Impact of life-threatening risk information on the evolution of patients’ anxiety and risk recall: The specific context of informed consent for experimental stem cell transplant

2009 ◽  
Vol 75 (2) ◽  
pp. 192-198 ◽  
Author(s):  
Isabelle Merckaert ◽  
Yves Libert ◽  
Dominique Bron ◽  
Marie-France Jaivenois ◽  
Philippe Martiat ◽  
...  
Keyword(s):  
Stem Cell ◽  
Informed Consent ◽  
Stem Cell Transplant ◽  
Risk Information ◽  
Cell Transplant ◽  
Specific Context ◽  
Life Threatening ◽  
Risk Recall

Autologous Stem Cell Transplant for Myasthenia Gravis: A Single-Centre Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3996-3996 ◽  
Author(s):  
Adam Bryant ◽  
Elizabeth Pringle ◽  
Christopher Bredeson ◽  
David S. Allan ◽  
Grizel Anstee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stem Cell ◽  
Myasthenia Gravis ◽  
Targeted Therapies ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Autoimmune Conditions ◽  
Life Threatening

Abstract Myasthenia Gravis is an antibody-mediated disease that affects the neuromuscular junction. Despite advances in immune-targeted therapies, a subset of patients demonstrate refractory disease with severe or life-threatening symptoms. Disease control has been achieved using autologous hematopoietic stem cell transplant (HSCT) in a variety of autoimmune conditions including multiple sclerosis, chronic inflammatory demyelinating polyneuropathy, stiff person syndrome, and others. Here we report our center’s experience using autologous HSCT in seven patients with myasthenia. Seven myasthenia patients underwent HSCT between 2001 and 2011. Six patients were female. Median age (range) was 37 at diagnosis (17-52) and 43 at HSCT (24-55). Before HSCT, myasthenia severity, standardized by the Myasthenia Foundation of America (MGFA) clinical classification, was graded as moderate in 2 patients, severe in 3 patients, and life-threatening in 2 patients. Treatment regimens included pyridostigmine in all patients, and immune-targeted therapies including: steroid therapy in all patients, an additional immunomodulating drug in 6 patients, and plasma exchange or intravenous immunoglobulin in all patients. All patients had at least one myasthenia-related emergency department visit or hospitalization prior to HSCT, 3 requiring ICU stays and 2 requiring intubation. All patients underwent HSCT mobilization with cyclophosphamide and filgrastim. Stem cells were harvested from peripheral blood and selected for CD34+ cells in all cases. Conditioning regimens used busulfan, cyclophosphamide, and antithymocyte globulin (Bu-Cy-ATG) in 4 patients, Cy-ATG and total body irradiation in 2 patients, and etoposide, melphalan and dexamethasone in 1 patient who was undergoing HSCT for relapsed follicular lymphoma (FL). Median post-HSCT follow-up was 40 months (range 29-149). At last follow-up MGFA postintervention status was classified as complete stable remission (CSR) in all patients, indicating patients bad been experiencing no myasthenia symptoms and were on no myasthenia therapy for at least one year. Six patients had no further hospitalizations or emergency department visits post HSCT. One patient required hospitalizations in the 6 months post HSCT but at time of writing had been not hospitalized for myasthenia for more than 10 years. One patient died 29 months post HSCT from relapsed FL. At time of death this patient’s myasthenia was in CSR. There were no HSCT regimen-related deaths. No patients required ICU care during HSCT admission. Absolute neutrophil count exceeded 0.5 x 109/L on median post HSCT day 11 (range 13 - 28). Median hospital stay, including administration of conditioning regimen was 34 days (range 20-43). In the first post-HSCT year the cohort experienced 6 viral reactivations in 3 patients: 3 cases CMV viremia, 1 case BK virus-induced hemorrhagic cystitis, 1 case VZV dermatitis, 1 case oral HSV. Two late post-HSCT complications were observed: one case of acquired amegakaryocytic thrombocytopenia (post-HSCT day 701), and one case of relapsed FL (post-HSCT day 846) resulting in patient death. HSCT resulted in longstanding symptom- and treatment-free remission in seven patients with refractory myasthenia gravis. The procedure was tolerable however the intense immune depletion transiently increased risk of viral reactivation. This experience demonstrates that in selected myasthenia gravis cases, HSCT is a viable option for long-term disease control. The novel application of HSCT for this and other autoimmune conditions is an area that warrants further exploration and long-term follow-up. Disclosures No relevant conflicts of interest to declare.

scholarly journals Rhabdomyolysis due to Trimethoprim-Sulfamethoxazole Administration following a Hematopoietic Stem Cell Transplant

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Alexander Augustyn ◽  
Mona Lisa Alattar ◽  
Harris Naina
Keyword(s):  
Stem Cell ◽  
Myeloid Leukemia ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Muscle Necrosis ◽  
Life Threatening ◽  
Prophylaxis Therapy ◽  
High Index Of Suspicion ◽  
Life Threatening Event

Rhabdomyolysis, a syndrome of muscle necrosis, is a life-threatening event. Here we describe the case of a patient with chronic myeloid leukemia who underwent a haploidentical stem cell transplant and subsequently developed rhabdomyolysis after beginning trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis therapy. Rechallenge with TMP/SMX resulted in a repeat episode of rhabdomyolysis and confirmed the association. Withdrawal of TMP/SMX led to sustained normalization of creatine kinase levels in the patient. A high index of suspicion is necessary to identify TMP/SMX as the cause of rhabdomyolysis in immunocompromised patients.

scholarly journals Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant

2015 ◽  
Vol 169 (5) ◽  
pp. 719-725 ◽  
Author(s):  
Jorge Labrador ◽  
Lucia López-Corral ◽  
Lourdes Vazquez ◽  
Fermin Sánchez-Guijo ◽  
Carmen Guerrero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Life Threatening

scholarly journals Status Epilepticus Due to Severe HHV-6 Encephalitis in an Allogeneic Stem Cell Transplant Recipient

2013 ◽  
Vol 6 (1) ◽  
pp. e2014008 ◽  
Author(s):  
Poorvi Chordia ◽  
Pranatharthi H Chandrasekar
Keyword(s):  
Stem Cell ◽  
Status Epilepticus ◽  
Transplant Recipient ◽  
Stem Cell Transplant ◽  
Clinical Manifestations ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Intravenous Ganciclovir ◽  
Life Threatening

Reactivation of human herpes virus-6 (HHV-6) after stem cell transplantation occurs frequently. It is associated with clinical manifestations varying from nonspecific symptoms such as fevers or rash, to severe life threatening complications including post-transplantation limbic encephalitis. We report a case of severe HHV-6 encephalitis with viremia in an allogeneic peripheral stem cell transplant recipient who presented with status epilepticus unresponsive to antiepileptic therapy.  With intravenous ganciclovir and supportive care, the patient’s condition improved. Awareness of HHV-6 infection in stem cell transplant recipients may help with early diagnosis and improved outcome.

scholarly journals DAS181 Treatment of Severe Parainfluenza Virus 3 Pneumonia in Allogeneic Hematopoietic Stem Cell Transplant Recipients Requiring Mechanical Ventilation

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
B. Dhakal ◽  
A. D’Souza ◽  
M. Pasquini ◽  
W. Saber ◽  
T. S. Fenske ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Parainfluenza Virus ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem ◽  
Life Threatening ◽  
Type 3

Parainfluenza virus (PIV) may cause life-threatening pneumonia in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Currently, there are no proven effective therapies. We report the use of inhaled DAS181, a novel sialidase fusion protein, for treatment of PIV type 3 pneumonia in two allogeneic hematopoietic SCT recipients with respiratory failure.

scholarly journals Pulmonary mucormycosis with diaphragm and liver involvement in a patient with haematopoietic stem cell transplant

2019 ◽  
Vol 30 (1) ◽  
pp. 144-145
Author(s):  
Jason Hongting Leung ◽  
Khong-Yik Chew ◽  
Alexander Yaw-Fui Chung ◽  
Tina Puay Theng Koh
Keyword(s):  
Stem Cell ◽  
Latissimus Dorsi ◽  
Transplant Patient ◽  
Stem Cell Transplant ◽  
Daily Activities ◽  
Haematopoietic Stem Cell Transplant ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Pulmonary Mucormycosis ◽  
Life Threatening

Abstract Pulmonary mucormycosis is a rare but life-threatening fungal infection. We report a post-haematopoietic stem cell transplant patient with pulmonary mucormycosis that extended to the diaphragm and subphrenic space. He underwent lung and diaphragm resection, debridement of liver capsule and diaphragm reconstruction using a pedicled latissimus dorsi flap. Following surgery, the patient remained well and has resumed his regular daily activities.

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