregivers' work and patient age for impact on daily activities and disease burden across time for impact on general health (all P < .05). CONCLUSION The outpatient model neither improves nor impairs global caregivers' burden compared to standard ASCT care. Further research is needed to confirm this observation and to better assess the burden and quality of life of caregivers and their influence on patient outcomes and quality of life.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | | | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Antonio Rossetti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Pasquale Fabio Provenzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Lucrezia Imbalzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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16
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Martino M, Paviglianiti A, Memoli M, Martinelli G, Cerchione C. Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art. Front Oncol 2020; 10:592487. [PMID: 33262948 PMCID: PMC7686536 DOI: 10.3389/fonc.2020.592487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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