scholarly journals White versus gray matter function as seen on neuropsychological testing following bone marrow transplant for acute leukemia in childhood

2008 ◽  
pp. 283 ◽  
Author(s):  
Fiona Anderson
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Bone Marrow Transplant ◽  
Gray Matter ◽  
Neuropsychological Testing ◽  
Marrow Transplant

Disentangled: A single institutional analysis comparing differences in end-of-life patterns and resource utilization in acute leukemia and bone marrow transplant units.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 90-90
Author(s):  
Gene Decastro ◽  
Samuel Anandan ◽  
Adam Ginsberg ◽  
Santiago Lopez
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
End Of Life ◽  
Bone Marrow Transplant ◽  
Palliative Medicine ◽  
Outcome Measure ◽  
Hematologic Malignancies ◽  
Marrow Transplant ◽  
Eol Care ◽  
To Receive

90 Background: The impact of palliative medicine in patients with hematologic malignancies is a growing area of investigation. Over the last year, the Palliative Medicine service at North Shore University Hospital (NSUH) has developed and sustained a co-management model for patients admitted to the acute leukemia (ALU) or bone marrow transplant (BMTU) units. Methods: The primary outcome measure was the time from admission to initial consult. The secondary outcome measure was length of stay in a goal concordant setting to receive end of life (EOL) care, namely our inpatient palliative care unit (PCU). Results: There were 106 new consults in twelve months (45 acute leukemia/lymphoma consults and 61 bone marrow transplant consults). The principal diagnosis seen on the ALU was acute myeloid leukemia (56%), whereas on the BMTU it was multiple myeloma (28%). The average time to consult for the ALU decreased from 18.8 days at 6 months to 8.8 days at 12 months. For the BMTU, time to consult decreased from 10.2 days at 6 months to 4.6 days at 12 months. The mortality rate of patients seen from the ALU and BMTU was 40% and 12%, respectively. Of the ALU population deaths, 83% were 65 or older, compared to 29% of the BMTU deaths. Mortality events in the ICU were greater for BMTU patients (43%) relative to ALU patients (11%). Fifty percent of the ALU inpatient expirations were able to receive EOL care in our PCU. The remaining deaths were in the ALU (39%) or ICU (11%). For BMT patients, 57% died on the BMTU, and 43% in the MICU. Despite comparable numbers of PCU transfers during the pre- and post-intervention period, our initiative increased the average LOS in the PCU from 1.1 to 5.7 days. Of the ALU patients electing DNR prior to death (83%), the average DNR-to-death days was 10.6 days, whereas BMTU patients who elected DNR prior to death (50%) had an average of 6.5 DNR-to-death days. Conclusions: This partnership allowed for recognition of differences in EOL care patterns across these populations. It has demonstrated a benefit by accelerating time to consult and enhancing transitions to goal concordant settings for patients with hematologic malignancies at the end of their lives.

scholarly journals Single Donor Versus Acrodose Platelets in Oncology Patients: A Single Institutional Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4298-4298
Author(s):  
Neil Dalal ◽  
Naveed Cheema ◽  
Leonard M. Klein
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Bone Marrow Transplant ◽  
Median Time ◽  
Marrow Transplant ◽  
Average Increase ◽  
Transplant Patients ◽  
Single Donor ◽  
Median Increase ◽  
Platelet Transfusions

Abstract INTRODUCTION: Patients undergoing hematopoetic stem cell transplantation or myelosuppressive chemotherapy for solid and hematologic malignancies commonly develop thrombocytopenia requiring prophylactic platelet transfusions once their level falls below ten thousand. In our institution, the primary replacement product is single donor platelets. This is collected by an apheresis machine using only one donor and they also undergo processing and testing prior to transfusion which leads to higher hospital costs. Recently, there has been the advent of Acrodose platelets which are obtained from whole blood. These platelets are leuko-reduced, ABO matched, pooled and bacteria tested making them "transfusion ready" for the hospital. These platelets enhance patient safety with culture-based bacteria testing for whole blood derived platelets. Moreover, it lowers handling costs at the hospital by eliminating the need for pooling and bacterial testing at the hospital. The Acrodose system can detect >1 CFU/ml of bacteria at a rate of 99.3% thus reducing the risks of false positives. They also have inline filtration systems capable of producing leukocyte reduced whole blood platelets and plasma. Each unit of Acrodose platelets contains pools of 4-6 units of lueko-reduced platelet concentrates in plasma. The purpose of this study is to evaluate platelet response and time to next transfusion in both leukemic and stem cell transplant patients between single donor and Acrodose platelet transfusions. METHODS: Data was collected from October 2012 to October 2013. There were a total of 349 platelet transfusions given, 61 were Acrodose and 288 were single donor. There were seventeen bone marrow transplant patients of which sixteen were autologous (seven had multiple myeloma, eight had Non-Hodgkin’s lymphoma and one had POEMS syndrome) and one was allogeneic for chronic lymphocytic leukemia. In addition, there were twenty acute leukemia patients. The bone marrow transplant patients received a total of 45 platelet transfusions of which 37 were single donor and 8 were Acrodose. The acute leukemia patients received a total of 150 platelet transfusions of which 17 were Acrodose and 133 were single donor. RESULTS: The average increase among all patients receiving Acrodose versus single donor platelets was 28.9 versus 19.8, respectively. The median increase for Acrodose versus single donor was 28 versus 16. The median time to next transfusion for Acrodose versus single donor was 4 versus 2 days. In subgroup analysis, the average increase among bone marrow transplant patients receiving Acrodose versus single donor platelets was 21.7 versus 27.8, respectively. The median increase for Acrodose versus single donor was 18 versus 20. The median time to next transfusion for Acrodose versus single donor was the same at 3 days. Among acute leukemia patients, the average increase in patients receiving Acrodose versus single donor platelets was 28 versus 18.6, respectively. The median increase for Acrodose versus single donor was 27 versus 15. The median time to next transfusion for Acrodose versus single donor was 4 versus 2 days. CONCLUSION: In our single institutional experience, Acodose platelets induced a more robust response and increased the time to next transfusion compared to single donor platelets among all patients and acute leukemia patients. That same effect was not see with the bone marrow transplant patients. The reason for this is unclear and more studies are needed. Disclosures No relevant conflicts of interest to declare.

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