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Background: The use of cryopreservation for stem cell grafts for both autologous stem cell and allogeneic cord blood transplant has been utilized for years. For other allogeneic stem cell transplant sources, the use of fresh collected grafts has been preferred due to concerns that cryopreservation may result in impaired graft function. With the onset of the COVID-19 pandemic a shift was made at our institution to exclusive use of cryopreservation Methods: In this retrospective single-center analysis a total of 133 patients undergoing allogeneic stem cell transplant at the University of Minnesota between 1/2018-6/2021 for a variety of malignancies were included, with 62 patients receiving fresh stem cell product and 71 patients receiving frozen stem cell product. Univariate statistical analysis was performed. Result(s): There was no significant difference between the two groups with regards to product type, sex, age, diagnosis (acute leukemia vs other), disease risk index, conditioning regimen, Karnofsky score, co-morbidity index, or cell dose (Table 1). Donor type was notably different between the two groups (p<0.01): matched sibling grafts were more commonly used for fresh products than frozen (85% vs. 35%), while matched unrelated donors were used more frequently for frozen than for fresh products (54% vs. 6%). Use of frozen product was associated with delayed neutrophil and platelet engraftment compared to fresh (median days to engraftment 15 vs 12 for neutrophils, 23 vs 17 for platelets, p<0.01 for both). Two-year relapse rates were significantly lower for frozen products (4%) than fresh (24%) (Table 2). This may be partially attributable to differences in follow up between the groups, as fresh products had a total of 910 days of follow up vs 432 for frozen products (P<0.0001). The difference in follow up remained statistically significant if the data was censored at 730 days (P<0.0001). Of note, the use of frozen products was associated with a lower rate of chronic graft-versus-host disease at one year post-transplant (p<0.01). There was no significant difference in the rates of acute GVHD between the groups. There were significant differences in GVHD prophylaxis regimens between the fresh and frozen groups (p<0.01). (Figure Presented)Two-year overall survival did not differ between groups (p=0.96). Conclusion(s): Use of cryopreserved stem cell products is associated with similar efficacy and outcomes as those seen with the use of fresh stem cell products. Although the data presented here suggest novel finding of decreased risk of relapse and chronic GVHD with the use of frozen stem cell products, additional follow up may abrogate these differences. Regardless, the logistical benefits of cryopreservation make this an attractive option for continued use in allogeneic transplants and our data presented here suggests that cryopreserved products remain an appropriate option for allogeneic stem cell transplant.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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INTRODUCTION: Adverse Social Determinants of Health (SDoH) negatively impact child health outcomes. Outpatient SDoH screening is recommended by the American Academy of Pediatrics, but inpatient screening is not routine. This study sought to identify the prevalence of adverse SDoH in families of children admitted to a tertiary care pediatric intensive care unit (PICU) and to identify patient characteristics associated with positive screens. METHODS: An existing SDoH measure modified to include domains for which we were equipped to provide support was administered by a social worker to a primary caregiver of PICU patients from 2/18/20 - 6/4/20. Screens were positive if caregivers reported lack of access or worry about lack of access to services within the past year. Domains included housing, utilities (electricity, gas, water), childcare, mental health care and transportation. Patient demographics, diagnoses, lengths of stay, survival, and Pediatric Logistic Organ Dysfunction (PELOD) scores were collected from electronic medical records. Due to SARS-CoV-2, our study was paused from 3/9/20 - 4/21/20, allowing secondary analysis of SDoH before and after onset of the pandemic. All families received a resource guide in support of SDoH;families with positive screens were provided personalized support by social workers. RESULTS: Of the 84 families screened in the PICU, 26 (31%) screened positive for at least one adverse SDoH. Transportation (17%) and housing (13%) were the most commonly reported adverse SDoH. Thirteen (15%) families reported needs in multiple SDoH domains. There were no differences between patient characteristics, primary diagnosis, PELOD score, survival, or length of stay between families with positive or negative SDoH screening. In the post-SARSCoV- 2 epoch, children were older (9 vs. 4 years), had shorter PICU lengths of stay (3 vs. 7 days), and presented with less sepsis (19% vs. 67%) and more neurologic and respiratory diagnoses (30% vs. 3% and 20% vs. 13%). Adverse SDoH were similar between epochs. CONCLUSIONS: Almost a third of families with children admitted to the PICU had adverse SDoH. The optimal approach to routine screening and support of SDoH in families with critically ill children should be studied.
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INTRODUCTION: To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning. METHODS: Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases. RESULTS: 1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were 'Not at all worried' about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be 'Not worried at all' compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use. CONCLUSION: Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience. IMPLICATIONS FOR PRACTICE: As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.