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1.
Curitiba; s.n; 20220602. 150 p. ilus, graf, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1381154

ABSTRACT

Resumo: O objetivo desta tese foi avaliar as alterações da qualidade de vida relacionada à saúde dos pacientes adultos com câncer hematológico, submetidos ao transplante de células-tronco hematopoéticas, nos primeiros cinco anos após o procedimento. Trata-se de um estudo quantitativo, longitudinal, observacional e analítico, realizado em hospital público do sul do Brasil, referência na América Latina para esta modalidade de tratamento. Foram incluídos 55 participantes com idade igual ou superior a 18 anos, que se submeteram a esta terapia. A coleta de dados ocorreu de setembro de 2013 a janeiro de 2021, com avaliações em dez etapas: pré-transplante (antes de iniciar o condicionamento), pancitopenia, pré-alta hospitalar, após 100 dias, após 180 dias, Follow up 1 (após 360 dias), e anualmente até completar cinco anos da realização do procedimento. Foram aplicados um instrumento para coleta de dados sociodemográficos e clínicos e os questionários de Qualidade de vida relacionada à saúde Quality of life Questionnaire Core 30 e Functional Assessment of Cancer Therapy - Bone Marrow Transplant, ambos traduzidos, adaptados e validados para o português - Brasil. Em relação ao diagnóstico, as leucemias estão presentes em 65% dos casos; quanto à modalidade de tratamento, o transplante de células-tronco alogênico foi realizado em 71% dos pacientes. No que diz respeito aos óbitos, a causa de maior incidência foi por recidiva da doença (44%), e o maior número ocorreu no primeiro ano (37%). A qualidade de vida global (56,6/100) e geral (90,7/148) apresentou os menores escores na etapa de pancitopenia, com melhores índices no quinto ano, (80,4/100) e (116,1/148), respectivamente. A análise com o modelo linear generalizado misto evidenciou alterações significativas nos escores dos domínios de qualidade de vida relacionada à saúde entre as etapas ao longo do tempo. Foi comprovada a hipótese de que os pacientes com melhores escores nos domínios de qualidade de vida relacionada à saúde observados no início do tratamento têm maior sobrevida. Os resultados do estudo inferem as correlações entre os domínios mensurados e encontram, assim, sustentação no modelo conceitual teórico utilizado. As contribuições consistem em reafirmar a dimensionalidade do constructo qualidade de vida relacionada à saúde, além de agregar conhecimento acerca das alterações autopercebidas pelos pacientes durante o tratamento.


Abstract: The objective of this thesis was to evaluate the changes in the health-related quality of life of adult patients with hematological cancer undergoing hematopoietic stem cell transplantation in the first five years after the procedure. This is a quantitative, longitudinal, observational and analytical study carried out in a public hospital in southern Brazil, a reference in Latin America for this treatment modality. We included 55 participants aged 18 years and over, who underwent this therapy. Data collection took place from September 2013 to January 2021, with evaluations in ten stages: pre-transplantation (before starting conditioning), pancytopenia, pre-hospital discharge, after 100 days, after 180 days, Follow up 1 ( after 360 days), and annually until completing five years of the procedure. An instrument for collecting sociodemographic and clinical data and the Health-related Quality of life Questionnaire Core 30 and Functional Assessment of Cancer Therapy - Bone Marrow Transplant questionnaires were applied, both translated, adapted and validated for Portuguese - Brazil. Regarding diagnosis, leukemias are present in 65% of cases; regarding the treatment modality, allogeneic stem cell transplantation was performed in 71% of the patients. With regard to deaths, the cause of highest incidence was disease recurrence (44%), and the highest number occurred in the first year (37%). The global (56.6/100) and general (90.7/148) quality of life had the lowest scores in the pancytopenia stage, with better rates in the fifth year (80.4/100) and (116.1/148), respectively. The analysis with the mixed generalized linear model showed significant changes in the scores of the health-related quality of life domains between the stages over time. The hypothesis was confirmed that patients with better scores in the domains of health-related quality of life observed at the beginning of treatment have greater survival. The study results infer the correlations between the measured domains and thus find support in the theoretical conceptual model used. The contributions consist of reaffirming the dimensionality of the health-related quality of life construct, in addition to adding knowledge about the self-perceived changes by patients during treatment.


Resumen: El objetivo de esta tesis fue evaluar los cambios en la calidad de vida relacionada con la salud de pacientes adultos con cáncer hematológico, sometidos a trasplante de células madre hematopoyéticas, en los primeros cinco años después del procedimiento. Se trata de un estudio cuantitativo, longitudinal, observacional y analítico realizado en un hospital público del sur de Brasil, referencia en América Latina para esta modalidad de tratamiento. Se incluyeron 55 participantes mayores de 18 años que se sometieron a esta terapia. La recolección de datos ocurrió de septiembre de 2013 a enero de 2021, con evaluaciones en diez etapas: pretrasplante (antes de iniciar el acondicionamiento), pancitopenia, alta prehospitalaria, después de 100 días, después de 180 días, Seguimiento 1 (después de 360 días), y anualmente hasta completar cinco años del procedimiento. Se aplicó un instrumento de recolección de datos sociodemográficos y clínicos y los cuestionarios Health-related Quality of life Questionnaire Core 30 y Functional Assessment of Cancer Therapy - Bone Marrow Transplant, ambos traducidos, adaptados y validados para portugués - Brasil. En cuanto al diagnóstico, las leucemias están presentes en el 65% de los casos; en cuanto a la modalidad de tratamiento, se realizó trasplante alogénico de células madre en el 71% de los pacientes. En cuanto a las defunciones, la causa de mayor incidencia fue la recidiva de la enfermedad (44%) y el mayor número se produjo en el primer año (37%). La calidad de vida global (56,6/100) y general (90,7/148) tuvieron las puntuaciones más bajas en la etapa de pancitopenia, con mejores tasas en el quinto año (80,4/100) y (116,1/148), respectivamente. El análisis con el modelo lineal generalizado mixto mostró cambios significativos en las puntuaciones de los dominios de calidad de vida relacionada con la salud entre las etapas a lo largo del tiempo. Se confirmó la hipótesis de que los pacientes con mejores puntajes en los dominios de calidad de vida relacionada con la salud observados al inicio del tratamiento tienen mayor sobrevida. Los resultados del estudio infieren las correlaciones entre los dominios medidos y así encuentran apoyo en el modelo teórico conceptual utilizado. Los aportes consisten en reafirmar la dimensionalidad del constructo calidad de vida relacionada con la salud, además de sumar conocimientos sobre los cambios autopercibidos por los pacientes durante el tratamiento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Quality of Life , Health , Bone Marrow Transplantation , Hematopoietic Stem Cell Transplantation , Habits , Hematologic Diseases
2.
Article in English | LILACS-Express | LILACS | ID: biblio-1387336

ABSTRACT

ABSTRACT This prospective cohort study aims to analyze the surveillance of COVID-19 at a single hematopoietic stem cell transplantation (HSCT) center in Brazil, in 29 patients undergoing allogeneic HSCT and 57 healthcare workers (nurses and dentists), through viral shedding of SARS-CoV-2 in saliva and plasma and seroprevalence of anti-SARS-CoV-2 IgG. In addition, we report two cases with prolonged persistent detection of SARS-CoV-2 without seroconversion. The sample collection was performed seven times for patients and five times for healthcare workers. Only two patients tested positive for SARS-CoV-2 in their saliva and plasma samples (6.9%) without seroconversion. All healthcare workers were asymptomatic and none tested positive. Two patients (6.9%) and four nurses (8%) had positive serology. No dentists had positive viral detection or positive serology. Our results reflect a low prevalence of positive RT-PCR and seroprevalence of SARS-CoV-2 in patients and healthcare workers at a single HSCT center. Results have also corroborated how the rigorous protocols adopted in transplant centers were even more strengthened in this pandemic scenario.

3.
Rev. bras. enferm ; 75(5): e20220114, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1387772

ABSTRACT

ABSTRACT Objective: To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients. Method: Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon's test. Results: There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05). Conclusion: The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.


RESUMEN Objetivo: Analizar efectos de técnica de imagen guiada por realidad virtual en los signos vitales de trasplantados de células madre hematopoyéticas. Método: Estudio cuasi experimental con 35 participantes que recibieron intervención de imagen guiada por realidad virtual con relajación muscular progresivo, aplicada tres veces por semana durante cuatro semanas, en hospital de referencia en trasplante del Sur de Brasil. Los datos recolectados fueron: temperatura, presión arterial, respiración, frecuencia cardíaca, dolor y saturación de oxígeno, antes y después de cada intervención. Las comparaciones analizadas por test de Wilcoxon. Resultados: Hubo significación clínica entre las medianas de los contrastes de antes y después para Frecuencia respiratoria (p=0,00) en todas etapas; y en las variables Frecuencia cardíaca, Temperatura y Saturación de oxígeno, entre la 1ª hasta 12ª evaluación (p=0,05). Conclusión: Los efectos de la intervención mostrados favorables, bajo costo y fácil realización, siendo una opción de acción de cuidado centrado en el paciente.


RESUMO Objetivo: Analisar os efeitos da técnica de imagem guiada por realidade virtual nos sinais vitais de transplantados de células-tronco hematopoéticas. Método: Estudo quase experimental com 35 participantes que receberam intervenção de imagem guiada por realidade virtual com relaxamento muscular progressivo, aplicada três vezes por semana durante quatro semanas, em um hospital de referência em transplante no Sul do Brasil. Os dados coletados foram: temperatura, pressão arterial, respiração, frequência cardíaca, dor e saturação de oxigênio, antes e depois de cada intervenção. As comparações foram analisadas pelo teste de Wilcoxon. Resultados: Houve significância clínica entre as médias das aferições de antes e depois para Frequência respiratória (p=0,00) em todas as etapas; e nas variáveis Frequência cardíaca, Temperatura e Saturação de oxigênio, entre a 1ª até 12ª avaliação (p=0,05). Conclusão: Os efeitos da intervenção se mostraram favoráveis, de baixo custo e fácil realização, sendo uma opção de ação de cuidado centrado no paciente.

4.
Rev. bras. enferm ; 75(4): e20210488, 2022. tab
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1365632

ABSTRACT

ABSTRACT Objectives: to describe the use of the International Classification for Nursing Practice (ICNP®) in the construction of a nursing care protocol for children undergoing hematopoietic stem cell transplantation. Methods: experience report. Results: nursing problems were defined based on complications identified in a previous study; later, the ICNP® enabled the organization and systematization of childcare. The care protocol consists of 40 nursing problems, with their human needs affected, diagnoses and nursing interventions. The axes Focus, Judgment, Location, Action, Means, Time, and Client were used in the elaboration of diagnoses and interventions proposed in the protocol. Final Considerations: the use of the classification allowed the establishment of nursing interventions compatible with the needs of the child undergoing transplantation, providing support for the care protocol. It made it possible to encourage the use of classification in this context, contribute to patient safety and strengthen professional practice.


RESUMEN Objetivos: describir utilización de la Clasificación Internacional para la Práctica de Enfermería (CIPE®) en la construcción de protocolo de cuidados de enfermería al niño sometido al trasplante de células madre hematopoyéticas. Métodos: relato de experiencia. Resultados: los problemas de enfermería delimitados basados en complicaciones identificadas en estudio anterior; posteriormente, la CIPE® posibilitó la organización y sistematización del cuidado al niño. Protocolo de cuidados es compuesto por 40 problemas de enfermería, con respectivas necesidades humanas afectadas, diagnósticos e intervenciones de enfermería. Ejes Enfoque, Juicio, Ubicación, Acción, Medios, Tiempo y Cliente utilizados en la elaboración de diagnósticos e intervenciones propuestos en el protocolo. Consideraciones Finales: utilización de la clasificación permitió el establecimiento de intervenciones de enfermería compatibles con las necesidades del niño sometido al trasplante, ofreciendo sostenimiento al protocolo de cuidados. Posibilitó incitar el uso de la clasificación en ese contexto, contribuir con la seguridad del paciente y fortalecer la práctica profesional.


RESUMO Objetivos: descrever a utilização da Classificação Internacional para a Prática de Enfermagem (CIPE®) na construção de protocolo de cuidados de enfermagem à criança submetida ao transplante de células-tronco hematopoiéticas. Métodos: relato de experiência. Resultados: os problemas de enfermagem foram delimitados com base em complicações identificadas em estudo anterior; posteriormente, a CIPE® possibilitou a organização e sistematização do cuidado à criança. O protocolo de cuidados é composto por 40 problemas de enfermagem, com respectivas necessidades humanas afetadas, diagnósticos e intervenções de enfermagem. Os eixos Foco, Julgamento, Localização, Ação, Meios, Tempo e Cliente foram utilizados na elaboração de diagnósticos e intervenções propostos no protocolo. Considerações Finais: o uso da classificação permitiu o estabelecimento de intervenções de enfermagem compatíveis com as necessidades da criança submetida ao transplante, fornecendo sustentação ao protocolo de cuidados. Possibilitou incitar o uso da classificação nesse contexto, contribuir com a segurança do paciente e fortalecer a prática profissional.

5.
Braz. oral res. (Online) ; 36: e016, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1360249

ABSTRACT

Abstract: The aim of the present study was to analyze the relationship of OM with possible risk factors such as oral health condition, immunological status and IL-1β profile in patients submitted to hematopoietic stem cell transplantation (HSCT). Fifty-four individuals submitted to HSCT were included. All patients received previous dental treatment and photobiomodulation (PBM) as the institutional OM preventive protocol. OM scores, immune status, and IL-1β levels were determined during the conditioning period and at D+3 and D+8 after HSC infusion. IL-1β gene polymorphism was also analyzed during conditioning. Possible associations of OM with risk factors were analyzed using conditional Fisher's exact test. OM was observed in 34 patients (62.9%) classified as Grade 1 (13 patients/24.1%), Grade 2 (14 patients/25.9%), Grade 3 (3 patients/5.5%), and Grade 4 (4 patients/7.4%). Allogeneic HSCT individuals exhibited a higher OM grade than autologous subjects. Moreover, an association was observed between severe OM and severe gingivitis (p = 0.01), neutropenia (p = 0.03), and leukopenia (p = 0.04). A significant association between OM and lower IL-1β levels was detected at three time points, i.e., conditioning (p = 0.048), D+3 (p = 0.01), and D+8 (p = 0.005). The results showed that IL-1β gene polymorphism was not associated with OM. Our study provided important insights into the scope of OM risk factors in the setting of HSCT. Patients submitted to HSCT with severe gingivitis prior to chemotherapy and with severe neutropenia and leukopenia exhibited a higher OM grade. Further investigation will be necessary to better understand the exact role of IL-1β in the context of OM pathobiology and to validate cytokine analysis in larger cohorts.

6.
Article in Chinese | WPRIM | ID: wpr-928760

ABSTRACT

OBJECTIVE@#To observe the clinical characteristics, treatment and prognosis of intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children and futher evaluate the occurring risk factors.@*METHODS@#The clinical data of 136 patients undergoing allo-HSCT in Wuhan Children's Hospital Affiliated to Tongji Medical College from August 2016 to August 2020 were retrospectively analyzed, clinical characteristics of children with intestinal aGVHD were observed. The risk factors of intestinal aGVHD were assessed by logistic regression while cumulative survival were analyzed by Kaplan-Meier method.@*RESULTS@#Among 136 patients intestinal aGVHD occurred in 24 (17.6%) cases, with 4 cases of grade II, 20 cases of grade III-IV, and the median occurrence time was 28(10-63) days. The clinical manifestations were diarrhea with intermittent abdominal pain, 17 cases with nausea and vomiting, 11 cases with fresh bloody stool, and 8 cases with skin rash before intestinal aGVHD. The average time for treatment was 33(11-100) days. 18 cases received electronic colonoscopy and histopathology examination. 20 out of 24 cases achieved remission after treatment, and the total effective rate was 83.3%. Finally, 9 out of 24 cases died during the follow-up time. Survival analysis showed that the cumulative survival rate of patients with intestinal aGVHD (15/24, 62.5%) were significantly lower than those without intestinal aGVHD (101/112, 90.2%) (Log-rank test, P=0.001). Univariate analysis showed that recipient age, sex, primary disease, donor age, donor sex, donor-recipient blood type, conditioning regimen, prophylaxis of GVHD, dosage of ATG, engraft time of blood platelet and neutrophils, and number of MNC/CD34+ were not risk factors for intestinal aGVHD (P>0.05). Only the type of HSCT (χ2=16.020, P=0.001) and matched degree of HLA (χ2=15.502, P=0.001) had statistical significance with intestinal aGVHD (P<0.05). Multivariate analysis showed that only HLA-mismatched unrelated donor was the risk factor for intestinal aGVHD for children (P=0.014,OR=16,95%CI 1.735-147.543).@*CONCLUSION@#Intestinal aGVHD is a risk factor for cumulative survial of patients who received allo-HSCT in children and HLA-mismatched unrelated donor is its independent risk factor.


Subject(s)
Acute Disease , Child , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Retrospective Studies , Risk Factors , Tissue Donors
7.
Article in Chinese | WPRIM | ID: wpr-928750

ABSTRACT

OBJECTIVE@#To investigate the difference of therapeutic effects on children with thalassemia at different age after hematopoietic stem cell transplantation.@*METHODS@#The clinical data of children with thalassemia treated in our hospital were retrospectively analyzed. The children were divided into 2-5 years old group and 6-12 years old group. The success rate of implantation, transplant-related mortality, GVHD incidence, and other transplant-related complications, as well as thalassemia-free survival (TFS) were compared between the two groups.@*RESULTS@#The incidence of GVHD, hemorrhagic cystitis and severe oral mucositis after transplantation in the 2-5 years old group were significantly lower than those in the 6-12 years old group, while there was no statistically significant difference in the TFS between the two groups.@*CONCLUSION@#Children in the low age (2-5 years old) group show fewer complications and higher quality of life after transplantation, therefore, stem cell transplantation at 2-5 years old is more conducive to rehabilitation of the children with thalassemia.


Subject(s)
Child , Child, Preschool , Graft vs Host Disease/complications , Hematopoietic Stem Cell Transplantation , Humans , Quality of Life , Retrospective Studies , Thalassemia/therapy , beta-Thalassemia/therapy
8.
Article in Chinese | WPRIM | ID: wpr-928746

ABSTRACT

OBJECTIVE@#To investigate the efficacy and safety of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in combination of ATG and post-transplant cyclophosphamide (PTCy) -induced immune tolerance after transplantation in treatment of childhood myelodysplastic syndromes(MDS).@*METHODS@#From July 2016 to November 2020, a total of 8 children with MDS receiving the haploidentical allo-HSCT combined with ATG and PTCy-induced immune tolerance after transplantation in our hospital were enrolled, whose clinical data were retrospected and analyzed.@*RESULTS@#Median age at diagnosis of the 8 children (1 male and 7 females) was 6.4 (range, 10 months to 15 years) years old. The median medical history of MDS was 2.7 years (range, 3 months to 8 years). Among the 8 patients, 7 cases were diagnosed with refractory cytopenia of childhood and one with refractory anemia with excess of blasts. The HSC donors were father, mother or brother of patients and HLA matching in 6-9/12 loci were identical. All the donors were healthy and didn't carry the same pathogenic genes as the recipients. The median age of donors was 36.4 (range, 25 to 49) years old. The median mononuclear cell (MNC) number of the graft was 19.8, ranging in (13.2-47.3)×108/kg, and the median CD34+ cell number was 11.8×106/kg, ranging in (5.0-18.3)×106/kg. Graft-versus-host disease prophylactic regimen was started on day 3 and 4 after transplantation, in which cyclophosphamide (50 mg/kg·d) was administered by intravenous infusion. From day 5 after transplantation, low-dose tacrolimus was administered by intravenous infusion and mycophenolate mofetil was administered orally. The median time of neutrophil and platelet engraftment was 12.6 (rang, 11 to 15) days and 13.3 (rang, 11 to 18) days, respectively. All the patients achieved full donor chimerism on neutrophil engraftment after transplantation. The median follow-up time was 1 032 (rang, 747 to 1 536) days. Both overall survival rate and disease-free survival rate were 100%.@*CONCLUSION@#Haplo-HSCT combined with ATG and PTCy-induced immune tolerance after transplantation is a safe and effective treatment for children with MDS.


Subject(s)
Adult , Child , Cyclophosphamide , Female , Graft vs Host Disease/drug therapy , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Myelodysplastic Syndromes/drug therapy , Transplantation Conditioning , Treatment Outcome
9.
Article in Chinese | WPRIM | ID: wpr-928723

ABSTRACT

OBJECTIVE@#To analyze the clinical effects of CCLG-AML-2015 protocol on newly diagnosed children with acute myeloid leukemia (AML).@*METHODS@#The clinical data of 60 newly diagnosed AML children in the Department of Hematology and Oncology, Wuhan Children's Hospital from August 2015 to September 2019 were summarized, the effect of chemotherapy using the CCLG-AML-2015 regimen (hereinafter referred to as the 2015 regimen) were retrospectively analyzed. 42 children with AML treated by the AML-2006 regimen (hereinafter referred to as the 2006 regimen) from February 2010 to July 2015 were used as control group.@*RESULTS@#There were no statistical differences between the 2015 regimen group and the 2006 regimen group in sex, age at first diagnosis, and risk stratification (P>0.05). The complete remission rate of bone marrow cytology after induction of 1 course of chemotherapy (84.7% vs 73.1%, P=0.155), and minimal residual disease detection (MRD) negative (42.3% vs 41.4%, P=0.928) in the 2015 regimen group were not statistically different than those in the 2006 regimen group. The bone marrow cytology CR (98.1% vs 80.6%, P=0.004) and MRD negative (83.3% vs 52.8%, P=0.002) in the 2015 regimen group after 2 courses of induction were higher than those in the 2006 regimen group. The 5-year overall survival (OS) rate in the 2015 regimen group (62.3%±6.4% vs 20.6%±6.4%, P=0.001), the 5-year disease-free survival (EFS) rate (61.0%±6.4% vs 21.0% ±6.4% , P=0.001) were better than those in the 2006 regimen group. The 5-year OS and EFS of high-risk transplant patients in the 2015 regimen group were significantly better than those of high-risk non-transplant patients (OS: 86.6%±9.0% vs 26.7%±11.4%, P=0.000; EFS: 86.6%±9% vs 26.7%±11.4%, P=0.000).@*CONCLUSION@#The 2015 regimen can increase the CR rate after 2 courses of induction compared with the 2006 regimen. High-risk children receiving hematopoietic stem cell transplantation can significantly improve the prognosis.


Subject(s)
Child , Disease-Free Survival , Humans , Leukemia, Myeloid, Acute/drug therapy , Prognosis , Remission Induction , Retrospective Studies
10.
Article in Chinese | WPRIM | ID: wpr-928708

ABSTRACT

OBJECTIVE@#To analyze the clinical characteristics of bloodstream infection (BSI) in patients treated by hematopoietic stem cell transplantation (HSCT).@*METHODS@#The clinical characteristics, distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed.@*RESULTS@#Among 910 HSCT patients, 111 patients were diagnosed as BSI within 100 days after transplantation, and 98 patients showed BSI during the period of agranulocytosis. Multivariate analysis showed that the usage of anti-thymocyte globulin (ATG), long duration of agranulocytosis and low infusion volume of mononuclear cell (MNC) were the independent risk factors affecting BSI after HSCT. Among 121 pathogenic bacteria isolated, 76 Gram-negative (G-) bacteria (62.8%), 40 Gram-positive (G+) bacteria (33.0%), and 5 fungi (4.1%) were detected out. The top three pathogens were Escherichia coli, Staphylococcus epidermidis and Pseudomonas aeruginosa. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3% and 7.7%, respectively, and Pseudomonas aeruginosa was 66.7%. The susceptibility of G+ bacteria to vancomycin, linezolid and teicoplanin was 97.5%, 100% and 100%, respectively. The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI (P<0.001).@*CONCLUSION@#The usage of ATG, long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT. The pathogens after HSCT are mainly G- bacteria. Pseudomonas aeruginosa is highly resistant to carbapenems. Key words  ;


Subject(s)
Bacteremia/epidemiology , Bacteria , Hematopoietic Stem Cell Transplantation , Humans , Retrospective Studies , Sepsis
11.
Article in Chinese | WPRIM | ID: wpr-928698

ABSTRACT

OBJECTIVE@#To evaluate the clinical effect of haploid allogeneic hematopoietic stem cell transplantation(haplo-HSCT) in the treatment of severe aplastic anemia (SAA), and to explore the efficacy different between post-transplant cyclophosphamide (PT/Cy) and standard-dose ATG.@*METHODS@#The clinical data of 38 patients with SAA in our hospital from January 2012 to December 2019 were collected and retrospectively analyzed. The efficacy was evaluated. The patients with haplo-HSCT were divided into low-dose ATG combined with PT/Cy group and standard-dose ATG group, and the blood cell hematopoietic reconstruction time, GVHD incidence, mortality and survival time of the patients in the two groups was compared.@*RESULTS@#Among the 32 patients, hematopoietic reconstitution were detected in 9375%(30/32) recipients. The median time of neutrophil and platelet engraftment was 15(10-22) days and 13(7-30) days, respectively. The incidence of GVHD was 21.89%, the incidence of infection was 93.75%, and the 2-year overall survival rate was 84.38%. The hematopoietic reconstitution time, incidence of GVHD, mortality rate and survival time were no statistical differences between the patients in the two groups(all P>0.05).@*CONCLUSION@#Haplo-HSCT is an effective method for the treatment of SAA,low-dose ATG combined with PT/Cy can lighten the economic burden on patients, it would be a feasible treatment plan for SAA with light side effect.


Subject(s)
Anemia, Aplastic/therapy , Cyclophosphamide , Graft vs Host Disease , Haploidy , Hematopoietic Stem Cell Transplantation , Humans , Retrospective Studies , Transplantation Conditioning
12.
Article in Chinese | WPRIM | ID: wpr-928686

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy, survival, and prognosis of autologous hematopoietic stem cell transplantation (ASCT) with new drug chemotherapy in the treatment of newly diagnosed multiple myeloma (NDMM) in the new drug era.@*METHODS@#The clinical data of 149 patients with NDMM treated with new drug induction regimen in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to December 2019 were retrospectively analyzed. Twenty-four patients who received ASCT were in ASCT group, and 125 patients who did not receive ASCT were in non-ASCT group. The median follow-up time was 43 (1-90) months. The propensity score matching (PSM) method was used to balance confounding factors, then depth of response, overall survival (OS), and progression-free survival (PFS) between the two groups were compared and subgroup analysis was performed.@*RESULTS@#After matching, the covariates were balanced between the two groups. Fifty-one patients (15 cases in ASCT group and 36 cases in non-ASCT group) were included. ASCT patients had a better complete response (CR) rate than non-ASCT patients receiving maintenance therapy (93.3% vs 42.3%, P=0.004), while there were no statistical differences in deep response rate and overall response rate (ORR) between the two groups (93.3% vs 65.4%, P=0.103; 93.3% vs 96.2%, P=1.000). Before matching, the 3 and 5-year PFS rate and median PFS (mPFS) in ASCT group and non-ASCT group were [89.6% vs 66.5%, P=0.024; 69.8% vs 42.7%; non-response (NR) vs 51.0 months], and the 3 and 5-year OS rate and median OS (mOS) were (100% vs 70.6%, P=0.002; 92.3% vs 49.6%; NR vs 54.0 months). After matching, the 3 and 5-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.6% vs 61.7%, P=0.182; 62.7% vs 45.7%; NR vs 51.0 months), the 3 and 5-year OS rate and mOS were (100% vs 65.6%, P=0.018; 88.9% vs 46.9%; NR vs 51.0 months). Subgroup analysis showed that patients with mSMART 3.0 high risk stratification, the 3-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.3% vs 41.5%, P=0.091; NR vs 34.0 months), and the 3-year OS rate and mOS were (100% vs 41.5%, P=0.034; NR vs 34.0 months). Patients with mSMART 3.0 standard risk stratification, the 3-year PFS rate and OS rate in ASCT group and non-ASCT group were (83.3% vs 76.8%, P=0.672; 100% vs 87.2%, P=0.155). The 3-year PFS and OS rate in MM patients who achieved deep response within 3 months after transplantation compared with non-ASCT patients who achieved deep response after receiving maintenance therapy were (83.1% vs 56.7%, P=0.323; 100% vs 60.5%, P=0.042), and the 3-year PFS and OS rate in patients who achieved overall response in both groups were (83.1% vs 62.5%, P=0.433; 100% vs 68.1%, P=0.082). After matching, Cox multivariate regression analysis showed that mSMART 3.0 risk stratification and ASCT were independent prognostic factors for OS.@*CONCLUSION@#In the new drug era, ASCT can increase CR rate and prolong OS of NDMM patients. ASCT patients who are mSMART 3.0 high risk stratification or achieved deep response within 3 months after transplantation have better OS than non-ASCT patients receiving new drug chemotherapy. ASCT and mSMART 3.0 risk stratification are independent prognostic factors for OS in NDMM patients.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Disease-Free Survival , Hematopoietic Stem Cell Transplantation , Humans , Multiple Myeloma/drug therapy , Pharmaceutical Preparations , Propensity Score , Retrospective Studies , Stem Cell Transplantation , Transplantation, Autologous , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-928676

ABSTRACT

OBJECTIVE@#To analyze the clinical characteristics and risk factors of invasive fungal infection (IFI) occurenced in patients with acute leukemia (AL) during treatment in tropical regions.@*METHODS@#The clinical data of 68 AL patients admitted to the Hainan Hospital of PLA General Hospital from April 2012 to April 2019 was retrospectively analyzed. Logistic regression analysis was used to analyze the factors affecting the occurrence of IFI in AL patients.@*RESULTS@#Among the 68 patients, 44 were acute myeloid leukemia, 24 were acute lymphoblastic leukemia, 39 were male, 29 were female and the median age was 41(13-75) years old. The 68 patients received 242 times of chemotherapy or hematopoietic stem cell transplantation(HSCT), including 73 times of initial chemotherapy or inducting chemotherapy after recurrence, 14 times of HSCT, 155 times of consolidating chemotherapy. Patients received 152 times of anti-fungal prophylaxis, including 77 times of primary anti-fungal prophylaxis and 75 times of secondary anti-fungal prophylaxis. Finally, the incidence of IFI was 31 times, including 24 times of probable diagnosis, 7 times of proven diagnosis, and the total incidence of IFI was 12.8%(31/242), the incidence of IFI in inducting chemotherapy was 24.66%(18/73), the incidence of IFI in HSCT patients was 28.57% (4/14), the incidence of IFI in consolidating chemotherapy was 5.80% (9/155). Multivariate analysis showed that inducting chemotherapy or HSCT, the time of agranulocytosis ≥7 days, risk stratification of high risk were the independent risk factors for IFI in AL patients during treatment in tropical regions.@*CONCLUSION@#The incidence of IFI in patients with AL in the tropics regions is significantly higher than that in other regions at homeland and abroad. Anti-fungal prophylaxis should be given to the patients with AL who have the high risk factors of inducting chemotherapy or HSCT, time of agranulocytosis ≥7 days and risk stratification of high risk.


Subject(s)
Adult , Aged , Antifungal Agents/therapeutic use , Female , Hematopoietic Stem Cell Transplantation , Humans , Invasive Fungal Infections/epidemiology , Leukemia, Myeloid, Acute/drug therapy , Male , Middle Aged , Retrospective Studies , Risk Factors
14.
Article in Chinese | WPRIM | ID: wpr-928671

ABSTRACT

OBJECTIVE@#To investigate the efficacy, safety and the risk factors affecting prognosis of high-risk acute myeloid leukemia (AML) patients treated by cladribine-based intensified conditioning regimen.@*METHODS@#The clinical data of 28 patients with high-risk AML treated by cladribine in combination with busulfan plus cyclophosphamide (BuCy) intensified conditioning regimen before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Zhujiang Hospital, Southern Medical University from October 2016 to June 2020 were analyzed retrospectively. The overall survival (OS) rate, cumulative progression-free survival (PFS) rate, relapse rate, non-relapse mortality (NRM), regimen related toxicity (RRT) and risk factors affecting prognosis of the patients were analyzed.@*RESULTS@#The 1-year OS and PFS of the patients after implantation was (78.8±8.6)% and (79.8±8.1)%, while the 1-year cumulative relapse rate and NRM of the patients was 9.3% and 22.0%, respectively. The 1-year expected OS of MRD- high-risk patients before HSCT was 100%. The 1-year expected OS and PFS of the patients in pre-transplant relapse group was (46.9±18.7)% and (50.0±17.7)%, respectively. The incidence of I/II grade RRT was 39.3%. NO III/IV grade RRT were found in 28 patients. Multivariate analysis showed that pre-transplant relapse was the independent risk factor affecting OS and PFS of the patients.@*CONCLUSION@#The intensified conditioning regimen of cladribine in combination with BuCy can reduce the relapse rate of high-risk AML transplantation, and its RRT is mild, exhibiting good safety. MRD- high-risk patients before HSCT can achieve better transplant benefits, but the prognosis of patients with relapse before transplantation is not significantly improved. Therefore, for non-relapsed high-risk AML patients, this intensified conditioning regimen deserves to be considered.


Subject(s)
Busulfan , Cladribine , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Humans , Leukemia, Myeloid, Acute/therapy , Retrospective Studies , Transplantation Conditioning
15.
Rev. gaúch. enferm ; 43: e20210028, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1376939

ABSTRACT

ABSTRACT Objective: To construct a nursing care protocol for children in post-hematopoietic stem cell transplantation. Method: Methodological research carried out from January to September 2019, in three steps: (a) integrative review (nursing care was identified); (b) theoretical structuring and organization of healthcare based on the Theory of Basic Human Needs and on the International Classification for Nursing Practice (supplementing the review data); and (c) development of a protocol in the three previously mentioned stages. Analysis of the understanding of the protocol's items/care was performed by three specialist nurses. Results: The care protocol consists of 40 nursing problems and is organized in accordance with the psychobiological, psychosocial, and psycho-spiritual needs of children undergoing transplantation, integrating practical and guidance care. Conclusion: The care protocol is an important technology for nursing care to transplanted children, aimed to prevent and manage transplantation complications.


RESUMEN Objetivo: Construir un protocolo de cuidados de enfermería para niños después del trasplante de células tronco hematopoyéticas. Método: Investigación metodológica realizada entre enero y septiembre de 2019 para construir un protocolo, en tres etapas: a) realización de revisión integradora (fueron identificados cuidados de enfermería); b) estructuración y organización teórica de cuidados a partir de la Teoría de las Necesidades Humanas Básicas y de la Clasificación Internacional para la Práctica de Enfermería, complementando los datos de la revisión; y, c) desarrollo del protocolo, cuya elaboración integró las etapas anteriores. El análisis de comprensión de ítems/cuidados del protocolo fue realizado por tres enfermeras especialistas. Resultados: El protocolo de cuidados está compuesto por 40 problemas de enfermería y está organizado de acuerdo con las necesidades psicobiológicas, psicosociales y psicoespirituales de niños sometidos a trasplante, integrando cuidados prácticos y de orientación. Conclusión: El protocolo de cuidados es una opción tecnológica para la asistencia de enfermería al niño trasplantado, con los objetivos de prevención y manejo de las complicaciones del trasplante.


RESUMO Objetivo: Construir protocolo de cuidados de enfermagem à criança no pós-transplante de células-tronco hematopoiéticas. Método: Pesquisa metodológica conduzida entre janeiro e setembro de 2019 e, em três etapas: a) realização de revisão integrativa (cuidados de enfermagem foram identificados); b) estruturação e organização teórica de cuidados a partir da Teoria das Necessidades Humanas Básicas e da Classificação Internacional para a Prática de Enfermagem, complementando os dados da revisão; c) desenvolvimento do protocolo, cuja elaboração integrou as etapas anteriores. A análise de compreensão de itens/cuidados do protocolo foi realizada por três enfermeiros especialistas. Resultados: O protocolo de cuidados é composto por 40 problemas de enfermagem e está organizado de acordo com as necessidades psicobiológicas, psicossociais e psicoespirituais de crianças submetidas ao transplante, integrando cuidados práticos e de orientação. Conclusão: O protocolo é opção tecnológica para a assistência de enfermagem à criança transplantada, com vistas à prevenção e manejo das complicações.

16.
Acta Paul. Enferm. (Online) ; 35: eAPE03502, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1364238

ABSTRACT

Resumo Objetivo Construir e validar uma tecnologia informativa para famílias de crianças/adolescentes com câncer submetidos ao transplante de células-tronco hematopoiéticas. Métodos Estudo metodológico fundamentado no Modelo do Cuidado Centrado no Paciente e Família e User-Centered Design, realizado em quatro etapas: avaliação das necessidades de informações; construção teórica e desenvolvimento do aplicativo; validação de conteúdo e semântica pelo comitê de juízes e população-alvo; avaliação da usabilidade por experts em informática. Os participantes do estudo foram profissionais e famílias de crianças com câncer. Para a validação de conteúdo e semântica, estabeleceu-se percentual de concordância entre juízes de 80% e Índice de Validade de Conteúdo de 0,8. Para a avaliação da usabilidade foram utilizadas as heurísticas de Nielsen. Os dados foram analisados por meio de estatística descritiva. Resultados Após identificação das necessidades de informações da família, na literatura e no estudo de campo, e construção do aplicativo, este foi validado por especialistas, obtendo percentual de concordância de 87% e índice de validade de conteúdo de 0,87; e pela população-alvo, de 98% e 0,98, respectivamente. Quanto a usabilidade, atingiu o grau de severidade simples. O aplicativo móvel TMO-App apresenta 268 telas e 95 ilustrações, contemplando as necessidades de informações da família antes, durante e após o transplante. Conclusão Os métodos utilizados para o desenvolvimento e validação mostraram-se satisfatórios para atingir os objetivos propostos. O aplicativo construído é confiável, de fácil uso, útil, completo e adequado. O estudo avança na proposição de nova estratégia informativa para promover o empoderamento da família em situação de doença crônica.


Resumen Objetivo Elaborar y validar una tecnología informativa para familias de niños/adolescentes con cáncer sometidos al trasplante de células madre hematopoyéticas. Métodos Estudio metodológico fundamentado en el Modelo del Cuidado Centrado en el Paciente y la Familia y User-Centered Design, realizado en cuatro etapas: evaluación de las necesidades de información, construcción teórica y desarrollo de la aplicación, validación semántica y del contenido por el comité de jueces y el público destinatario, evaluación de usabilidad por especialistas en informática. Los participantes del estudio fueron profesionales y familias de niños con cáncer. Para la validación semántica y de contenido, se estableció un porcentaje de concordancia entre los jueces del 80 % y un Índice de Validez de Contenido de 0,8. Para la evaluación de usabilidad se utilizaron las heurísticas de Nielsen. Los datos fueron analizados mediante estadística descriptiva. Resultados Después de identificar las necesidades de información de la familia, en la literatura y en el estudio de campo, y de elaborar la aplicación, esta fue validada por especialistas y obtuvo un porcentaje de concordancia del 87 % y un Índice de Validez de Contenido de 0,87. A su vez, los resultados del público destinatario fueron 98 % y 0,98, respectivamente. Respecto a la usabilidad, alcanzó un nivel de severidad simple. La aplicación móvil TMO-App presenta 268 pantallas y 95 ilustraciones que contemplan las necesidades de información de la familia antes, durante y después del trasplante. Conclusión Los métodos utilizados para el desarrollo y validación demostraron ser satisfactorios para alcanzar los objetivos propuestos. La aplicación elaborada es confiable, de fácil uso, útil, completa y adecuada. El estudio avanza en la propuesta de una nueva estrategia informativa para promover el empoderamiento de familias en situación de enfermedad crónica.


Abstract Objective To develop and validate an informative technology for families of children/adolescents with cancer undergoing hematopoietic stem cell transplantation. Methods A methodological study grounded on the Patient-and Family-Centered Care Model and User-Centered Design, conducted in four stages: assessment of information needs; theoretical construction and development of the mobile application; content and semantic validation by a committee of experts and target population; usability evaluation by computer experts. The participants of the study were professionals and families of children with cancer. For content and semantic validation, an inter-rater agreement percentage of 80% and a Content Validity Index of 0.8 were established. For usability evaluation, Nielsen's heuristics were used. The data were analyzed using descriptive statistics. Results After the information about the family's needs was obtained from the published literature and field study, the application was developed and validated by experts. Agreement of 87%, and a content validity index of 0.87, were achieved with the expert group; 98% and 0.98, respectively, with the target population. With regard to usability, the level of simple severity was reached. The BMT-App mobile application contains 268 screens and 95 illustrations, addressing the family's information needs before, during, and after transplantation. Conclusion The methods used for development and validation were satisfactory to achieve the intended objectives. The application constructed is reliable, easy to use, useful, complete, and adequate. The study advances the proposition of a new informative strategy to promote empowerment of the family confronting chronic disease.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Hematopoietic Stem Cell Transplantation , Mobile Applications , Neoplasms , Family/psychology , Epidemiology, Descriptive , Patient-Centered Care , Evaluation Studies as Topic
17.
Rev. latinoam. enferm. (Online) ; 30: e3569, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1376959

ABSTRACT

Resumo Objetivo: analisar os fatores associados ao insucesso do Transplante de Células-Tronco Hematopoiéticas (TCTH) em pacientes submetidos ao retransplante de Células-Tronco Hematopoiéticas (RCTH). Método: estudo quantitativo do tipo caso-controle para avaliar pacientes submetidos ao RCTH. Para tanto, utilizou-se amostra pareada de dois controles para cada caso (2:1). O grupo caso foi constituído pelos prontuários de saúde com todos os pacientes que foram submetidos ao RCTH (28) e o grupo controle (56) incluiu pacientes que receberam apenas um transplante. Três variáveis nortearam o pareamento: sexo, diagnóstico e tipo de transplante. Resultados: vinte e quatro (85,71%) pacientes do grupo caso receberam retransplante devido a recidiva da doença e quatro (14.29%) devido a falha do enxerto. Uma diferença estatística foi encontrada na análise entre os pacientes que não usaram o ácido ursodesoxicólico, analgésicos opioides ou imunossupressores. A necessidade de um RCTH entre aqueles que usaram estes medicamentos de forma inapropriada foi 16,12, 12,79 e 4,5 vezes maior, respectivamente, do que entre os que as usaram corretamente. Conclusão: houve uma diferença relacionada ao motivo que levou ao retransplante e os indivíduos analisados. A conclusão é que a razão preditiva para retransplante nesta amostra foi a recidiva da doença.


Abstract Objective: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR). Method: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant. Results: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly. Conclusion: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.


Resumen Objetivo: analizar los factores asociados con el fracaso del Trasplante de Células Madre Hematopoyéticas (TCMH) en pacientes sometidos al Retrasplante de Células Madre Hematopoyéticas (RCMH). Método: estudio cuantitativo de tipo caso-control que abordó pacientes sometidos al RCMH. Para esto, se utilizó una muestra pareada de dos controles para cada caso (2:1). El grupo caso estuvo formado por los registros médicos de todos los pacientes que fueron sometidos al RCMH (28) y el grupo control (56) por los que fueron sometidos a un solo trasplante. Tres variables guiaron el emparejamiento: género, diagnóstico y tipo de trasplante. Resultados: un total de 24 (85.71%) pacientes en el grupo caso fueron retransplantados debido a la recaída de la enfermedad y 4 (14.29%) por el fracaso del injerto. Hubo una diferencia estadística en el análisis entre los pacientes que no usaron ácido ursodesoxicólico, analgésicos opioides e inmunosupresores. La necesidad de RCMH entre los que usaron estos medicamentos de manera inapropiada se encontraba 16,12 - 12,79 y 4,5 veces más probable, respectivamente, que aquellos que los usaron correctamente. Conclusión: hubo diferencia en cuanto a las razones que llevaron al retrasplante de los sujetos analizados. Este estudio concluyó que la razón predictiva del retrasplante, en la muestra estudiada, fue la recidiva de la enfermedad.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Recurrence , Reoperation , Hematopoietic Stem Cells , Retrospective Studies , Hematopoietic Stem Cell Transplantation
18.
Organ Transplantation ; (6): 522-2022.
Article in Chinese | WPRIM | ID: wpr-934775

ABSTRACT

Immune deficiency of the host caused by allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the initial factor of reactivation of latent human cytomegalovirus (HCMV). The risk factors of reactivation of HCMV in allo-HSCT recipients consist of the serological status of HCMV in donors and recipients, the matching degree of human leukocyte antigen (HLA) and pretreatment patterns, etc. The reactivation of HCMV is associated with the expression of a series of viral cleavage and proliferation proteins induced by the overexpression of major immediate early promoter/enhancer (MIEP) in the viral genome. In this article, the risk factors of reactivation of HCMV after allo-HSCT, the molecular changes related to maintaining latent infection of HCMV, the key role of MIEP overexpression in reactivation of HCMV, and the molecular pathways involved in reactivation of HCMV after allo-HSCT were reviewed and the major molecular events of reactivation of HCMV after allo-HSCT were elucidated, aiming to provide reference for the prevention and treatment of cytomegaloviral disease (CMVD) after allo-HSCT.

19.
Article in Chinese | WPRIM | ID: wpr-934316

ABSTRACT

Objective:To observe aqueous cytomegalovirus (CMV) DNA load in patients with cytomegalovirus retinitis (CMVR) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT), and to explore influencing factors for transient elevation of CMV-DNA load during the treatment.Methods:A retrospective study. From January 2016 to July 2020, 28 eyes of 19 patients with CMVR after Allo-HSCT diagnosed in the Department of Ophthalmology of Peking University People's Hospital were included in the study. Among them, there were 8 males with 12 eyes, 11 females with 16 eyes; the mean age was 28 years; 10 patients were unilateral and 9 patients were bilateral. During the course of treatment and follow-up, the blood CMV-DNA remained negative. All patients were treated with intravitreal injection of 60 mg/ml ganciclovir 0.05 ml (containing ganciclovir 3 mg), twice a week for two weeks in induction phase and weekly injection in maintenance phase. Aqueous humor sample was collected during injection of ganciclovir (IVG) and CMV-DNA load was determined by real-time quantitative polymerase chain reaction. Intravitreal treatment was terminated if aqueous CMV-DNA load turned negative after the fourth or later intravitreal injection. The patients were followed up every 2 weeks for at least 6 months. Serum CMV-DNA was negative in all patients during treatment and follow-up. All the eyes were divided into continuous decline group and non-continuous decline group depending on whether there was transient elevation of aqueous CMV-DNA load, and data between two groups were compared. Pearson linear regression analysis was used to analyze the correlation between aqueous CMV-DNA load and injection times or treatment duration.Results:At the end of treatment, the median number of IVG in the affected eye was 7 (4, 9). The results of correlation analysis showed that the aqueous humor CMV-DNA load of the affected eye was related to the number of treatments [ R2=0.385, P<0.000 1, B=-0.237 log 10 copies/(ml·time)], and the duration of treatment [ R2=0.394, P <0.000 1, B=-0.301 log 10 copies/(ml·week)] were negatively correlated. Among the 28 eyes, 13 eyes (46.4%, 13/28) in the continuous decline group and 15 eyes (53.6%, 15/28) in the non-sustained decline group. Baseline visual acuity ( t=-1.223), intraocular pressure ( t=1.538), aqueous humor CMV-DNA load ( t=-0.109), retinitis lesion area ( Z=-0.308) in the continuous decline group and the non-continuous decline group), the number of quadrants involved ( Z=-0.024) and whether the macula was involved ( Z=-1.826), combined with anterior segment inflammation ( Z =-0.499), combined with high intraocular pressure ( Z=-1.342), terminal visual acuity ( t =-0.845), intraocular pressure ( t=-0.068), total IVG times ( Z=0.907), age ( Z=-0.832), gender composition ( Z=-1.074), etc. The difference was not statistically significant ( P>0.05). Conclusion:The CMV-DNA load in aqueous humor decreases by about 50% every week during the treatment of CMVR eyes after Allo-HSCT; the transient increase in the CMV-DNA load in the aqueous humor during treatment does not affect the treatment process and clinical prognosis.

20.
Article in Chinese | WPRIM | ID: wpr-933672

ABSTRACT

Objective:To explore the safety and advantages of non-cryopreserved sibling umbilical cord blood hematopoietic stem cell transplantation for major thalassaemia in children.Methods:From October 2016 to June 2021, 9 patients with major beta thalassaemia received non-cryopreserved hematopoietic stem cell transplantation of sibling umbilical cord blood at Zhongshan Hospital of Xiamen University. The pretreatment scheme, the process of stem cell implantation and follow-up were analyzed and summarized.Results:Among the 9 cases, there were 5 males and 4 females with a median age of 4(2~11)years. Median level of ferritin was 2 997(1 936~5 512)μg/L. At gestational weeks 12~16, each patient's mother underwent villi testing to confirm that the donor without thalassaemia major was complete HLA-matched with the patient. All of them received an intensive conditioning regimen made up of cyclophosphamide(CTX), fludarabine and busulfan(Bu). Graft-versus-host disease(GVHD) was prevented by cyclosporine A(CSA)and mycophenolate mofetil(MMF)with or without methotrexate(MTX). Except for one failed implant, 8 cases were successfully engrafted. Median time of neutrophil implantation was 19.5(15~26)days, median time of platelet implantation 32(22~34)days and median time of erythrocyte implantation 30.5(18~37)days. Up until September 1, 2021, the median follow-up period was 27(3~59)months and the rate of successful engraftment 88.89%. There was no transplant-related mortality. Overall survival was 100% and thalassaemia-free survival 88.89%. Two patients developed grades Ⅱ skin acute GVHD(22.2%). No grade Ⅲ-Ⅳ GVHD or chronic GVHD occurred. Epstein-Barr virus infection occurred in 1 case.No infection of cytomegalovirus occurred.Conclusions:For major thalassaemia in children, stem cell transplantation of non-cryopreserved sibling cord blood is both safe and feasible with a high implantation rate and a low incidence of GVHD.

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