The experience of Japanese adolescents and young adults after losing siblings to childhood cancer: three types of narratives.

The aim of this study was to describe Japanese adolescents' and young adults' experiences after losing siblings to childhood cancer. A conceptual framework of the transition and analysis based on narrative method were adopted from qualitative data from 6 Japanese adolescents and young adults who had lost their siblings to childhood cancer. It was revealed that the participants' psychological experience after the sibling's death was directed by their perceptions of their mothers' responses to bereavement. We also found that the psychological distance between participants and their mothers could be an important factor in enabling transition into mourning and in orienting the lost sibling in their mind. The stories obtained from these 6 participants were categorized into the following 3 types of narratives: "Mother in another world and the sibling who became a god," "Return of the loving mother and the sibling as savior," and "The poor mother and the sibling who needs my help to carry on her legacy." This typology will serve as a framework for grief care and future research.

Online reporting system for transfusion-related adverse events to enhance recipient haemovigilance in Japan: a pilot study.

BACKGROUND: A surveillance system for transfusion-related adverse reactions and infectious diseases in Japan was started at a national level in 1993, but current reporting of events in recipients is performed on a voluntary basis. A reporting system which can collect information on all transfusion-related events in recipients is required in Japan. METHODS: We have developed an online reporting system for transfusion-related events and performed a pilot study in 12 hospitals from 2007 to 2010. RESULTS: The overall incidence of adverse events per transfusion bag was 1.47%. Platelet concentrates gave rise to statistically more adverse events (4.16%) than red blood cells (0.66%) and fresh-frozen plasma (0.93%). In addition, we found that the incidence of adverse events varied between hospitals according to their size and patient characteristics. CONCLUSION: This online reporting system is useful for collection and analysis of actual adverse events in recipients of blood transfusions and may contribute to enhancement of the existing surveillance system for recipients in Japan.

The hematological and clinical effects of X-ray contrast medium contaminating autologous blood for transfusion purposes.

Little information is available regarding the influence of non-ionic low-osmolar iodinated contrast medium (CM) in stored blood on the quality of blood components. We sought to evaluate the quality of such CM-contaminated blood in terms of the degree of hemolysis, production of microaggregates, level of iodine concentration, and RBC shape, and to identify the pros and cons of autologous blood donation immediately after X-ray examination using CM. In conclusion, contamination by such CM in blood collected around 2h after the completion of X-ray examination appears unlikely to induce deleterious effects on blood components.

Guidelines for safety management of granulocyte transfusion in Japan.

Granulocyte transfusion (GTX) has recently been revived by the ability to stimulate granulocyte donors with granulocyte colony-stimulating factor (G-CSF), resulting in a greatly increased number of cells that can be collected. However, there is a paucity of guidelines for assessing the appropriateness and safety management of GTX. The objective of this study was to establish guidelines for the safety management of GTX appropriate for the clinical situation in Japan. The Japan Society of Transfusion Medicine and Cell Therapy, Granulocyte Transfusion Task Force issued the first version of guidelines for GTX considering the safety management of both granulocyte donors and patients who receive GTX therapy. The current guidelines cover issues concerning: (1) the appropriateness of medical institutions, (2) management of granulocyte donors, (3) quality assurance of granulocyte concentrates, (4) administration of granulocyte concentrates, (5) evaluation of the effectiveness of GTX therapy, and (6) complications of GTX therapy. The simple 'bag separation method' without apheresis may be recommended for granulocyte collection in pediatric patients. The first version of guidelines for GTX therapy has been established, which may be appropriate for the clinical situation in Japan. Care should be taken to perform the safety management of both granulocyte donors and patients who receive GTX therapy.

Accumulated cytokines in stored autologous blood do not cause febrile nonhemolytic transfusion reactions.

Accumulated inflammatory cytokines are considered to be a cause of febrile nonhemolytic transfusion reactions (FNHTRs) of platelet transfusions. Inflammatory cytokines have been found in red cell components stored at 4 degrees C; however, their relationship to FNHTRs has not been clearly demonstrated following red cell transfusions. We measured cytokine levels in stored blood, and determined whether inflammatory marker concentrations were elevated in subjects infused with autologous blood stored for 5 weeks. In conclusion, cytokines accumulated in blood stored at 4 degrees C, but their increases were small. No changes were seen in recipients' inflammatory markers after blood transfusion. Our results indicate that cytokines in stored autologous blood are not responsible for FNHTRs.

Selection of hematopoietic stem cells with a combination of galactose-bound vinyl polymer and soybean agglutinin, a galactose-specific lectin.

BACKGROUND: Selection of hematopoietic stem cells can be used to prevent graft-versus-host disease (GVHD) after allograft transplantation. The purpose of the study was to examine a novel cell separation system comprising a galactose-bound vinyl polymer (Gal-VP) and soybean agglutinin (SBA), a galactose-specific lectin. STUDY DESIGN AND METHODS: A vinyl polymer (VP) containing alpha-1,6- and beta-1,4-linked galactose terminals was used to facilitate cell separation. A VP containing an alpha-1,4-linked glucose terminal (alpha-1,4-Glu-VP) was also synthesized as a control for alpha-1,6- and beta-1,4-Gal-VP. Peripheral blood samples were collected from healthy volunteers and umbilical cord blood cells were collected after normal labor. RESULTS: The sugar-VP was adsorbed on the surface of various materials. In the presence of SBA, T lymphocytes bound to beta-1,4-Gal-VP-coated microbeads, but not to alpha-1,4-Glu-VP-coated microbeads. When peripheral or cord blood cells were cultured on alpha-1,6-Gal-VP-coated plates, most red blood cells, lymphocytes, granulocytes, and monocytes adhered to the plate in the presence of 300 mg per mL SBA, whereas few CD34+ cells attached, even with 800 mg per mL SBA. CONCLUSION: SBA binds selectively to blood cells by recognizing cell-surface sugars, which are dependent on the extent of cellular differentiation. Therefore, the combination of alpha-1,6-Gal-VP and SBA might be useful for separation of blood cells according to their stage of differentiation and lineage.

Elevated serum levels of human matrix metalloproteinase-9 (MMP-9) during the induction of peripheral blood stem cell mobilization by granulocyte colony-stimulating factor (G-CSF).

To investigate the role of matrix metalloproteinases (MMPs) in the mobilization of peripheral blood stem cells stimulated by granulocyte colony-stimulating factor (G-CSF), we analyzed MMP serum levels in 11 healthy donors and 9 patients who had hematological malignancies or germ cell tumors. A dose of 5-10 microg/kg per day of G-CSF (lenograstim) was administered for 4-8 days to each subject. The serum levels of MMP-2, and MMP-9; interleukin-3, -6, -8, and -10; stem cell factor; interferon-gamma; and tumor necrosis factor-alpha were measured both before and during G-CSF administration. MMP-9 was found to be increased in both the cancer patients and the healthy donor group. In contrast, the levels of each of the other factors tested were unchanged. No significant positive correlation was observed between the MMP-9 levels and the number of CD34+ cells. Hence, we found no significant role for MMPs during the mobilization of peripheral blood stem cells stimulated by G-CSF.

Long-term follow-up of autologous stem cell transplantation for patients with aggressive non-Hodgkin lymphoma who had bone marrow involvement at initial diagnosis in the pre-rituximab era.

BACKGROUND: High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is an important treatment option for selected patients with aggressive non-Hodgkin lymphoma; however, the effectiveness of HDT for patients with bone marrow (BM) involvement of lymphoma cells is not well defined. PATIENTS AND METHODS: Between February 1991 and December 2001, 57 patients with aggressive non-Hodgkin lymphoma were treated with HDT and ASCT. Thirteen of 57 patients who had BM infiltration at initial diagnosis were analyzed. RESULTS: Median follow-up was 11.5 years. Eleven of 13 patients (85%) exhibited complete remission after HDT. The overall survival (OS) at 10 years was 49%, and the median survival time was 74.3 months. Meanwhile, the probability of OS at 10 years for 44 patients who did not have BM disease was 60%. There was no significant difference in OS (P=0.895) between patients with or without BM disease at initial diagnosis. CONCLUSION: High-dose therapy treatment followed by ASCT might save some groups of patients with lymphoma regardless of BM involvement at initial diagnosis.

Successful treatment of Diamond-Blackfan anemia with metoclopramide.

Diamond-Blackfan anemia (DBA) is a congenital anemia characterized by a low reticulocyte count, the absence or severe reduction of hemoglobin-containing cells in the bone marrow, and normal megakaryocytic and granulocytic differentiation. Although the anemia may initially respond to corticosteroid therapy, many patients require lifelong red blood cell (RBC) transfusion, leading to infectious complications and iron overload. Metoclopramide has recently been used to treat DBA. Treatment with metoclopramide induces the release of prolactin from the pituitary and stimulates erythropoiesis. For these reasons, we used metoclopramide to treat a 20-year-old man with DBA refractory to low and high doses of corticosteroids, cyclosporin A, and tacrolimus (FK506). The hemoglobin and hematocrit slowly increased, and he has remained asymptomatic and transfusion-independent for 8 months. Metoclopramide therapy should be considered in patients with refractory DBA before treatment-related complications develop.

Outcome of 154 patients with severe aplastic anemia who received transplants from unrelated donors: the Japan Marrow Donor Program.

We retrospectively analyzed results for 154 patients with acquired severe aplastic anemia who received bone marrow transplants between 1993 and 2000 from unrelated donors identified through the Japan Marrow Donor Program. Patients were aged between 1 and 46 years (median, 17 years). Seventy-nine donor-patient pairs matched at HLA-A, -B, and -DRB1 loci, as shown by DNA typing. Among the 75 mismatched pairs, DNA typing of 63 pairs showed that 51 were mismatched at 1 HLA locus (18 HLA-A, 11 HLA-B, 22 HLA-DRB1) and 12 were mismatched at 2 or more loci. Seventeen patients (11%) experienced either early or late graft rejection. The incidence of grade III/IV acute graft versus host disease and chronic graft versus host disease was 20% (range, 7%-33%) and 30% (range, 12%-48%), respectively. Currently, 99 patients are alive, having survived for 3 to 82 months (median, 29 months) after their transplantations. The probability of overall survival at 5 years was 56% (95% confidence interval, 34%-78%). Multivariate analysis revealed the following unfavorable factors: transplantation more than 3 years after diagnosis (relative risk [RR], 1.86; P =.02), patients older than 20 years (RR, 2.27; P =.03), preconditioning regimen without antithymocyte globulin (RR 2.28; P =.04), and HLA-A or -B locus mismatching as determined by DNA typing. Matching of HLA class I alleles and improvement of preparative regimens should result in improved outcomes in patients with severe aplastic anemia who receive transplants from unrelated donors.

Health-related quality of life of unrelated bone marrow donors in Japan.

To promote bone marrow donation, both the safety and well-being of healthy unrelated volunteer donors must be protected. This prospective cohort study evaluated donors' health-related quality of life (HRQOL) and identified factors associated with it. Using the Medical Outcomes Study Short Form 36 Health Survey (SF-36) before bone marrow harvesting (BMH), and again 1 week and 3 months after the donors' discharge, we evaluated HRQOL of 565 donors (329 men, 236 women) registered with the Japan Marrow Donor Program (JMDP). We also examined the data routinely collected by the JMDP, such as BMH-related problems and other demographic and medical variables, to determine whether such data could be used to predict donors' HRQOL after discharge. Mean scores of all pre-BMH SF-36 subscales showed better functioning than the national norm. One week after discharge, mean scores on physical functioning (PF) and role-physical (RP) subscales, indicative of physical states, and bodily pain (BP) were approximately 1 SD lower than the national norm; however, mental health (MH) and general health perception (GH) remained above normal; the most frequent BMH-related problems were pain at the donation site and lower back pain, which were associated with lower PF, RP, and BP scores. Female gender and duration of procedure predicted lower PF, RP, and BP. Three months after discharge, mean scores of all SF-36 subscales had returned to baseline levels. These data show that the adverse effects of BMH on donors' HRQOL are transient and can be minimized by better management of pain.