Risk factors for capillary leakage syndrome after bone marrow transplantation

1997 ◽  
Vol 74 (5) ◽  
pp. 221-224 ◽  
Author(s):  
W. Nürnberger ◽  
R. Willers ◽  
S. Burdach ◽  
U. Göbel
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Capillary Leakage ◽  
Capillary Leakage Syndrome

scholarly journals Predictors of death from chronic graft-versus-host disease after bone marrow transplantation

Blood ◽  
1989 ◽  
Vol 74 (4) ◽  
pp. 1428-1435 ◽  
Author(s):  
JR Wingard ◽  
S Piantadosi ◽  
GB Vogelsang ◽  
ER Farmer ◽  
DA Jabs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Hazard Ratio ◽  
Actuarial Survival ◽  
Host Disease ◽  
Late Morbidity

Abstract Chronic graft-v-host disease (chronic GVHD) is a frequent cause of late morbidity and death after bone marrow transplantation (BMT). The actuarial survival after onset of chronic GVHD in 85 patients was 42% (95%Cl = 29%, 54%) at 10 years. Baseline characteristics present at the onset of chronic GVHD (before therapy) in 85 patients were reviewed to determine which were risk factors for death. In a multivariate proportional hazards analysis, three baseline factors emerged as independent predictors of death: progressive presentation (chronic GVHD following acute GVHD without resolution of acute GVHD; hazard ratio of 4.1, 95% Cl = 2.1 to 7.8), lichenoid changes on skin histology (hazard ratio of 2.2, 95% Cl = 1.1 to 4.3), and elevation of serum bilirubin greater than 1.2 mg/dL (hazard ratio = 2.1, 95% Cl = 1.1 to 4.1). Actuarial survival of 23 chronic GVHD patients with none of these risk factors was 70% at 6 years (95% Cl = 38%, 88%). Thirty-eight patients with one of these risk factors had a projected 6-year survival of 43% (95% Cl = 21%, 63%). The 29 patients with any combination of two or more of these factors had a projected 6-year survival of only 20% (95% Cl = 8%, 37%). Identification of baseline risk factors should facilitate design of trials of chronic GVHD therapies and assignment of high-risk patients to more aggressive innovative therapeutic regimens.

Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia

1989 ◽  
Vol 71 (4) ◽  
pp. 535-543 ◽  
Author(s):  
Roy S. Weiner ◽  
Mary M. Horowitz ◽  
Robert Peter Gale ◽  
Karel A. Dicke ◽  
Dirk W. Bekkum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anaemia ◽  
Interstitial Pneumonia ◽  
Marrow Transplantation ◽  
Severe Aplastic Anaemia

Ethical Reasoning About Allogeneic Bone Marrow Transplantation and Patient Eligibility Based on Psychosocial Criteria.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 635-635
Author(s):  
Larry Foster ◽  
Linda McLellan ◽  
Lisa Rybicki ◽  
Brian Bolwell
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Social Workers ◽  
Early Onset ◽  
Marrow Transplantation ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Mild Dementia

Abstract Purpose: Bone marrow transplantation has been given insufficient attention as a context for clinical ethics. Of concern are the patient and family who disagree with a BMT program’s “do not proceed” decision based on psychosocial issues and who request an ethics review. In follow-up to a 2006 national survey in which patients were determined not to be appropriate candidates for allogeneic (allo) BMT based on select psychosocial risk factors, this study reports on whether ethicists agreed with decisions of their oncology colleagues and how they justified their agreements/disagreements. Methods: A self-administered questionnaire was sent to chairpersons of ethics committees at hospitals with a BMT Program that does adult allo BMT, is accredited by the Foundation for the Accreditation of Cellular Therapy, and is designated as a National Marrow Donor Program Transplant Center. The questionnaire included six case vignettes on which oncology physicians, nurses, and social workers in the 2006 study agreed not to proceed with allo BMT based on a patient having one of the following psychosocial risk factors: suicidal ideation; use of addictive, illicit drugs; history of non-compliance with treatment; lives far from the hospital and has no caregiver; drinks daily and is told he is an alcoholic; and has mild dementia from early onset of Alzheimer’s disease. In each case allo BMT is the only curative option, the patient has leukemia, has a matched donor, and both patient and family want to proceed. Results: The survey response rate was 37%. On average, ethicists were older than professionals from each of the three other groups. Percentage of male ethicists was higher than nurses or social workers, but lower than physicians. Ethicists’ years of experience were similar to physicians, but more than nurses or social workers. The opinion of ethicists regarding whether or not to proceed with BMT differed from the other three professional groups on one case only, a patient with mild dementia from early onset of Alzheimer’s disease. For this case, 27% of ethicists recommended not proceeding with BMT; this was significantly lower than the do not proceed recommendation from nurses (68%, P<0.001), physicians (63.5%, P<0.001), and social workers (51.9%, P= 0.05). As with BMT clinicians, ethicists’ decisions in all six cases were often conditional but appealed more to ethical ideals, especially in the case of patients with mild dementia; thematic were concerns about doing good (beneficence), avoiding harm (non-maleficence), potential for quality of life, and a fair allocation of resources (justice). Conclusions: Access to health care is commonly understood to be an ethical issue, but the gravity of BMT as a potentially life saving decision adds urgency to the issue. BMT clinicians can be reassured that, for the most part, ethicists concur with their “do not proceed” decisions. That ethicists appear reluctant to attempt to over-rule clinicians, except in the case of mild dementia, may reflect the ethicists’ ideal of maximizing potential to do good in conflict with the clinicians’ bedside reality of minimizing potential harms to a patient who lacks decisional capacity and may be unable to comply with difficult treatment protocols. Ethics consults may prove a helpful resource when patients/families disagree with BMT programs’ decisions to base eligibility on psychosocial as well as biomedical criteria.

Norethisterone Treatment, a Major Risk-Factor for Veno-Occlusive Disease in the Liver After Allogeneic Bone Marrow Transplantation

Blood ◽  
1998 ◽  
Vol 92 (12) ◽  
pp. 4568-4572
Author(s):  
Hans Hägglund ◽  
Mats Remberger ◽  
Sven Klaesson ◽  
Berit Lönnqvist ◽  
Per Ljungman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Allogeneic Bone Marrow Transplantation ◽  
Occlusive Disease ◽  
Allogeneic Bone ◽  
Hla Antigen ◽  
Hematopoietic Stem ◽  
Heparin Prophylaxis

In this single-center study, we retrospectively analyzed incidence and risk factors for hepatic veno-occlusive disease (VOD) in 249 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation between January 1990 and June 1995. Twenty-four of the 249 transplanted patients developed VOD. The probabilities of developing VOD were 17% among women and 7% in men (P = .01). In women treated with norethisterone, the incidence was 27% compared with 3% in women without this treatment (P = .007). One-year survival rates were 17% and 73% in patients with (n = 24) or without VOD (n = 225), respectively. The use of heparin prophylaxis (100 IE/kg/24 hours for 1 month) did not alter the incidence or 1-year mortality of VOD. In multivariate analysis, the following risk factors were significant: norethisterone treatment (P < .001), bilirubin >26 μmol/L before bone marrow transplantation (BMT) (P = .002), one HLA-antigen mismatch (P = .003), previous abdominal irradiation (P = .02), and conditioning with busulphan (P = .02). Our conclusion is that norethisterone treatment should not be used in patients undergoing BMT and heparin prophylaxis did not affect the incidence or mortality of VOD.

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