ABSTRACT
Allogeneic hematopoietic cell transplantation (allo-HCT), the only curative therapy for numerous hematological malignancies, carries a significant risk of morbidity and mortality. The patients and families' expectations regarding the procedure, the prognosis uncertainties, as well as the existence of potential new therapeutic possibilities, lead to frequent use of intensive care. Even though the transplant physicians are highly skilled in acute care, their knowledge of palliative approach is limited, making the use of palliative care insufficient and often late. By promoting reflection on the proportionality of care and the patients' quality of life, palliative care may contribute to the allo-HCT patients management. Nevertheless, obstacles to this approach remain. The objective of this work is to propose recommendations to promote the implementation of palliative care into transplant units.
Subject(s)
Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Palliative Care , Advance Directives , Allografts , Attitude of Health Personnel , Bacterial Proteins , Child , Clinical Decision-Making , Clinical Deterioration , Glucosyltransferases , Health Care Surveys/methods , Health Care Surveys/statistics & numerical data , Hematopoietic Stem Cell Transplantation/psychology , Humans , Interdisciplinary Communication , Interprofessional Relations , Palliative Care/organization & administration , Palliative Care/psychology , Prognosis , Qualitative Research , Quality of Life , Societies, Medical , Terminal CareABSTRACT
Since 2010 there has been an exponential increase of the number of transplants performed from related donors. The development of haploidentical transplants increases the resort to related-donation, which presents two main advantages: a less important financial cost and a faster availability of the graft. Standards for mandatory accreditation exist, but the adherence to these recommendations is not optimal: currently, different practices regarding the organizational modalities of care, recruitment criteria, qualification and follow-up of related donors have been observed among French transplant centers. The Francophone Society of Marrow Transplant and Cellular Therapy (SFGM-TC) has developed guidelines for the consent and the non-eligibility criteria for hematopoietic stem cell donors. A multidisciplinary group has devised a booklet as a medium to inform donors about hematopoietic cell donation and transplantation in a clear and accessible language. This paper provides recommendations on post-donation follow-up, taking into account both medical standards and organizational constraints of French centers. Some tools are proposed.
