Musculoskeletal impairments in children receiving intensive therapy for acute leukemia or undergoing hematopoietic stem cell transplant: A report from the Children's Oncology Group

2021 ◽  
Author(s):  
Joel Thompson ◽  
Brian Fisher ◽  
Lillian Sung ◽  
Christopher Dvorak ◽  
Ha Dang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Leukemia ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Intensive Therapy ◽  
Cell Transplant ◽  
Oncology Group ◽  
Hematopoietic Stem ◽  
Musculoskeletal Impairments

scholarly journals Barriers and Support-System while Considering Hematopoietic Stem Cell Transplant (HSCT): A Qualitative Study of Pre-HSCT Acute Leukemia Patients from a Standalone Transplant Laboratory in India

2021 ◽  
Vol 42 (02) ◽  
pp. 153-160
Author(s):  
Hina Solanki ◽  
Aseem K. Tiwari ◽  
Naveen Vashisht ◽  
Vimarsh Raina ◽  
Girish Sharma
Keyword(s):  
Stem Cell ◽  
Qualitative Study ◽  
Acute Leukemia ◽  
Hematopoietic Stem Cell ◽  
Support System ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Patients Experience

Abstract Introduction Hematopoietic stem cell transplant (HSCT) is the definite treatment for acute leukemia but considering HSCT is challenging for the patients. There are many studies that have described the patients’ experience after HSCT but very few studies have reported their experience before going for HSCT and there is no published report in India on patients’ experience before HSCT. Objective We conducted a qualitative study to understand barriers, and support-system while considering HSCT and the chances of getting matched unrelated donor (MUD) for these patients. Materials and Methods The present study was a qualitative study. Demographic details of 514 patients who consented for the study were noted and the patients and their families were interviewed using a semistructured interview booklet before HSCT. The interview sessions were recorded, transcribed verbatim, and analyzed for emerging themes. The study data were analyzed using QDA Miner Lite 4.0 software (Provalis Research, Montreal, Canada). Descriptive statistics such as frequency and percentage were used. The chances of getting a human leukocyte antigen (HLA)-matched donor were also computed by “HLA-matching software.” Results Acute myeloid leukemia (64.01%) was commoner than acute lymphoid leukemia (35.99%) with male: female ratio as 1.98:1. The study showed nine themes as barriers and six themes emerged in regard to the support system for HSCT decision making. The biggest barriers identified among these patients pre-HSCT were related to cost, probability of “success of transplant,” and probable “quality of life.” The family support was the biggest support system variable followed by “treating doctor.” The chances of getting a MUD for these patients were 13.22% and 5.44% in global and Indian data pool, respectively. Conclusion Deciding upon HSCT can be challenging for patients and understanding of barriers and support-system variables among these patients would provide important insights and help design better counseling techniques for such patients of HSCT and future studies in this context.

scholarly journals Clostridium Difficile Infection Is Independently Associated with Significantly Worse Outcomes in Acute Leukemia Patients Undergoing Chemotherapy and/or Hematopoietic Stem Cell Transplant

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-14
Author(s):  
Prasanth Lingamaneni ◽  
Vatsala Katiyar ◽  
Krishna Moturi ◽  
Binav Baral ◽  
Ishaan Vohra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Acute Leukemia ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Mortality Rates ◽  
Cell Transplant ◽  
Inpatient Mortality ◽  
Hematopoietic Stem

Background: Risk factors for Clostridium difficile infection (CDI) include antibiotic use, prolonged hospitalization, cancer chemotherapy, hematopoietic stem cell transplantation (HSCT) and gastric acid suppression, all of which, are encountered in acute leukemia patients. We sought to examine the impact of CDI on inpatient outcomes and resource utilization, as well as, to evaluate the trends of CDI in acute leukemia patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adults with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), who were admitted between 2012 and 2017 for inpatient chemotherapy and/or hematopoietic stem cell transplant (HSCT). Those with and without CDI were compared. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for CDI, as well as, inpatient mortality. Statistical tests for trends of resource utilization across six years were performed. Results: A total of 187,105 admissions met the inclusion criteria, of which, 5.3% had CDI. Mean age (51.3 years) and gender (male 56.4%) did not significantly differ between those with and without CDI. AML accounted for a larger proportion of the CDI group (72.4% vs 64.6%, p<0.0001). CDI was associated with higher rates of inpatient mortality (8.9% vs 4.4%), ICU-level care (8.5% vs 3.7%), shock (9.6% vs 3.6%) and acute kidney injury (21.2% vs 11.1%), p<0.0001 for all outcomes. On multivariate analysis, independent risk factors for CDI included: AML, HSCT, neutropenia, higher comorbidity burden (in the form of Charlson comorbidity index) and being treated at a teaching hospital. Blacks had lower rates of CDI. After adjusting for demographic variables, comorbidities, and accounting for higher proportion of AML, HSCT and neutropenia in the CDI group, CDI still accounted for higher risk for inpatient mortality (aOR 1.76, 95% CI 1.48-2.10, p<0.001), increased length of stay by 9 days (95% CI: 8.0-10.1, p<0.001) and higher hospitalization charges by around $33k per admission (95% CI: $25k-39k, p<0.001). CDI rate in acute leukemia patients remained stable between 2012 to 2017. The mortality rates declined in both groups (9.8% in 2012 to 6.3% in 2017, p<0.01 in the CDI group and 5.7% in 2012 to 1.9% in 2017, p<0.001 in the non-CDI group). Similarly, length of hospital stay improved in both groups (31 to 27 days in CDI group, p=0.04 and 17 to 13 days in non-CDI group, p<0.001). While the hospitalization costs improved significantly in the non-CDI group ($52k to $42k, p<0.001), there was no statistically significant change in the CDI group ($112k to 102k, p=0.90). Conclusions: CDI has a substantial impact on outcomes in acute leukemia patients. Higher incidence of CDI in HSCT recipients may be explained by prolonged hospitalizations, increased antibiotic exposures, and extended periods of impaired host immunity. Additionally, GVHD may also play a role in the incidence of CDI and its outcomes. Despite improvement in outcomes over the years, mortality rates and financial burden of CDI on health care, is still substantially higher in those without CDI, therefore, there is a need to focus on preventive measures. Disclosures No relevant conflicts of interest to declare.

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