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Lo TY, Wang YL, Jaing TH, Chang TY, Wen YC, Chiu CC, Hsiao YW, Chen SH. Early Allogeneic Transplantation Favorably Influences the Outcome of Pediatric Acute Myeloid Leukemia-A Retrospective Study in a Single Center Over 2 Decades. Transplant Proc 2024; 56:201-210. [PMID: 38245493 DOI: 10.1016/j.transproceed.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Transplantation advancements offer the potential for improving the prognosis of patients with acute myeloid leukemia (AML). Controversies surrounding indications and timing persist. We focused on identifying prognostic factors and exploring the advantages of early transplantation. PATIENTS AND METHODS We studied 102 pediatric patients with AML (February 1999-August 2022), using Cox regression to analyze survival and hematopoietic cell transplantation (HCT) outcomes and Kaplan-Meier curves to assess HCT timing's impact on prognosis. RESULTS "Treatment in First Complete Remission [CR1]: Chemotherapy" showed increased risk in multivariate and univariate Cox regression analyses, whereas "HCT during the study period" displayed divergent outcomes. Focusing on transplanted patients, "Treatment in CR1: Chemotherapy" still correlated with higher mortality risk. These findings emphasize the pivotal role of the treatment strategy adopted in CR1 on overall survival rather than HCT alone. Donor cytomegalovirus (CMV) positivity is also related to reduced mortality risk. Kaplan-Meier analysis supported superior 5-year survival rates with "HCT" compared with "chemotherapy" in CR1. In the 3-arm analysis, "HCT in CR1" demonstrated better 5-year overall survival (OS) and 5-year disease-free survival (DFS) compared with "Never HCT," whereas "HCT in CR2" had the least favorable prognosis (5-year OS: 79.2% vs 57.1% vs 50%, P = .056; 5-year DFS: 73.6% vs 55.2% vs 0%, P = .000). CONCLUSION Our study highlights the benefits of transplantation during CR1 on prognosis. However, when contemplating CR1 transplantation recommendations, evaluation of various factors, such as the patient's clinical state, relapse risk, transplant-related mortality, CMV status, and other pertinent considerations, is vital. Comprehensive case discussions with patients and families are demanded in optimizing treatment.
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Affiliation(s)
- Tzu-Ya Lo
- Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Lun Wang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Wen Hsiao
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Liao FY, Wang YL, Wen YC, Chiu CC, Chang TY, Jaing TH. Vitiligo and Alopecia Areata After Donor Lymphocyte Infusions in a Child With Relapsed Acute Myeloid Leukemia. Cureus 2024; 16:e52810. [PMID: 38389613 PMCID: PMC10883748 DOI: 10.7759/cureus.52810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Rarely do patients with chronic graft-versus-host disease (cGVHD) experience vitiligo and alopecia areata. Nevertheless, the exact cause of vitiligo and alopecia areata is still not fully understood. The patient experienced a relapse of acute myeloid leukemia (AML) following a second complete remission after undergoing HLA-6/8 mismatched unrelated donor hematopoietic cell transplantation (HCT). Achieving full donor chimerism was successful during the initial stages of the transplant. Nevertheless, the molecular evidence of measurable residual disease remained, prompting the administration of donor lymphocyte infusions (DLI) following a dose-escalation protocol. After three cycles of DLI given at two-month intervals, the circulating blasts eventually vanished. After the third DLI dose, vitiligo developed despite achieving molecular remission. The dermatologist confirmed the presence of vitiligo and alopecia areata, along with cutaneous cGVHD. The outcome was the complete elimination of the molecular presence, and the patient experienced both clinical and molecular remission for a period of five years following DLI. Based on our observations, it was found that DLI could effectively eradicate molecular leukemia in cases of AML relapse after HCT. The development of vitiligo and alopecia areata was influenced by the destruction of melanocytes due to autoimmune reactions caused by cGVHD.
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Affiliation(s)
- Fan-Yu Liao
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, TWN
| | - Yi-Lun Wang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, TWN
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, TWN
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, TWN
| | - Tsung-Yen Chang
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, TWN
| | - Tang-Her Jaing
- Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, TWN
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Wang YL, Chang TY, Wen YC, Yang SH, Hsiao YW, Chen SH, Jaing TH. Ruxolitinib add-on therapy in steroid-refractory graft-vs-host disease following hematopoietic cell transplantation: A single institutional experience. Pediatr Neonatol 2024; 65:85-86. [PMID: 37951828 DOI: 10.1016/j.pedneo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Yi-Lun Wang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ho Yang
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Wen Hsiao
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Hsiao YW, Chiu CC, Lin YT, Wen YC, Yang SH, Wang YL, Chang TY, Chen SH, Jaing TH. Clinical outcomes of COVID-19 in pediatric hematology-oncology patients: A single-institution experience. Pediatr Neonatol 2023; 64:679-680. [PMID: 37648604 DOI: 10.1016/j.pedneo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Yi-Wen Hsiao
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ting Lin
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ho Yang
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Lun Wang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chiu CC, Hsiao YW, Wen YC, Chang TY, Chen SH, Jaing TH. Aloe vera gel for prevention of chemotherapy-induced hyperpigmentation: Four case reports. Medicine (Baltimore) 2023; 102:e34037. [PMID: 37352058 PMCID: PMC10289538 DOI: 10.1097/md.0000000000034037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE This study aimed to evaluate the efficacy of topical application of Aloe vera gel in preventing chemotherapy-induced hyperpigmentation (CIH). CIH is a common side effect of chemotherapy that causes skin irritation, redness, and itching. Aloe vera has been studied for its potential use in treating radiation-induced dermatitis, which may help alleviate some of the symptoms associated with this condition. PATIENT CONCERNS In this study, 4 children requiring curative chemotherapy were prospectively enrolled and treated with Aloe vera gel. DIAGNOSIS Acute skin reactions were monitored and classified according to the Common Terminology Criteria for Adverse Events Grading Scale. INTERVENTIONS Patients were asked to use the gel on one-half of the body field twice daily from the beginning of treatment until 4 weeks after the completion of chemotherapy, with no medication to be used on the other half. OUTCOMES The results indicate that applying Aloe vera gel may reduce the visibility of hyperpigmentation at subsequent time points. The most important observation was that the continued application of Aloe vera gel 4 weeks after the completion of chemotherapy was effective in reducing the grading of CIH. LESSONS These effects highlight the potential of Aloe vera gel as a topical onconutraceutical treatment for CIH.
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Affiliation(s)
- Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Wen Hsiao
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
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Wang YL, Chang TY, Hsieh HY, Chen SH, Wen YC, Chiu CC, Jaing TH. Association of CD34 + Cell Dose with Progression-free Survival after Allogeneic Peripheral Blood Hematopoietic Cell Transplantation in Children with Hematologic Malignancies. Transplant Proc 2023; 55:481-484. [PMID: 36863969 DOI: 10.1016/j.transproceed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/23/2022] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND A Higher CD34+ cell dose is associated with improved engraftment but may also be associated with an increased risk of complications after allogeneic hematopoietic stem cell transplantation, including graft-versus-host disease (GVHD). METHODS We retrospectively analyze the impact of CD34+ cell dose on OS, PFS, neutrophil engraftment, platelet engraftment, treatment-related mortality, and GVHD grading. RESULTS For analyses, CD34+ cell dose was stratified into low (< 8.5 × 106/kg) and high (> 8.5 × 106/kg). A subgroup analysis of higher CD34+ cell dose leads to prolonged OS and PFS, but statistical significance was achieved only for PFS (OR 0.36; 95%CI 0.14-0.95; P = 0.04). CONCLUSIONS This study reinforced that CD34+ cell dose at the time of allo-HSCT retained a positive impact on PFS.
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Affiliation(s)
- Yi-Lun Wang
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Divisions of Hematology/Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Yi Hsieh
- Department of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Divisions of Hematology/Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Divisions of Hematology/Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Tung YL, Wang YL, Chang TY, Chiu CC, Wen YC, Jaing TH. Allogeneic stem cell transplantation without preconditioning in a child with therapy-related myelodysplastic syndrome: A case report. Medicine (Baltimore) 2023; 102:e32770. [PMID: 36820588 PMCID: PMC9907963 DOI: 10.1097/md.0000000000032770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE Infants with mixed-lineage leukemia (MLL)-rearranged leukemia are usually refractory to standard induction therapy and are not immediate candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Chromosome 11q23 translocations, resulting in MLL rearrangement, have been well characterized in infant acute lymphoblastic leukemia (ALL). While t(4;11) ALL continues to have carry a bleak prognosis, patients with therapy-related myelodysplastic syndrome (t-MDS) have a shorter median overall survival than those compared with de novo MDS. PATIENT CONCERNS We describe a child with t-MDS who evolved from MLL-rearranged ALL and was successfully treated with HSCT without toxic preconditioning. DIAGNOSES MDS diagnosis was based on morphological characteristics of bone marrow dysplasia in patients with clinical manifestations evidence of hematopoiesis impairments by different combinations of anemia, leukopenia, neutropenia, and thrombocytopenia. INTERVENTIONS Although the best donor for allo-HSCT is generally considered an human leukocyte antigen-matched sibling, only ~ 30% of patients have a suitable sibling. HSCT from an unrelated donor is a suitable option for patients with t-MDS who do not have matched sibling donors. OUTCOMES Allo-HSCT without recipient preconditioning could be a promising treatment option for t-MDS, especially for patients with recurrent or persistent infections. LESSONS Cytogenetics, prognosis, and treatment of t-MDS are briefly discussed. Preconditioning before allo-HSCT seriously damages immune function. This work reviews our experience with a patient with t-MDS following ALL complicated by recurrent infections, and highlights our choice to omit preconditioning from allo-HSCT.
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Affiliation(s)
- Yi-Ling Tung
- Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Lun Wang
- Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology and Oncology, Chang Gung Children’s Hospital, Chang Gung University, Taoyuan, Taiwan
- * Correspondence: Tang-Her Jaing, Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, 5 Fu-Shin Street, Kwei-Shan, Taoyuan 33305, Taiwan (e-mail: )
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Muacevic A, Adler JR, Wang Y, Chang TY, Wen YC, Hsiao YW, Chen SH, Jaing TH. Immersive Virtual Reality to Distract From Pain in Children Treated With L-asparaginase by Intramuscular Injection. Cureus 2023; 15:e34317. [PMID: 36860237 PMCID: PMC9970793 DOI: 10.7759/cureus.34317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
Background Treatment-related pain and discomfort are two of the most common manifestations in children with acute lymphoblastic leukemia (ALL). Patients with ALL are usually treated with L-asparaginase (L-ASP) by intramuscular injection. Children receiving L-ASP chemotherapy must bear adverse reactions such as pain caused by intramuscular injections. The use of virtual reality (VR) distraction technology could be a non-pharmacological intervention to bolster patients' comfort and decrease anxiety and procedure-related pain within hospital settings. Methodology The study explored the potential benefits of VR as a psychological intervention to induce positive emotions and reduce pain levels in participants receiving L-ASP injections. Participants in the study had the opportunity to select a nature theme of their choosing during their treatment session. The study provided a noninvasive solution that promoted relaxation to reduce anxiety by shifting an individual's mood positively during treatment. The objective was met by measuring participants' mood and pain levels before and after the VR experience and participant satisfaction with the use of the technology. This mixed-methods study of children aged six to 18 received L-ASP between April 2021 and March 2022, using a Numerical Rating Scale (NRS) with sheer numbers ranging from 0 (no pain) to 10 (extreme or most pain possible). Semi-structured interviews were conducted to collect new data and explore participants' thoughts and beliefs about a particular topic. A total of 14 patients participated. Descriptive statistics and content analysis are used to describe the data analyzed. VR is an enjoyable distraction intervention for managing treatment-related pain in ALL with intramuscular chemotherapy. Results Eight of 14 patients found a reduction in perceived pain after wearing VR. During the intervention implementation, the primary caregivers felt that the patient's pain perception was more positive when using the virtual reality device, and there was less resistance and less crying. Conclusions This study describes changes and experiences associated with pain and physical discomfort in children with ALL receiving intramuscular chemotherapy. This teaching model is applied to developing medical personnel, providing information about the disease and daily care, and educating the participants' family members. This study may expand the usage of VR applications so that more patients can benefit from them.
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Chiu CC, Jaing TH, Lai JY, Chen SH, Chang TY, Hsueh C, Wen YC, Tsay PK. Malignant testicular tumors in children: A single institution's 12-year experience. Medicine (Baltimore) 2022; 101:e29735. [PMID: 35866814 PMCID: PMC9302240 DOI: 10.1097/md.0000000000029735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Testicular neoplasms are not commonly found in children and are a formidable threat if treated inappropriately. However, there is no consensus regarding its management. This study aimed to create a holistic picture of the interprofessional team in the management of malignant testicular tumors. Seventeen patients had mixed germ cell tumors, 15 had pure yolk sac tumors, 2 had immature teratomas, 2 had teratocarcinomas, and 1 had a sex cord stromal tumor. Five lesions were diagnosed as nongerm cell tumors: 2 embryonal rhabdomyosarcomas, 2 lymphomas, and 1 acute myeloid leukemia. At initial presentation, retroperitoneal (n = 2), bone marrow (n =1), and mediastinal (n = 1) metastases were identified in 4 (10%) patients. The operative interventions performed included radical inguinal orchiectomy (n = 5), scrotal orchiectomy (n = 31), and testicular biopsy or testis-sparing enucleation of the tumor (n = 6). Postoperatively, 18 patients received either adjuvant chemotherapy (n = 14) or chemoradiation (n = 5). Five patients with mixed germ cell tumors (n = 2), group IV paratesticular rhabdomyosarcoma (n = 2), and acute myeloid leukemia with myeloid sarcoma (n =1) died of disease progression. Thirty-six patients remained alive and disease-free at the last visit. Malignant testicular tumors in children deserve proper diagnostic support from a therapeutic perspective. Any concern or suspicion of a testicular tumor warrants an inguinal approach to avoid scrotal violation.
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Affiliation(s)
- Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taiwan
| | - Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taiwan
- *Correspondence: Tang-Her Jaing, Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, 5 Fu-Shin Street, Kwei-Shan 33305, Taoyuan, Taiwan (e-mail: )
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Children’s Hospital, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taiwan
| | - Tsung-Yen Chang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taiwan
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Jaing TH, Chang TY, Chen SH, Lin CW, Wen YC, Chiu CC. Molecular genetics of β-thalassemia: A narrative review. Medicine (Baltimore) 2021; 100:e27522. [PMID: 34766559 PMCID: PMC8589257 DOI: 10.1097/md.0000000000027522] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT β-thalassemia is a hereditary hematological disease caused by over 350 mutations in the β-globin gene (HBB). Identifying the genetic variants affecting fetal hemoglobin (HbF) production combined with the α-globin genotype provides some prediction of disease severity for β-thalassemia. However, the generation of an additive composite genetic risk score predicts prognosis, and guide management requires a larger panel of genetic modifiers yet to be discovered.Presently, using data from prior clinical trials guides the design of further research and academic studies based on gene augmentation, while fundamental insights into globin switching and new technology developments have inspired the investigation of novel gene therapy approaches.Genetic studies have successfully characterized the causal variants and pathways involved in HbF regulation, providing novel therapeutic targets for HbF reactivation. In addition to these HBB mutation-independent strategies involving HbF synthesis de-repression, the expanding genome editing toolkit provides increased accuracy to HBB mutation-specific strategies encompassing adult hemoglobin restoration for personalized treatment of hemoglobinopathies. Allogeneic hematopoietic stem cell transplantation was, until very recently, the curative option available for patients with transfusion-dependent β-thalassemia. Gene therapy currently represents a novel therapeutic promise after many years of extensive preclinical research to optimize gene transfer protocols.We summarize the current state of developments in the molecular genetics of β-thalassemia over the last decade, including the mechanisms associated with ineffective erythropoiesis, which have also provided valid therapeutic targets, some of which have been shown as a proof-of-concept.
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Affiliation(s)
- Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Wei Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chang TY, Wang YL, Chang CC, Chen SH, Wen YC, Tsay PK, Jaing TH. Comparable Outcomes Between Adolescent/Young Adults and Children With Acute Myeloid Leukemia Following Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience. Transplant Proc 2021; 53:3075-3079. [PMID: 34756713 DOI: 10.1016/j.transproceed.2021.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The cytogenetics of acute myeloid leukemia (AML) increases exponentially with age. Adolescent and young adult (AYA) patients have specific psychosocial and other challenges, influencing their ability to access appropriate treatment. Therefore, in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for AML, inferior outcomes would be observed in AYA patients compared to children. METHODS We defined the age range of AYA patients as 15 to 29 years. Sixty-three patients who underwent allo-HSCT from 1998 to 2020 at Chang Gung Children Hospital were enrolled in this study. Overall survival was the time duration from HSCT to death from any cause. Disease-free survival was the time duration from HSCT to the last follow-up or first event (failure to achieve complete remission, relapse, secondary malignancy, or death from any cause). RESULTS Thirty-seven (59%) patients were <15 years of age during allo-HSCT, and 26 (41%) were 15 to 29 years of age. The median age during allo-HSCT was 6.3 years for those <15 years of age compared with 15.7 years for AYA patients. The median follow-up period was 2.2 years after hematopoietic stem cell transplantation for patients <15 years old and 3.8 years after hematopoietic stem cell transplantation for AYA patients. Univariate analysis revealed no significant difference in the 5-year overall survival or disease-free survival among all patients. CONCLUSIONS Several distinct AML subtypes could be amenable to treatment deintensification and targeted therapies. Furthermore, we found that children and AYA patients who underwent allo-HSCT for AML had similar survival.
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Affiliation(s)
- Tsung-Yen Chang
- Division of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Lun Wang
- Division of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Chu Chang
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Division of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
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Liu YM, Jaing TH, Wen YC, Chen SH, Weng PY, Lin L, Wu CL. Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation. Qual Life Res 2021; 30:3421-3430. [PMID: 34018123 DOI: 10.1007/s11136-021-02887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We examined the association between health-related quality of life (HRQoL) of pediatric patients during hospitalization for allogeneic hematopoietic cell transplantation (HCT) and length of hospital stay, and 1-year survival. METHODS Primary family caregivers were proxy-assessors for the Pediatric Quality of Life (PedsQL) Stem Cell Transplant Module at three time points: 5-days pre-HCT (T0); 14-days post-HCT (engraftment, T1); and 1-week before hospital discharge (T2). Cox regression analyses determined predictors of the overall 1-year survival after allogeneic HCT. RESULTS Thirty-nine eligible caregivers completed all assessments. The mean age of the pediatric patients was 9.07 years (SD = 5.2). PedsQL Stem Cell Transplant Module scores decreased from 71.33 (SD = 13.26) at T0 to 55.41(SD = 13.05) at T1 (p < 0.001) and increased to 68.46 (SD = 13.97) at T2 (p < 0.001). There was no significant difference between scores at T0 and T2. Longer length of hospital stay was associated with children who were younger and had greater relative changes in scores on the caregiver-proxy PedsQL Stem Cell Transplant Module from T0 to T1. PedsQL Stem Cell Transplant Module scores ≥ 58.07 at T2 were associated with higher 1-year survival rates (Hazard Ratio = 0.12, 95% Confidence Interval = 0.02-0.78; p = 0.03). CONCLUSION Our findings suggest that assessment of HRQoL during early HCT can add prognostic value beyond demographic and HCT factors. Understanding the HRQoL status during hospitalization for HCT could help identify pediatric patients with low prospects of 1-year survival in order to provide support interventions to improve HRQoL and survival rates.
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Affiliation(s)
- Ying-Mei Liu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- , No. 261, Wen-Hwa 1st Road, Guishan District, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Yin Weng
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lin Lin
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Chia-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Lin YT, Wong CY, Chang TY, Chiu CC, Wen YC, Jaing TH. The effect of tetrastarch solution for capillary leak syndrome following allogeneic hematopoietic stem cell transplantation: A report of 2 cases. Hematol Rep 2021; 13:8750. [PMID: 33747410 PMCID: PMC7967264 DOI: 10.4081/hr.2021.8750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Abstract
Capillary leak syndrome (CLS) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) characterized by weight gain, generalized edema, hypotension, and hypoalbuminemia. The primary pathogenesis is injury of the capillary endothelium resulting in a loss of intravascular fluid into the interstitial space. Treatment is limited to vascular endothelial growth factor withdrawal and systemic corticosteroids. We report two cases with CLS where weight gain, ascites, and hypotension developed after neutrophil engraftment following allogeneic HSCT. We obtained serial electrolytes, blood urea nitrogen, creatinine, and albumin from these patients. Ultrasound with Doppler tracing performed on both patients showed no reversal of portal venous flow. Issues addressed were the restoration of regular hydration by hydroxyethyl starch (HES) solutions, together with systemic corticosteroids and forced diuresis. Tetrastarch was administered 10 and 20 days, respectively. Both patients recovered without sequelae. CLS is a frequent complication after allogeneic HSCT. The effects of HES on CLS merit further consideration and prospective study.
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Affiliation(s)
- Yu-Ting Lin
- Division of Clinical Pharmacy, Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan
| | | | - Tsung-Yen Chang
- Divisions of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
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14
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Chang TY, Chen SH, Jaing TH, Yang SH, Wen YC, Yang CP, Hung IJ. Cytogenetic aberration in mixed-phenotype acute leukemia in children: A single-center retrospective review. Pediatr Neonatol 2021; 62:21-25. [PMID: 32859541 DOI: 10.1016/j.pedneo.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Mixed-phenotype acute leukemia (MPAL) poses a diagnostic and therapeutic dilemma. No consensus exists on the strategy to assign patients with MPAL to either lymphoid- or myeloid-directed treatment. Thus, a better understanding of the characteristics of MPAL is a crucial unmet need. This study aims to provide information on a population-based cohort of children who received treatment based on standard, simple immunophenotypic criteria. METHODS Single-center, retrospective clinical and laboratory reviews of patients with MPAL were provided by morphology, immunophenotyping, cytogenetics, and molecular methods. We identified 242 flow cytometry samples. Of all consecutive pediatric patients with acute leukemia, we identified 8 (3.3%) patients with MPAL fulfilling WHO 2016 criteria; these were classified as follows: B-lymphoid + myeloid (n = 4), T-lymphoid + myeloid (n = 2), and B + T-lymphoid (n = 2). RESULTS Of 8 MPAL cases, 4 were boys and 4 girls [median age at diagnosis: 10.8 (range 1.1-17) years]. The b3a2 (p210) and e1a2 (p190) BCR/ABL fusion transcripts were detected in 1 patient with B/myeloid MPAL. Regarding the morphology, all patients were initially diagnosed as acute lymphoblastic leukemia, but no morphological characteristics or cytogenetic aberration was particularly predictive of an MPAL. Furthermore, 4 of 8 patients (50%) with MPAL were associated with chromosome 21 monosomy or partial trisomy. CONCLUSION Despite no single recurrent chromosomal abnormality that could serve as a hallmark lesion in MPAL, cytogenetic alterations are frequent and predominantly associated with complex karyotype involving chromosome 21 abnormalities.
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Affiliation(s)
- Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Shu-Ho Yang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
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15
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Liu YM, Wen YC, Weng PY, Jaing TH, Chen SH. Effectiveness of a Three-Stage Intervention in Reducing Caregiver Distress During Pediatric Hematopoietic Stem Cell Transplantation: A Randomized Controlled Trial. J Pediatr Oncol Nurs 2020; 37:377-389. [PMID: 32326815 DOI: 10.1177/1043454220911358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
More than one fourth of primary caregivers report clinically significant distress during the hematopoietic stem cell transplantation (HSCT) process. Providing early support to primary caregivers could reduce caregiver distress and improve the quality of life. This study examined the effects of a three-stage caregiver support intervention designed to reduce caregiver distress and improve quality of life during pediatric HSCT hospitalization. A two-group comparative study was conducted with repeated measures. Participants were randomly assigned to an intervention group or a control group. The intervention group received the support intervention 5 days before the transplant, 14 days after transplant, and 1 week before hospital discharge. The control group received standard support provided in the hospital ward. Measures were obtained at all three time points from self-report questionnaires, which were related to anxiety, depression, perceived stress, and quality of life. Findings indicated that primary caregivers in the intervention group (n = 22) reported significantly lower levels of perceived stress and higher levels of quality of life than the control group (n = 23) at 14 days after transplant. In the intervention group, caregiver distress significantly decreased from pretransplant through 14 days after transplant, while over the same period caregiver quality of life significantly increased. The intervention effectively changed the trend of distress and quality of life for caregivers of children during the process of HSCT and hospitalization. The findings of this study suggest that it is important to provide early targeted interventions at critical junctures for caregivers at risk of adverse outcomes.
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Affiliation(s)
- Ying-Mei Liu
- Chang Gung University of Science and Technology, Taiwan.,Linkou Chang Gung Memorial Hospital, Taiwan
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16
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Liu YM, Wen YC, Weng PY, Jaing TH, Chen SH. Exploring the concerns and experiences of parents of children scheduled to receive haematopoietic stem cell transplant. J Adv Nurs 2020; 76:1737-1745. [PMID: 32281120 DOI: 10.1111/jan.14386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
AIMS To explore the concerns and experiences of parents of children scheduled to receive allogeneic haematopoietic stem cell transplantation. DESIGN A qualitative secondary analysis of interview data from an intervention study. METHODS A total of 28 parents (4 fathers and 24 mothers) were recruited from a children's hospital, which performs approximately one-third of all paediatric haematopoietic stem cell transplantation cases in Taiwan. Data were collected between September 2015-August 2018 by one researcher with face-to-face interviews, which were tape-recorded and transcribed verbatim. The data were analysed using inductive content analysis to extract the main themes. RESULTS Five themes describing parental concerns prior to paediatric haematopoietic stem cell transplantation were identified: the child became their first priority, seeking solutions, an interweaving of hope and uncertainty, grateful for the chance of a cure and the long road to recovery. CONCLUSION Understanding the concerns and experiences of our participants as they navigated the pre-transplantation period could reduce parents' uncertainty and improve the care of their child. IMPACT These experiences provide information that could be used by healthcare professionals to develop support interventions and strategies tailored to the individual needs of each parent, which could prepare parents for their child's haematopoietic stem cell transplantation.
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Affiliation(s)
- Ying-Mei Liu
- Department of Nursing, Chang Gung University of Science and Technology, Linkou, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Yin Weng
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
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17
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Jaing TH, Chang TY, Chen SH, Wen YC, Yu TJ, Lee CF, Yang CP, Tsay PK. Factors associated with cytomegalovirus infection in children undergoing allogeneic hematopoietic stem-cell transplantation. Medicine (Baltimore) 2019; 98:e14172. [PMID: 30681583 PMCID: PMC6358375 DOI: 10.1097/md.0000000000014172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
While preemptive therapy with ganciclovir (GCV) for cytomegalovirus (CMV) infection is used following allogeneic hematopoietic stem-cell transplantation (HSCT), risk factors for CMV infection in children undergoing HSCT are poorly understood.We studied CMV reactivation following allogeneic HSCT by retrospectively analyzing pediatric patients who received allogeneic HSCT and preemptive GCV therapy between 1998 and 2016. The level of viremia requiring preemptive GCV therapy was >1 CMV antigen-positive cells per 5 × 10 leukocytes during the antigenemia assay era and >1000 copies/mL in the polymerase chain reaction era. Among 290 at-risk patients, 54 (18.6%) patients had primary CMV infection or CMV reactivation occurring at a median of 76 days (range, 7-234) following HSCT. CMV reactivation occurred in 28.2% (44/156) of CMV-seropositive transplant recipients at a median of 26 days posttransplant.Univariate and multivariate analyses revealed statistically significant relationships between CMV infection and grade III-IV acute graft-vs-host disease, seronegative donor/seropositive recipient combination, and unrelated/mismatched donors. The remaining demographic factors were not predictive of CMV infection.The seronegative donor/seropositive recipient combination for HSCT was associated with an incomplete response to antiviral therapy. Human leukocyte antigen identical donors were the best choice for patients undergoing allogeneic HSCT to reduce the incidence of CMV disease and mortality.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital
| | - Tsung-Yen Chang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital
| | | | | | - Ching-Fen Lee
- Division of Clinical Pharmacy, Department of Pharmacy, Chang Gung Memorial Hospital
| | - Chao-Ping Yang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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18
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Jaing TH, Chen SH, Wen YC, Chang TY, Tsai DY, Chung HT, Tsay PK. Factors Affecting Survival in Children With Pericardial Effusion After Hematopoietic Stem Cell Transplantation. Cell Transplant 2018; 26:1792-1797. [PMID: 29338379 PMCID: PMC5784522 DOI: 10.1177/0963689717727285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to determine the incidence, risk factors, outcome, and clinical significance of pericardial effusion (PE). We retrospectively analyzed outcomes of 272 pediatric patients undergoing their first hematopoietic stem cell transplantation (HSCT) from 1998 to 2016. In total, 15% (3/20) and 5.9% (15/252) of autologous and allogeneic HSCT recipients, respectively, were identified with PE. However, there was no statistically significant difference in the incidence of PE between the 2 groups. The mean age at transplantation was 11.12 ± 5.41 y. Eighteen patients developed PE at 4.13 ± 4.44 mo after HSCT. PE was confirmed by echocardiogram in all patients. Three patients presented with severe PE with cardiac tamponade and required urgent pericardiocentesis. Overall survival (OS) rates for patients who developed PE were 83.3% and 38.9% at 100 d and 3 y, respectively, after HSCT. Death was not directly attributable to PE in patients who died in the first year after HSCT. Multivariable analysis identified the following variables to be associated with OS: PE (relative risk[RR]: 3.70; 95% confidence interval [95% CI]: 1.89-7.23; P < 0.001), active disease at HSCT (RR: 1.59; 95% CI: 1.02-2.49; P < 0.001), and thalassemia (RR: 0.62; 95% CI: 0.45-0.84; P < 0.001). PE is, thus, a debilitating and significant complication of pediatric HSCT. Therefore, prospective studies are required for better determination of the etiology and optimal method of PE treatment after HSCT.
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Affiliation(s)
- Tang-Her Jaing
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Shih-Hsiang Chen
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Yu-Chuan Wen
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Tsung-Yen Chang
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Dai-Yun Tsai
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Hung-Tao Chung
- 3 Division of Cardiology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Pei-Kwei Tsay
- 4 Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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19
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Jaing TH, Chang TY, Chen SH, Wen YC, Chuang WY, Yang CP. Small cell variant of ALK-positive anaplastic large cell lymphoma with primary subcutaneous presentation: A case report. Medicine (Baltimore) 2018; 97:e11222. [PMID: 29952979 PMCID: PMC6039684 DOI: 10.1097/md.0000000000011222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE The rare morphological variant of anaplastic large cell lymphoma (ALCL) may pose a challenge in diagnosis, especially when presentation primarily involves skin lesions. PATIENT CONCERNS Here we describe a rare case of small cell variant of ALCL in an 11-year-old girl. DIAGNOSIS We performed clinical, morphological, and immunohistochemical analyses of developed cutaneous nodules. INTERVENTIONS Pathologists should consider this small cell variant in ALCL differential diagnosis, as early and correct diagnosis has important clinical implications. OUTCOMES Allogeneic hematopoietic stem cell transplantation appears to be a promising treatment option for small cell variant of ALCL. LESSONS Histological diagnosis of small cell variant of ALCL is challenging among pediatricians because of its low incidence and atypical presentation. We provide a short review of the small cell variant of ALCL to facilitate the diagnosis of this difficult-to-recognize entity.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University
| | - Tsung-Yen Chang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University
| | - Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung University and Memorial Hospital
| | - Wen-Yu Chuang
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University
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20
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Jaing TH, Chen SH, Wen YC, Chang TY, Yang YC, Tsay PK. Effects of Cryopreservation Duration on the Outcome of Single-Unit Cord Blood Transplantation. Cell Transplant 2018; 27:515-519. [PMID: 29737201 PMCID: PMC6038043 DOI: 10.1177/0963689717753187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cryopreservation is widely used in umbilical cord blood (UCB) banking, yet its impact on progenitor cell function remains largely unaddressed. It is unknown whether long-term cryopreservation affects UCB transplantation outcomes. Herein, we evaluated the impact of UCB age on clinical outcomes and investigated the effect of cryopreservation duration of UCB on hematopoietic potency in 91 patients receiving single cord blood transplantations. UCB cryopreservation duration was 0.7 to 13.4 y. The most common indication of transplant was thalassemia (48%). There was no significant association between cryopreservation duration and neutrophil engraftment probability (P = 0.475). Cryopreservation duration did not affect the post-thaw viability and subsequent neutrophil engraftment rate. Therefore, UCB units can undergo cryopreservation for at least 8 y with no impact on clinical outcomes.
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Affiliation(s)
- Tang-Her Jaing
- 1 Division of Hematology and Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.,2 Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- 1 Division of Hematology and Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.,2 Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- 3 Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- 1 Division of Hematology and Oncology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.,2 Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chun Yang
- 3 Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Kwei Tsay
- 2 Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.,4 Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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21
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Lee CF, Chen CH, Wen YC, Chang TY, Lai MW, Jaing TH. Copper-associated hepatitis in a patient with chronic myeloid leukemia following hematopoietic stem cell transplantation: A case report. Medicine (Baltimore) 2017; 96:e9041. [PMID: 29245301 PMCID: PMC5728916 DOI: 10.1097/md.0000000000009041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE We report a complicated case of cholestatic hepatitis with suspected autoimmune hemolytic anemia (AIHA) and copper toxicity syndrome after HSCT and donor lymphocyte infusion (DLI). PATIENT CONCERNS A 19-year-1-month-old girl presented with a history of CML. She underwent matched unrelated donor HSCT and donor lymphocyte infusion subsequently. Three months later, yellowish discoloration of the skin was found, which was accompanied by progressive itchy skin, easy fatigability, insomnia, and dark urine output. After admission, liver function disorders were observed. INTERVENTION Methylprednisolone was administered for suspected hepatic GVHD. Although abdominal sonography revealed no evidence of biliary tract obstruction and the viral hepatitis survey disclosed unremarkable findings; silymarin and ursodeoxycholic acid were administered to preserve the liver function. In addition, rituximab was prescribed for suspected AIHA. Because hyperbilirubinemia was progressive, mycophenolate and high-dose intravenous immunoglobulin were accordingly administered. As drug-induced liver injury cannot be excluded, all potential unconfirmed causes of drug-related hepatoxicity were discontinued. DIAGNOSIS In this case, the patient's history of shrimps and chocolate consumption led us to strongly suspect cholestatic hepatitis associated with copper toxicity syndrome. High 24-hour urine copper excretion and low serum zinc levels were also confirmed. Accordingly, D-penicillamine and zinc gluconate were administered. OUTCOMES She succumbed to progressive hepatic failure and eventual multisystem organ failure 14 months after HSCT. No autopsy was performed. LESSONS This report described the combined effects of hepatic GVHD, AIHA, drugs, and copper toxicity on liver damage, and demonstrated the potential diagnostic challenges and treatment dilemmas associated with this disease.
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Affiliation(s)
- Ching-Fen Lee
- Division of Clinical Pharmacy, Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan
| | - Chi-Hua Chen
- Division of Clinical Pharmacy, Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan
| | - Tsung-Yen Chang
- Divisions of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
- Liver Research Center, Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
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22
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Chang TY, Jaing TH, Wen YC, Huang IA, Chen SH, Tsay PK. Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children. Medicine (Baltimore) 2016; 95:e5396. [PMID: 27861376 PMCID: PMC5120933 DOI: 10.1097/md.0000000000005396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is a clinically relevant complication after allogeneic hematopoietic stem cell transplantation (HSCT). Currently, there is no established consensus regarding the optimal therapeutic approach. Whether AIHA contributes to increased mortality is still somewhat controversial.We investigated the incidence, risk factors, and outcome of post-transplant AIHA in 265 consecutive pediatric patients undergoing allo-HSCT over a 17-year period. Onset of AIHA was calculated from the first documented detection of AIHA by either clinical symptoms or positive direct agglutinin test. Resolution of AIHA was defined as normalization of hemoglobin and biochemical markers of hemolysis with sustained transfusion independence.We identified 15 cases of AIHA after allo-HSCT (incidence rate, 6%). Ten (67%) of these patients had a positive direct antiglobulin test. Data were obtained for 9 boys and 6 girls after a median follow-up of 53 months (range 4-102). The median age was 5.1 years (range 0.5-15.4) at the time of HSCT and the median time to emergence was 149 days (range 42-273). No significant risk factor for post-transplant AIHA has emerged from our data to date. In the majority (14 of 15; 93%) of AIHA patients, multiple agents for treatment were required, with 12 of 15 (80%) patients achieving complete resolution of AIHA. No splenectomy was performed in any of our patients.For various reasons, post-transplantation AIHA poses an extraordinary challenge to transplant physicians. Despite the advancements in diagnostic tools, therapeutic challenges remain due to the myriad interacting pathways in AIHA.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/epidemiology
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Child, Preschool
- Coombs Test/methods
- Disease Management
- Female
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Incidence
- Longitudinal Studies
- Male
- Outcome and Process Assessment, Health Care
- Risk Factors
- Taiwan/epidemiology
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Affiliation(s)
| | | | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Children's Hospital
| | - I-Anne Huang
- Divisions of Hematology/Oncology
- Division of Pediatric General Medicine, Department of Pediatrics
| | | | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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Jaing TH, Chen SH, Wen YC, Chang TY, Huang JL, Tsay PK. Assessment of Platelet Activation and Immature Platelet Fraction as Predictors of Platelet Engraftment After Hematopoietic Stem Cell Transplantation. Cell Transplant 2016; 25:1259-64. [PMID: 26765743 DOI: 10.3727/096368916x690412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Delayed platelet engraftment is a well-known complication of umbilical cord blood transplantation (CBT). Megakaryocytes derived from cord blood (CB) in vitro are smaller than megakaryocytes derived from bone marrow (BM) in adults. A small megakaryocyte size might contribute to delayed megakaryocytic maturation. This study included 37 patients undergoing hematopoietic stem cell transplantation (HSCT) at Chang Gung Children's Hospital between July 2011 and June 2013. Blood samples were obtained at different times: preconditioning and post-HSCT days 56 and 97. To test whether platelet activation persists posttransplantation, two commonly used platelet activation marker antibodies, CD62P (P-selectin) and CD42b, were evaluated using whole blood flow cytometry, combining thiazole orange and anti-CD41a staining, to assess reticulated platelets. Serial peripheral blood (PB) samples were obtained posttransplantation from patients undergoing CBT (CBT group; n = 15) and mobilized peripheral blood transplantation (PBT group; n = 22). Platelet activation in the postengraftment samples was considerably higher in the PBT group than the CBT group. Moreover, immature platelet fractions (IPF) were higher in the CBT group. Our results emphasize the role of IPF for dynamic prediction of platelet engraftment in CBT.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
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24
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Zhang XF, Sun Q, Wen YC, Liu WM, Eggert S, Ji AC. Rydberg polaritons in a cavity: a superradiant solid. Phys Rev Lett 2013; 110:090402. [PMID: 23496692 DOI: 10.1103/physrevlett.110.090402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 06/01/2023]
Abstract
We study an optical cavity coupled to a lattice of Rydberg atoms, which can be represented by a generalized Dicke model. We show that the competition between the atom-atom interaction and atom-light coupling induces a rich phase diagram. A novel superradiant solid (SRS) phase is found, where both the superradiance and crystalline orders coexist. Different from the normal second order superradiance transition, here both the solid-1/2 and SRS to SR phase transitions are first order. These results are confirmed by large scale quantum Monte Carlo simulations.
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Affiliation(s)
- Xue-Feng Zhang
- Physics Department and Research Center OPTIMAS, University of Kaiserslautern, 67663 Kaiserslautern, Germany
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25
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Jaing TH, Hung IJ, Chen SH, Lee WI, Wen YC, Fang EC. Successful transplantation of ethnically mismatched cord blood in a boy with atypical chronic myeloid leukemia. Int J Hematol 2012; 97:144-6. [PMID: 23264127 DOI: 10.1007/s12185-012-1251-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 12/16/2022]
Abstract
In the present study, we describe unrelated umbilical cord blood transplantation (CBT) in a 7-year-old Taiwanese boy with atypical chronic myeloid leukemia (BCR-ABL 1 negative). Physical examination was notable for splenomegaly. Cytogenetic analyses from the bone marrow revealed a t(3;5)(p21;q31) translocation. The patient then underwent CBT from an HLA-mismatched (two loci by serotype, three loci by genotype) unrelated donor of Caucasian origin. Times to neutrophil and platelet engraftment were 21 and 62 days post-transplant, respectively. Acute graft-versus-host disease following transplantation was minimal. The patient remains in continuing hematological remission with full donor chimerism 28 months after transplantation.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, 5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan.
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26
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Lu SC, Jaing TH, Wen YC, Jane SW, Lin SW. [The experiences of caregivers caring for children with cord blood transplantation]. Hu Li Za Zhi 2011; 58:34-42. [PMID: 22024803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Advancing technology has greatly increased cord blood transplantation (CBT) success rates. However, transplant patient caregivers may encounter a great deal of stress related to knowledge deficits with regard to post-transplant care and lack of relevant care experience. Existing studies for CBT primarily focus on investigating the transplant process and survival rate. Studies on the experience of caregivers caring for CBT children are extremely scarce. It is important for future studies to explore the care experiences of CBT caregivers. PURPOSE This study explored the experiences of primary caregivers responsible to care for pediatric patients after CBT. METHODS Researchers conducted a phenomenological study of lived experiences using qualitative interviews that were in-depth, face-to-face, and semi-structured. RESULTS Colaizzi analysis identified three themes, as follows: (1) emotional transition; (2) bearing indescribable of stress; (3) searching for management in meaningful resolutions. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Study results can provide valuable insights and information to healthcare providers developing preparatory educational programs for caregivers of discharged CBT patients. Findings can help alleviate care stress and anxiety in caregivers and nurses.
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Affiliation(s)
- Shu-Chen Lu
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Medical Foundation Hospital, Linkou, Taoyuan County, Taiwan, ROC
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Su CK, Ho CM, Kuo HH, Wen YC, Chai CY. Sympathetic-correlated c-Fos expression in the neonatal rat spinal cord in vitro. J Biomed Sci 2009; 16:44. [PMID: 19409080 PMCID: PMC2687431 DOI: 10.1186/1423-0127-16-44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 05/01/2009] [Indexed: 02/07/2023] Open
Abstract
An isolated thoracic spinal cord of the neonatal rat in vitro spontaneously generates sympathetic nerve discharge (SND) at ~25 degrees C, but it fails in SND genesis at < or = 10 degrees C. Basal levels of the c-Fos expression in the spinal cords incubated at < or = 10 degrees C and ~25 degrees C were compared to determine the anatomical substrates that might participate in SND genesis. Cells that exhibited c-Fos immunoreactivity were virtually absent in the spinal cords incubated at < or = 10 degrees C. However, in the spinal cords incubated at ~25 degrees C, c-Fos-positive cells were found in the dorsal laminae, the white matter, lamina X, and the intermediolateral cell column (IML). Cell identities were verified by double labeling of c-Fos with neuron-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), or choline acetyltransferase (ChAT). The c-Fos-positive cells distributed in the white matter and lamina X were NeuN-negative or GFAP-positive and were glial cells. Endogenously active neurons showing c-Fos and NeuN double labeling were scattered in the dorsal laminae and concentrated in the IML. Double labeling of c-Fos and ChAT confirmed the presence of active sympathetic preganglionic neurons (SPNs) in the IML. Suppression of SND genesis by tetrodotoxin (TTX) or mecamylamine (MECA, nicotinic receptor blocker) almost abolished c-Fos expression in dorsal laminae, but only mildly affected c-Fos expression in the SPNs. Therefore, c-Fos expression in some SPNs does not require synaptic activation. Our results suggest that spinal SND genesis is initiated from some spontaneously active SPNs, which are capable of TTX- or MECA-resistant c-Fos expression.
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Affiliation(s)
- Chun-Kuei Su
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, Republic of China
| | - Chiu-Ming Ho
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan, Republic of China
| | - Hsiao-Hui Kuo
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, Republic of China
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan, Republic of China
| | - Yu-Chuan Wen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, Republic of China
| | - Chok-Yung Chai
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan, Republic of China
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei 114, Taiwan, Republic of China
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Jaing TH, Tsay PK, Lin TL, Yang CP, Hung IJ, Wen YC. Pre-freeze and post-thaw characteristics on chimerism patterns in double-unit cord blood transplantation. Pediatr Blood Cancer 2009; 52:547-50. [PMID: 19061224 DOI: 10.1002/pbc.21882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We analyzed the pre-freeze and post-thaw characteristics on chimerism patterns in 20 cases of double-unit cord blood transplantation. The cord blood units (CBUs) were a 4/6 HLA match or better with recipients and achieved a minimum combined precryo-preservation cell dose of 3.7 x 10(7) total nucleated cell (TNC)/kg. The unit with a higher cell dose was infused first. All evaluable patients engrafted at a median of 18 days. By day 42, neutrophil engraftment was derived from both donors in 63% of cases and a single donor in 37% of patients. By day 100, one unit predominated in 80% of the patients. Higher pre-freeze TNC and CD34+ cell doses were associated with cord predominance in 67% of patients.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology and Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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29
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Jaing TH, Sun CF, Lee WI, Wen YC, Yang CP, Hung IJ. Successful unmanipulated peripheral blood progenitor cell transplantation from an HLA haploidentical 2-locus-mismatched mother in a thalassemic patient with primary graft failure after transplantation of bone marrow and cord blood from unrelated donors. Pediatr Transplant 2008; 12:232-4. [PMID: 18307674 DOI: 10.1111/j.1399-3046.2007.00844.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report on a boy with beta-thalassemia major who developed early graft failure after double-unit unrelated cord blood transplantation, who subsequently received a myeloablative preconditioning regimen using non-T-cell-depleted PBSCT from his HLA-haploidentical 2-loci-mismatched mother. Neutrophil recovery with full donor chimerism was observed at post-transplantation day +11. Furthermore, GVHD was easy to control. The patient was transfusion-independent with complete donor chimerism eight months post-transplant. The result indicated that fetomaternal microchimerism may be an important attribute of a successful transplant. We suggested that a third allo-HSCT may be taken into consideration for patients with transfusion-dependent thalassemia who experience graft failure, even after two previous transplants.
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Affiliation(s)
- Tang-Her Jaing
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
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30
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Liang FC, Wei YC, Jiang TH, Hsiehi MY, Wen YC, Chiou YS, Wu SH, Chen LC, Huang JL, Lee WI. Current classification and status of primary immunodeficiency diseases in Taiwan. Acta Paediatr Taiwan 2008; 49:3-8. [PMID: 18581721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The incidence of primary immunodeficiency diseases (PIDD) in Taiwan is estimated at 2.17 per 100,000 live births. This is much lower than in Sweden, with 8.4 per 100,000 live births. Patients with critical combined T-cell and B-cell immunodeficiency (CID) seem to be under-diagnosed because of delayed referrals to a tertiary care center which is able to organize a cooperative transplantation team encompassing, at least, a pediatric hematologist and a immunologist for severe combined immunodeficiency (SCID) classified as "pediatric emergency". Moreover, there are rare reported cases of adult-onset (over 18-years-old) common variable immunodeficiency (CVID). These cases are possibly treated as autoimmune diseases, but not PIDD. To date around the world, 206 kinds of PIDD have been found and 110 causal genetic effects were identified. Although epidemiological studies show wide geographical and racial variations in the prevalence and distribution of PIDD, we believe in Taiwan that those patients with Mendelian susceptibility to mycobacteria disease (MSMD), belonging to "congenital phagocyte defect", are often treated as isolated refractory mycobacterial infections or chronic granulomatous disease. Also, "diseases of innate immunity" and "autoimflammatory disorders" are not yet identified. To manage patients with hemophagocytic lymphohisticytosis syndromes, one of "disease of immune dysregulation, stem cell transplantation will be considered if there is poor response to chemotherapy. Patients with PIDD need better access to specialized clinical, laboratory and therapeutic resources.
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Affiliation(s)
- Fang-Chen Liang
- Primary Immunodeficiency Care and Research (PICAR) Institute, Department of Chinese Medical Sciences, Chang Gung University College of Medicine and Children's Hospital, Taoyuan, Taiwan
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Cawood TJ, McKenna MJ, Gallagher CG, Smith D, Wen YC, Gibney J, Dodd JD, O'Shea D. Oral bisphosphonates improve Bone Mineral Density in adults with cystic fibrosis. Ir Med J 2005; 98:270-3. [PMID: 16300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In adults with Cystic Fibrosis (CF) we sought to establish the effect of oral bisphosphonate therapy. Bone densitometry measured by dual energy X-ray absorptiometry (DXA), and clinical patient data, were reviewed retrospectively. Eighty-one patients (median age 27 years) had baseline and follow-up DXA, with an interval of 19.2 +/- 7.1 months. Thirty-six patients were treated with bisphosphonates (alendronate=23 and risedronate=13). Median follow-up Bone Mineral Density in the bisphosphonate group was 3.7% greater at the lumbar spine (95%CI 1.9 to 5.7%, P<0.0005) and 2.4% greater at the femur (95%CI 0.8 to 3.9%, P<0.005) than the group not treated with bisphosphonates. Oral bisphosphonate therapy had a beneficial effect on BMD in adults with CF.
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Affiliation(s)
- T J Cawood
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland.
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Lock H, Xiong J, Wen YC, Parkinson BA, Maciel GE. Solid-state 29Si, 113Cd, 119Sn, and 31P NMR studies of II-IV-P2 semiconductors. Solid State Nucl Magn Reson 2001; 20:118-129. [PMID: 11846235 DOI: 10.1006/snmr.2001.0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Solid-state 29Si, 113Cd, 119Sn, and 31P MAS NMR spectra are reported on a series of II-IV-P2 compounds. In favorable cases (e.g., high degree of crystallinity, low concentration of unpaired electrons), well-defined spectra, with sharp lines for each specific nearest-neighbor configuration, are observed; in such cases, expected J coupling patterns are also seen. High-resolution solid-state NMR studies of this type provide useful information on structure (disorder), doping, and electron-mediated coupling in semiconductor systems.
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Affiliation(s)
- H Lock
- Department of Chemistry, Colorado State University, Fort Collins 80523, USA
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Wu J, Norris LA, Wen YC, Sheppard BL, Feely J, Bonnar J. The effects of hormone replacement therapy on plasma vitamin E levels in post-menopausal women. Eur J Obstet Gynecol Reprod Biol 1996; 66:151-4. [PMID: 8735738 DOI: 10.1016/0301-2115(96)02399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To measure vitamin E levels in post-menopausal women before and after HRT, compared with levels in premenopausal women. DESIGN Post-menopausal women (n = 21) had plasma vitamin E levels measured before treatment and after 6 and 12 months treatment with HRT (2 mg 17-beta-oestradiol and 1 mg norethisterone acetate). The pre-menopausal group (n = 20) had plasma vitamin E levels measured at day 15-18 of the menstrual cycle. RESULTS There was no significant difference in vitamin E levels between the pre-menopausal group and the post-menopausal group. Plasma vitamin E levels were not significantly altered by 12 months HRT. CONCLUSION Post-menopausal women did not have altered levels of vitamin E compared with pre-menopausal women. Similarly HRT has no effect on plasma vitamin E levels. We conclude therefore that HRT does not reduce vitamin E levels in a similar manner to oral contraceptives and consequently post-menopausal women are unlikely to need a vitamin E supplement.
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Affiliation(s)
- J Wu
- Department of Obstetrics and Gynaecology, Trinity College Centre for the Health Sciences, Coombe Women's Hospital, Dublin, Ireland
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Abstract
One fluorescent compound previously named TDP-2 was isolated and purified from a rice culture of Fusarium equiseti (Alaska 2-2). Mass spectral and nuclear magnetic resonance data indicated that it is a C-3'-N-acetyl derivative of fusarochromanone, a newly discovered mycotoxin. Time course studies of synthesis of these two compounds on autoclaved rice and Czapek-Dox medium enriched with soybean peptone indicated that fusarochromanone was converted to TDP-2 in the cultures. A high concentration of peptone in the liquid medium may stimulate both fusarochromanone synthesis and its conversion to TDP-2.
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Affiliation(s)
- W P Xie
- Department of Plant Pathology, University of Minnesota, St. Paul 55108
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35
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Chen ZR, Wen YC, Chen YQ. [Synthesis of 6-(2-cyanoethyl)-17 alpha- acetoxy-progesterone compounds]. Yao Xue Xue Bao 1982; 17:299-301. [PMID: 7136717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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