Antibiotic Therapy and Gastrointestinal Graft-Versus-Host Disease in the Allogeneic Stem Cell Transplantation Population.

PURPOSE: Hematopoietic stem cell transplantation patients undergo rigorous courses of myeloablative chemotherapy that increase vulnerability for infections. Complications can arise in the form of graft-vs.-host disease (GvHD) manifesting in various organs, including the skin, lung, liver, and gastrointestinal (GI) tract. Antibiotic therapy is generally begun in order to prevent further complications from infection but may increase the risk for acute GI GvHD. Studies that investigated antibiotic therapy and the subsequent occurrence of GI GvHD in allogeneic stem cell transplantation (aSCT) patients were reviewed. METHODS: PubMed, Scopus, and CINAHL databases were utilized. Articles published between January 1, 2009, and December 15, 2019, were included in this review. A total of 1,142 articles were retrieved. Duplicates, reviews, letters to the editors, irrelevant interventions/outcomes, and non-English articles were excluded. Inclusion criteria included individuals who were undergoing an aSCT and received antibiotic therapy. A total of seven articles were included for this review after applying the inclusion and exclusion criteria. RESULTS: The use of broad-spectrum antibiotics increased the risk of developing GI GvHD. Stool analysis when available showed a decrease in the diversity of the gut microbiome, which in turn led to the increase in acute GvHD. IMPLICATIONS: The increased risk of GvHD may have implications for the standard of care therapy, which includes treatment, for infections during SCTs. Providers will need to weigh the risk vs. benefit of antibiotic therapy and exercise judicious selection of antibiotics prior to engraftment.

Early Detection of Vulvovaginal Graft-Versus-Host Disease: An Integrative Review.

INTRODUCTION: Vulvovaginal graft-vs.-host disease (VVGvHD) is a condition caused by a T-cell mounted immune response after allogeneic hematopoietic stem cell transplant (alloHSCT), which can lead to sclerotic changes of the external genital organs. A common complication of alloHSCT, VVGvHD is underreported and underdiagnosed in female patients. Without detection and treatment, VVGvHD can progress to complete obliteration of the vaginal canal requiring surgical intervention in severe cases. DESIGN: This review summarizes findings to assist providers in detecting and treating VVGvHD. It utilized PubMed, Scopus, and CINAHL databases. Inclusion criteria consisted of female patients, a history of stem cell transplantation, and a history of VVGvHD. Studies not published in English and dated more than 15 years were excluded. After the evaluation of 333 articles, 10 were included based on relevance and applicability. Limitations of this review included small sample sizes, retrospective nature of articles, and lack of randomized control trials. FINDINGS: Early identification of VVGvHD requires identifying the rate of occurrence and risk factor profile, recognizing the presenting symptoms, improving VVGvHD assessment techniques, ascertaining when to biopsy, and establishing clinically targeted surveillance programs. CONCLUSION: For female patients who have undergone alloHSCT, targeted surveillance for early identification of VVGvHD results in earlier treatment initiation. Subsequently, this can improve sexual health, partner relationships, and quality of life in patients after stem cell transplant.

Telehealth Interventions for Supportive Management and Early Recognition of Treatment-Related Symptoms in Patients With Hematologic Malignancies.

Purpose: The purposes of this literature review were to (1) establish the utility of supportive telehealth interventions focusing on early identification of treatment-related symptoms in adult patients with hematologic malignancies, with a secondary aim to (2) evaluate acceptability and feasibility. Methods: A literature review was conducted using PubMed, Cochrane Database of Systematic Reviews, CINAHL, Scopus, and Embase. Dates searched were from January 2007 through December 2019. Inclusion criteria included a diagnosis of hematologic malignancy, incorporation of telehealth interventions, effects on physiological outcomes, and participants ages 18 or older. Articles were excluded if they were a duplicate, had an irrelevant title, or were an incomplete study. Results: Results indicated overall utility, acceptability, and feasibility of the interventions, including improved awareness of late and long-term therapy-related sequelae in survivorship, an overall decline in the number of chemotherapy delays with decreased rates in dose reductions, a means to further manage exercise remotely, and finally, improved communication between provider and patient with real-time management of acute and chronic treatment-related side effects using supportive telemetric interventions. Conclusion: Overall, the use of telehealth interventions in adult patients with hematologic malignancies positively impacts patient health, and telehealth interventions were found to be both accepted and feasible. Future studies should be directed at the role and involvement of the advanced practitioner, and current literature calls for well-planned studies as methodologic limitations remain in the evidence.

Diagnostic and Prognostic Biomarkers for Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation.

PROBLEM IDENTIFICATION: A lack of testing options for the diagnosis and prognosis of chronic graft-versus-host disease (cGVHD) is a barrier to clinical management. Studies that have investigated the role of blood proteins as diagnostic and prognostic biomarkers for cGVHD were reviewed. LITERATURE SEARCH: PubMed and Scopus databases were searched for articles published from January 1, 2000, to May 31, 2019. 660 articles were retrieved. DATA EVALUATION: The authors appraised seven articles based on the inclusion and exclusion criteria to summarize identified blood protein biomarkers for cGVHD. SYNTHESIS: Several blood proteins were identified as potential diagnostic and prognostic biomarkers. Most of these proteins are thought to be key contributors in cGVHD pathogenesis and, therefore, could be ideal biomarkers to guide clinical management. IMPLICATIONS FOR PRACTICE: These biomarkers could aid providers in diagnosing cGVHD, identifying patients at high risk for development of cGVHD, and initiating preemptive therapy.

The Impact of Peripheral Cooling on Chemotherapy-Induced Peripheral Neuropathy: An Integrative Review.

Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent, potentially long-lasting side effect of select chemotherapies. It contributes to suboptimal chemotherapy dosing, and its symptoms negatively impact patients' quality of life. To date, interventions to effectively prevent this toxicity have not been established, and interventions to treat CIPN have produced only modest results. The purpose of this integrative review is to examine the impact of regional cooling applied to distal extremities on the severity of CIPN. A literature review was performed using SCOPUS and PubMed databases. The search was not restricted by date but was restricted to English language. Forty-two articles were identified in the search, and six were included in the review after applying inclusion and exclusion criteria. Results related to protective effects from peripheral cooling against CIPN were variable. Four out of six studies demonstrated benefit of peripheral cooling in reducing the severity of CIPN. There was evidence to suggest that applying a relatively greater degree of cooling compared with a lesser degree may confer benefit in reducing the severity of CIPN. Both direct application of cooling and use of compression to achieve fingertip cooling showed potential benefit.

Risk Factors for Ifosfamide-Related Encephalopathy in Adult Cancer Patients: An Integrative Review.

Patients receiving ifosfamide as part of their cancer treatment are at risk for ifosfamide-related encephalopathy (IRE), a potentially serious adverse event affecting up to 60% of patients. Symptoms range from transient altered mental status to coma and death. Consensus regarding risk factors for the development of IRE has not been reached in the literature. The purpose of this review is to identify risk factors for the development of IRE in adult cancer patients. A literature review was completed by searching PubMed and Scopus databases to identify articles published between 2008 and 2018. A total of 76 search results were reduced to a final sample of seven articles after applying inclusion and exclusion criteria. Published data suggest that Eastern Cooperative Oncology Group (ECOG) performance status of greater than or equal to 2, impaired renal function, hypoalbuminemia, and having multiple risk factors are risk factors for the development of IRE. Knowledge of which patients are at increased risk for the development of IRE could help clinicians to appropriately counsel patients and families regarding personal risk for the development of IRE. Clinicians may also more closely monitor patients with risk factors for IRE.