Mental status changes after hematopoietic stem cell transplantation Exercise during hematopoietic stem cell transplant hospitalization in children. Use of Chamomilla recutita in the Prevention and Treatment of Oral Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized, Controlled, Phase II Clinical Trial Facing the Challenges of Hematopoietic Stem Cell Transplantation With Mindfulness Meditation: A Pilot Study Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention. Safety, Pharmacokinetics, and Efficacy of Palifermin in Children and Adolescents with Acute Leukemias Undergoing Myeloablative Therapy and Allogeneic Hematopoietic Stem Cell Transplantation: A Pediatric Blood and Marrow Transplant Consortium Trial. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial Donor-derived marrow mesenchymal stromal cell co-transplantation following a haploidentical hematopoietic stem cell transplantation trail to treat severe aplastic anemia in children Neuropsychological and psychiatric functioning pre- and posthematopoietic stem cell transplantation in adult cancer patients: a preliminary study. Detectable minimal residual disease before allogeneic hematopoietic stem cell transplantation predicts extremely poor prognosis in children with acute lymphoblastic leukemia. Eligibility for hematopoietic stem-cell transplantation for primary systemic amyloidosis is a favorable prognostic factor for survival. Venous Thromboembolism after Allogeneic Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Study Palifermin reduces patient-reported mouth and throat soreness and improves patient functioning in the hematopoietic stem-cell transplantation setting. Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Development and implementation of an Internet-based survivorship care program for cancer survivors treated with hematopoietic stem cell transplantation A prospective randomized double-blind trial of antithrombin III concentrate in the treatment of multiple-organ dysfunction syndrome during hematopoietic stem cell transplantation. A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation Phase I/II Randomized Trial Evaluating the Safety and Clinical Effects of Repifermin Administered to Reduce Mucositis in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial. Impact of Thrombophilic Gene Mutations and Graft-versus-Host Disease on Thromboembolic Complications after Allogeneic Hematopoietic Stem-Cell Transplantation Utility of flexible bronchoscopy in the evaluation of pulmonary infiltrates in the hematopoietic stem cell transplant population -- a single center fourteen year experience.
The growing numbers of survivors of innovative cancer treatments  , such as hematopoietic stem cell transplantation ( HSCT )  , often report subsequent cognitive difficulties . The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia ( CML ) or primary myelodysplastic syndrome ( MDS ) after allogeneic HSCT or other therapies PURPOSE The purpose of this controlled trial was to assess the effect of an approximately 3-wk intrahospital exercise intervention performed during inpatient hospitalization for pediatric allogeneic hematopoietic stem cell transplant ( HSCT ) on ( i ) immune cell recovery and ( ii ) body composition . METHODS Immune ( i.e. , blood counts of leukocytes , monocytes , lymphocytes , and lymphocyte sub population s ) and anthropometric variables ( i.e. , body mass , body mass index , and estimated fat-free mass ) were measured before and after ( + 15 and 30 d ) HSCT . Seven children ( 5 boys and 2 girls ; age ( mean + /- SD ) = 8 + /- 4 yr ) with high-risk cancer performed an individualized training program ( aerobic + resistance exercises ) in their isolated hospital rooms . We also assessed a control group ( n = 13 ; 9 boys and 4 girls ; age = 7 + /- 3 yr ) with similar medical conditions and following the same transplant protocol . RESULTS In both groups , the dendritic cell count decreased from pre-HSCT to + 15 d post-HSCT and thereafter ( up to + 30 d ) remained stabile ; however , the posttransplant decrease was more abrupt in the control group than that in the intervention group ( -87 % vs -63 % , respectively , from pre-HSCT to + 15 d ) . The rest of the immune cell parameters measured showed a similar response from pre-HSCT to post-HSCT in both groups . We found a significant effect of the interaction group x time for all anthropometric variables ( weight , body mass index , body fat , and fat-free mass ) , indicating an increase over the hospitalization period only in the intervention group , for example , body mass increased from 32.9 + /- 18.7 kg pre-HSCT to 35.4 + /- 18.6 kg at + 30 d in the intervention group versus a decrease from 30.2 + /- 16.6 to 29.3 + /- 6.3 kg in the control group . CONCLUSION Our findings support the feasibility of exercise training interventions during hospitalization , including immunocompromised children Background : Oral mucositis is a common inflammatory complication among patients undergoing hematopoietic stem cell transplantation ( HSCT ) . Among its therapeutic properties , Chamomilla recutita has anti-inflammatory effects . Objective : The aim of this study was to identify the dosage of the liquid extract of C recutita in mouthwash that is needed to reduce the incidence and intensity of oral mucositis in adult patients undergoing allogenic HSCT . Methods : In a r and omized phase II clinical trial , 40 patients were r and omized to receive routine care plus mouthwash containing a liquid extract of C recutita at 0.5 % , 1 % , or 2 % ( experimental groups ) or st and ard care alone ( control group ) . Daily evaluation was performed using the measurement scale for oral toxicity defined by the World Health Organization . Statistical analysis was performed , in which the incidence , intensity , and duration of oral mucositis were compared between each experimental group and the control group . Results : The experimental group at the 1 % dosage demonstrated reduced incidence , intensity , and duration of oral mucositis compared with the control group . The formulation was well tolerated by patients and was safe , as no moderate or severe adverse effects were identified . Conclusions : In this study , the use of mouthwash containing 1 % C recutita extract can be associated with reduced incidence , intensity , and duration of mucositis in adults patients undergoing allogenic HSCT . Implication s for Practice : The results of this investigation will help nurses and other professionals in selecting the C recutita dosage used to manage oral mucositis in patients undergoing HSCT The hematopoietic stem cell transplant ( HSCT ) experience is emotionally and physically stressful for cancer patients who undergo this procedure .  Mindfulness-based interventions have been studied in patients with various diagnoses , including cancer , although minimal work has applied this intervention to hospitalized patients . Use of mindfulness meditation has potential to provide HSCT patients with coping skills to deal with unpleasant symptoms and an uncertain future . This exploratory study examined feasibility , physiological arousal , and psychological and physical symptoms in HSCT patients participating in a mindfulness meditation intervention that begins before and continues throughout hospitalization and involves one-on-one guided sessions and daily practice using a 17-minute meditation CD .  Of the 20 participants , 78.9 % completed the intervention . Statistically significant decreases in heart and respiratory rates and improvements in symptoms immediately before and after each session were found . These findings demonstrate feasibility and preliminary support of a mindfulness meditation intervention with symptomatic , hospitalized cancer patients PURPOSE / OBJECTIVES To examine the patterns of fatigue , physical activity , health status , and quality of life before and after  high-dose chemotherapy and hematopoietic stem cell transplantation ( HSCT )  and to examine the feasibility of obtaining real-time fatigue and physical activity data . DESIGN Prospect i ve , repeated measures . SETTING Two midwestern academic medical centers . SAMPLE Convenience sample of autologous or allogeneic patients undergoing HSCT ( N = 20 baseline , N = 17 post-transplant ) . METHODS Subjects were assessed over a five-day period before and after HSCT for a total of 10 days . Subjects rated fatigue intensity three times daily and wore a wrist actigraph to measure physical activity .  At the end of both five-day periods , subjects completed measures of perceived health status ( European Organization for Research and Treatment of Cancer Quality of Life Question naire-Core 30 ) and life satisfaction Quality of Life Index ) . MAIN RESEARCH VARIABLES Fatigue , physical activity , perceived health status , and quality of life . FINDINGS Study results indicate that fatigue significantly increased and physical activity decreased following high-dose chemotherapy and HSCT . The decline coincided with diminished physical , emotional , role , and cognitive functioning . The symptoms that patients experienced ( i.e. , fatigue , pain , nausea and vomiting , sleep disturbances , appetite loss , and diarrhea ) increased during the acute post-transplant period . No significant changes in life satisfaction were found . CONCLUSIONS The study findings suggest that patients receiving high-dose chemotherapy followed by HSCT  experience increased fatigue , reduced physical activity , diminished functioning , and poorer quality of life immediately after transplant . Findings demonstrate that real-time fatigue and physical activity data can feasibly be collected in acutely ill patients . IMPLICATION S FOR NURSING Patients undergoing HSCT require considerable supportive nursing care immediately following transplant . Clinicians and research ers need to strive for effective symptom management to improve the likelihood of successful outcomes UNLABELLED An allogeneic hematopoietic stem cell transplantation ( HSCT ) can have profound and lasting adverse effects on a patient 's physical and psychological well-being . So far , only few studies have investigated the effectiveness of physical activity over the entire inpatient phase of an allogeneic HSCT . PURPOSE We performed a r and omized controlled study to examine the influence of a controlled moderate exercise program starting parallel to chemotherapeutic conditioning and total body irradiation on the patient 's physical and psychological constitution . PATIENTS AND METHODS Forty-seven patients undergoing an allogeneic HSCT were r and omly assigned to an exercise group ( EG ) or a control group ( CG ) . While the EG took part in an endurance and activity of daily living-training twice a day , the CG received the clinic 's st and ard physiotherapy program once a day . RESULTS Significant differences and /or trends in favor of the EG were observed regarding the primary endpoint endurance performance ( P=0.002 ) , muscular strength ( P=0.022 ) , fatigue ( P=0.046 ) , and emotional state ( P=0.028 ) without posing an additional risk for the individual . CONCLUSION The results show that the training program is feasible and seems to have positive influences on physical performance and quality of life in patients undergoing an allogeneic HSCT . However , further studies are necessary to confirm these results Currently , effective pharmacologic treatment to reduce severe oral mucositis ( OM ) result ing from high-dose myeloablative cytotoxic therapy in the pediatric population is not available . Palifermin has been proven to decrease the incidence and duration of severe OM in adults with hematologic malignancies undergoing hematopoietic stem cell transplantation ( HSCT ) . In the pediatric population , however , data on palifermin treatment are limited . A phase I dose-escalation study of palifermin in pediatric patients with acute leukemias undergoing myeloablative HSCT with total body irradiation , etoposide , and cyclophosphamide  was performed to determine a safe and tolerable dose and to characterize the pharmacokinetic ( PK ) profile and efficacy of palifermin . Twenty-seven patients in 3 age groups ( 1 to 2 , 3 to 11 , and 12 to 16 years ) and 3 dose levels ( 40 , 60 , and 80 μg/kg/day ) were studied . There were no deaths , dose-limiting toxicities , or treatment-related serious adverse events . Long-term safety outcomes did not differ from what would be expected in this population . PK data showed no differences between the 3 age groups . Exposure did not increase with increase in dose . The maximum severity of OM ( WHO grade 4 ) occurred in 6 patients ( 22 % ) , none of whom was in the 80-μg/kg/day dosing group . This study showed that all doses were well tolerated and a good safety profile in all 3 pediatric age groups was seen Background Insight regarding transfusion practice s in Hematopoietic Stem cell Transplantation ( HSCT ) are lacking and the impact of red cell transfusion in this high risk group on outcomes following HSCT are not well appreciated . Red blood cell transfusion can be life-saving , however , liberal use of transfusion in critically ill patients failed to demonstrate significant clinical benefit . A large number of other observational studies have also demonstrated an association between red blood cell transfusions and increased morbidity such as infections and multi organ failure as well as increased mortality . The role of red cell transfusion on the clinical outcomes observed in patients undergoing HSCT remains poorly understood and a prospect i ve r and omized study of transfusion is required to gain insight and knowledge on best transfusion practice s in this high risk population . Methods This report describes the design and method ological issues of a r and omized pilot study evaluating red cell transfusion triggers in the setting of Hematopoietic Stem Cell Transplantation . This study has been funded by a peer review grant from the Canadian Blood Services and is registered on Clinical trials.gov NCT01237639 . Results In 3 Canadian centres , 100 patients undergoing Hematopoietic Stem Cell Transplantation will be r and omized to either a restrictive ( target hemoglobin of 70 - 90 g/L ) or liberal ( target hemoglobin of 90 - 110 g/L ) red cell transfusion strategy , based daily hemoglobin values up to 100 days post-transplant . The study will stratify participants by centre and type of transplant . The primary goal is to demonstrate study feasibility and we will collect clinical outcomes on 1 ) Transfusion Requirements , 2 ) Transplant Related Mortality , 3 ) Maximum grade of acute Graft versus Host Disease , 4 ) Veno-occlusive Disease , 5 ) Serious Infections , 6 ) Bearman Toxicity Score , 7 ) Bleeding , 8) Quality of Life , 9 ) Number of Hospitalizations and 10 ) Number of Intensive Care Unit ( ICU ) Admissions . Conclusion Upon completion , this pilot trial will provide preliminary insight into red cell transfusion practice and its influence in hematopoietic stem cell transplant outcomes . The results of this trial will inform the conduct of a larger study Haploidentical hematopoietic stem cell transplantation ( haplo-HSCT ) is associated with an increased risk of graft failure and severe graft-versus-host disease ( GVHD ) . Recent studies have shown that mesenchymal stromal cells ( MSCs ) display potent immunosuppressive effects and can support normal hematopoiesis . In a multi-center trial , we co-transplanted culture-exp and ed donor-derived bone marrow MSCs ( BM-MSCs ) into 35 children with severe aplastic anemia ( SAA ) undergoing haplo-HSCT .  All 35 patients ( 100 % ) achieved hematopoietic reconstitution and showed sustained full donor chimerism . The median time for myeloid engraftment was 14 days ( range 10–22 days ) , while that for platelet engraftment was 18 days ( range 9–36 days ) . The incidence of grade II – IV acute GVHD and chronic GVHD was 25.71 and 22.86 % , respectively . The overall survival rate was 85.71 % with a median of 22 months ( range 3.5–37 months ) . The combined transplantation of haploidentical HSCs and BM-MSCs into children with SAA without an HLA-identical sibling donor is relatively safe and may represent an effective new therapy to improve survival rates and reduce the risk of graft failure The current study characterizes cognitive and psychiatric status in  hematopoietic stem cell transplantation ( HSCT ) patients shortly before and after transplant . Thirty adult patients were assessed prospect ively 1 - 2 weeks before transplantation and 100 days posttransplantation on neuropsychological and psychiatric measures . Before transplant , participants showed mild impairments on several neuropsychological measures , with the poorest performances occurring on learning and attention . Psychiatric functioning was significantly elevated compared with normative data . Significant improvements , however , were observed on neuropsychological measures by 100 days after transplant . Depression and anxiety scores also improved . C and i date s for HSCT experienced mild diffuse cognitive dysfunction and psychiatric morbidity before the procedure , but these symptoms significantly improved by 3 months following their transplant in this small sample . Education about these possible pretransplant sequelae and the potential for rebound may be helpful to patients and families as they prepare for this treatment and the recovery period BACKGROUND The level of minimal residual disease ( MRD ) prior to allogeneic hematopoietic stem cell transplantation ( HSCT ) has been shown to be an independent prognostic factor for outcome of pediatric patients with high-risk acute lymphoblastic leukemia ( ALL ) . Retrospective studies which used ( semi- ) quantitation of clone-specific immunoglobulin/T-cell receptor ( Ig/TCR ) rearrangements have documented the feasibility and practicality of this technique . This approach has also been disputed due to the occurrence of clonal evolution and generally high MRD levels prior to HSCT . PROCEDURE In our prospect i ve study , MRD before and after HSCT was monitored using quantitative real-time PCR in a cohort of 36 children with ALL consecutively transplanted in our center between VIII/2000 and VII/2004 . RESULTS In 25 of 36 patients , MRD level prior HSCT was assessed . Seventeen patients were classified as MRD-negative and eight were MRD-positive up to 9 x 10(-2 ) . In MRD-positive subgroup , seven events ( six relapses ) occurred post-transplant in striking contrast to only one relapse in MRD-negative subgroup ( event-free survival ( EFS ) log-rank P < 0.0001 ) . MRD proved to be the only significant prognostic factor in a multivariate analysis ( P < 0.0001 ) . Adoptive immunotherapy including donor lymphocyte infusions in patients with adverse dynamics of MRD after HSCT had only limited and /or temporary effect . Clonal evolution did not present a problem precluding MRD monitoring in any of patients suffering a post-transplant relapse . CONCLUSIONS We show that MRD quantitation using clonal Ig/TCR rearrangements successfully assesses the risk in pediatric ALL patients undergoing allogeneic HSCT . As our ability to treat detectable MRD levels after HSCT is very limited , alternative strategies for MRD-positive patients prior HSCT are necessary PURPOSE Based on the success of hematopoietic stem-cell transplantation ( HSCT ) for multiple myeloma , HSCT is being used to treat patients with primary systemic amyloidosis ( AL ) . This article addresses the extent to which eligibility to undergo HSCT is a favorable prognostic feature and explores prognostic factors within the subset of eligible patients . PATIENTS AND METHODS The Mayo Clinic amyloid data base was queried for all patients with AL seen at the Mayo Clinic from 1983 through 1997 who would have been eligible for peripheral-blood stem-cell transplantation . Inclusion criteria included biopsy-proven amyloid , symptomatic disease , absence of a clinical diagnosis of multiple myeloma , age < or = 70 years , cardiac interventricular septal thickness < or = 15 mm , cardiac ejection fraction more than 55 % , serum creatinine < or = 2 mg/dL , and direct bilirubin < or = 2.0 mg/dL. RESULTS Median age was 56 years ( range , 25 to 70 ) with 79 ( 34 % ) older than 60 years . One hundred patients had early cardiac involvement ; 41 , hepatic involvement ; 167 , renal involvement ; and 39 , nerve involvement . The 229 patients have had a median follow-up of 52 months , and 151 have died . The median survival was 42 months with 5- and 10-year survival rates of 36 % and 15 % , respectively . Important predictors of survival were size of M-component in 24-hour urine , number of involved organs , alkaline phosphatase , performance score , and weight loss . CONCLUSION The same patients who are eligible for HSCT are a good-risk population who do relatively well with chemotherapy ( median survival , 42 months ) , substantially better than the expected median survival of 18 months for all patients with AL . A r and omized trial is needed to assess the true effect of HSCT Objective : Venous thromboembolism ( VTE ) in children who undergo hematopoietic stem cell transplantation ( HSCT )  has high morbidity . The aim of this study is to assess the incidence of VTE in allogeneic pediatric HSCT recipients and the contribution of pretransplant prothrombotic risk factors to thrombosis . Material s and Methods : We retrospectively evaluated 92 patients between April 2010 and November 2012 undergoing allogeneic HSCT who had completed 100 days post-HSCT .  Before HSCT , coagulation profiles ; acquired and inherited prothrombotic risk factors including FV G1691A ( factor V Leiden ) , prothrombin G20210A , methylenetetrahydrofolate reductase ( MTHFR ) C677 T , and MTHFR A1298C mutations ; and serum homocysteine and lipoprotein ( a ) , plasma antithrombin III , protein C , and protein S levels were obtained from all patients . Results : In the screening of thrombophilia , 8 patients ( 9 % ) were heterozygous for factor V Leiden , 5 ( 6 % ) were homozygous for MTHFR 677TT , 12 ( 14 % ) were homozygous for MTHFR 1298CC , and 2 ( 2 % ) were heterozygous for prothrombin G20210A mutation . We observed VTE in 5 patients ( 5.4 % ) ; a prothrombotic risk factor was found in 3 out of these 5 patients , while 4 out of 5 patients had central venous catheters . It was determined there was no significant relationship between VTE and inherited prothrombotic risk factors . Conclusion : VTE after HSCT seems to be a low-frequency event that may be due to low-dose , low-molecular-weight heparin prophylaxis , and the role of inherited prothrombotic risk factors can not be entirely excluded without a prospect i ve study PURPOSE To describe patient-reported outcomes of mouth and throat soreness ( MTS ) and related sequelae on daily activities from a phase III study of palifermin in the autologous hematopoietic stem-cell transplantation ( HSCT ) setting and to compare patient self-evaluations with clinicians ' assessment s of oral mucositis using objective scales . PATIENTS AND METHODS Patients ( n = 212 ) received  palifermin  ( 60 microg/kg/d ) or placebo for 3 days before  total-body irradiation ( 12 Gy ) ,  etoposide 60 mg/kg , and cyclophosphamide 100 mg/kg , and 3 days after HSCT . Patients completed a daily question naire ( Oral Mucositis Daily Question naire [ OMDQ ] ) evaluating MTS severity and its effects on daily functional activities . Patients ' self- assessment data were compared with clinicians ' assessment s of oral mucositis using the objective scales . RESULTS Palifermin reduced the incidence and duration of severe oral mucositis , as assessed by both clinicians and patients . Comparisons between patient and clinician assessment s demonstrated that the average daily scores between mucositis grade and subjective ( MTS ) instruments were similar , although patients reported MTS onset , peak , and resolution earlier ( 1 to 3 days ) than clinicians ' assessment s. Patients receiving palifermin reported statistically significant improvements ( P < .001 ) in daily functioning activities ( swallowing , drinking , eating , talking , sleeping ) and required significantly less narcotic opioids ( P < .001 ) ; improvement in the patient 's overall physical and functional well-being was also reported . This was confirmed by the results of the Functional Assessment of Cancer Treatment question naire . CONCLUSION These results support the clinical benefit of palifermin in the HSCT setting , providing evidence that a patient 's self- assessment instrument ( OMDQ ) may serve as an alternative tool to assess oral mucositis severity in clinical trials To prospect ively assess the applicability of reduced-intensity conditioning hematopoietic stem cell transplantation ( RIC-HSCT ) , we wrote a protocol in which all untreated patients 50 years or older with acute myeloid leukemia ( AML ) and unfavorable cytogenetics would be evaluated during induction for a possible  RIC-HSCT in first complete remission ( CR1 ) . Ninety-nine of 259 patients entered CR . Fifty-three of the 99 were seen by the Transplant Service with the remainder not seen because of illness , lack/unavailability of siblings , refusal , or , primarily , unclear reasons ( 21 patients ) . A donor was identified for 26 patients ( 21 sibling , 5 unrelated ) with  RIC-HSCT  performed in 14 ( 13 sibling ) . Results in consulted patients suggested that 50 % or fewer of the 85 patients who did not undergo transplantation were potential transplant c and i date s. We attempted to find one or more chemotherapy pair-mates for each patient who underwent transplantation based on cytogenetics , age , and a relapse-free survival ( RFS ) time that was more than or equal to the time from CR1 to RIC-HSCT in the patient who underwent transplantation . Thirty-two of the 39 matches favored ( longer RFS ) RIC-HSCT and 7 , chemotherapy . The probability that the corresponding beta distribution was different than expected ( ie , that RIC-HSCT was superior ) was 0.99 ( P=.004 ) . Results were similar with respect to survival . While RIC-HSCT thus seems of interest , methods are needed to extend its applicability Introduction The Internet provides a widely accessible modality for meeting survivorship care needs of cancer survivors . In this paper , we describe the development and implementation of an Internet site design ed as a base from which to conduct a r and omized controlled trial to meet psycho-educational needs of hematopoietic stem cell transplantation ( HSCT ) survivors . Methods A cross-disciplinary team design ed , wrote content , and programmed an Internet site for online study registration , consent , assessment , and study implementation . All survivors who were 3–18 years after HSCT for hematologic malignancy and treated at one transplant center were approached by mail for participation . All study activities could be conducted without study staff contact . However , participants had options for phone or email contact with study staff as desired . Results Of 1,775 participants approached for the study , 775 ( 58 % of those eligible ) consented and completed baseline assessment . Mean age was 51.7 ( SD , 12.5 ; age range , 18–79 years ) , with 56 % male . Fifty-seven percent required staff contact one or more times ; a majority were for minor technical issues or delays in completion of enrollment or baseline assessment . Discussion s/ conclusions This study demonstrated the potential for providing Internet-based survivorship care to long-term survivors of HSCT . Although building a survivorship Internet site requires a team with diverse expertise , once built , these re sources can be implemented rapidly with large numbers of survivors . Implication s for cancer survivorsWhile Internet-based services will not meet all the needs of cancer survivors , this methodology represents an important modality for augmenting onsite clinical services as a method for meeting psycho-educational , information , and re source needs of cancer survivors Many of the complications of high-dose therapy with hematopoietic stem cells are caused by or lead to the multiple-organ dysfunction syndrome ( MODS ) . In hematopoietic stem cell transplantation ( HSCT ) , acquired antithrombin III ( ATIII ) deficiency is independently associated with MODS to the exclusion of transplant type , preparative regimen , and bacteremia . In experimental setting s , replacement of ATIII can ameliorate the severity of MODS that develops in response to a variety of pathologic stimuli , suggesting that ATIII supplementation might improve the clinical course of MODS in patients undergoing HSCT . We performed a study to determine if ATIII can improve the morbidity of MODS in HSCT . Forty-nine patients undergoing HSCT , who developed pulmonary dysfunction ( oxygen saturation of < 90 % ) , central nervous system dysfunction ( drop of > 4 points in the mini-mental status exam ) , or hepatic dysfunction ( bilirubin > 34 micromol/L [ 2.0 mg% ] , weight gain of > 5 % over baseline , and abdominal pain , possibly of hepatic origin ) with a concomitant ATIII activity of < 84 % were double-blind r and omized to receive ATIII concentrate , 70 units/kg within 24 hours of recognition of initial organ dysfunction followed by 50 units/kg 8 , 16 , 48 , and 72 hours later , or albumin placebo . The group r and omized to ATIII had a lower severity-of-illness score ( 15.7 + /- 19.2 vs. 28.6 + /- 25.2 , p = 0.03 ) , shorter duration of hospitalization ( 14.9 + /- 16.7 vs. 25.7 /- 17.9 days , p = 0.03 ) , and lower hospital charges ( $ 138,700 + /- $ 23,500 vs. $ 206,400 + /- $ 34,000 ) . ATIII concentrate was associated with improved morbidity of MODS in patients undergoing HSCT when given early in the evolution of the syndrome Summary : Oral mucositis is a complication common to many cancer therapies and produces considerable pain and morbidity . The present study reports a double-blind , prospect i ve , r and omized clinical trial testing the efficacy of a calcium phosphate mouth rinse ( Caphosol ® ) with fluoride treatments vs a st and ard regimen of fluoride rinsing and placebo tray treatments in 95 patients undergoing hematopoietic stem cell transplantation ( HSCT ) .  The days and severity of mucositis were prospect ively evaluated . There were statistically significant decreases in days of mucositis ( 3.72 vs 7.22 P=0.001 ) , duration of pain ( 2.86 vs 7.67 , P=0.0001 ) , dose of morphine ( 34.54 mg vs 122.78 mg ) , days of morphine ( 1.26 vs 4.02 , P=0.0001 ) and days to the onset of engraftment ANC ( absolute neurotrophil count)>200 mm3 ( 11.12 vs 12.56 ) in the Caphosol ® and fluoride treatment group vs fluoride-rinse group , respectively . Caphosol ® , a neutral , supersaturated , Ca2+/PO43− mouth rinse , used in combination with topical fluoride treatments , is superior to fluoride rinse alone in reducing the frequency , intensity and duration of oral mucositis in patients undergoing HSCT Purpose : To evaluate the safety of repifermin ( keratinocyte growth factor-2 ) administered before and after autologous hematopoietic stem cell transplantation ( auto-HSCT ) . A preliminary analysis of the ability of keratinocyte growth factor-2 to prevent mucositis was also done . Experimental Design : Forty-two patients received intravenous repifermin ( 25 μg/kg or 50 μg/kg ) or placebo for 3 days before their auto-HSCT conditioning regimen and for up to 10 days after auto-HSCT . Within each dose level , 14 patients were r and omized to repifermin  and 7 patients to placebo . Clinical evaluations of mucositis were scheduled before auto-HSCT conditioning regimen , on the day of transplant , and three times per week until mucositis resolved . Results : In general , the incidence of adverse events was similar for patients treated with repifermin and placebo . No clinical ly meaningful differences were noted among treatment groups for clinical laboratory variables . Treatment groups experienced similar time to engraftment . The frequency of Grade 2 to 4 mucositis was 100 % for patients in the placebo group , 64 % for patients in the 25 μg/kg group ( P = 0.041 versus placebo ) , and 50 % for patients in the 50 μg/kg group ( P = 0.006 versus placebo ) . Results of other endpoints , including pain on swallowing and use of pain medication specifically for mucositis , suggested a better outcome for patients in the 50 μg/kg group compared with the placebo and 25 μg/kg groups . Conclusions : Repifermin was well tolerated . Repifermin given before and after auto-HSCT seems to be active in reducing mucositis , but a larger trial will be necessary to determine the  efficacy of repifermin with this dose schedule Before , during , and after allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) , patients experience considerable physical and psychologic distress . Besides graft-versus-host disease and infections , reduced physical performance and high levels of fatigue affect patients ' quality of life . This multicenter r and omized controlled trial examined the effects of a partly self-administered exercise intervention before , during , and after allo-HSCT on these side effects . After r and omization to an exercise and a social contact control group  105 patients trained in a home-based setting before hospital admission , during inpatient treatment and a 6- to 8-week period after discharge .  Fatigue , physical performance , quality of life , and physical/psychologic distress were measured by st and ardized instruments at baseline , admission to , and discharge from hospital and 6 to 8 weeks after discharge . The exercise group showed significantly improvement in fatigue scores ( up to 15 % improvement in exercise group vs up to 28 % deterioration in control ; P<.01-.03 ) , physical fitness/functioning ( P=.02-.03 ) and global distress ( P=.03 ) . All effects were at least detectable at one assessment time point after hospitalization or repeatedly . Physical fitness correlated significantly with all reported symptoms/variables . In conclusion , this partly supervised exercise intervention is beneficial for patients undergoing allo-HSCT . Because of low personnel requirements , it might be valuable to integrate such a program into st and ard medical care Studies applying exercise , relaxation training , and psychoeducation have each indicated a positive impact on physical performance and /or psychological factors in patients diagnosed with cancer . We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) . Forty-two patients ( 18 - 65 years ) were r and omized either to an intervention or a control group . The intervention group received st and ard treatment and care , and a supervised four- to six-week structured exercise program , progressive relaxation , and psychoeducation during hospitalization , one hour per day for five days per week . The control group received st and ard treatment , care , and physiotherapy . A 24-item symptom assessment question naire was completed weekly during hospitalization , and at three and six months after allo-HCST . Through principal component analysis with varimax rotation , individual symptoms were grouped into five symptom clusters : mucositis , cognitive , gastrointestinal , affective , and functional symptom clusters . Then , a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups , but in the intervention group , there was an overall significant reduction ( P<0.05 ) in symptom intensity over time for all clusters except the affective symptom cluster . This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT Background . Hemostatic events in patients undergoing allogeneic hematopoietic stem-cell transplantation ( HSCT )  increase the morbidity and mortality in this cohort . Little is known about the impact of graft-versus-host disease ( GvHD ) or of thrombophilic gene mutations/polymorphisms on these complications . Study Design . Eighty-nine allogeneic stem-cell recipients and their donors were evaluated prospect ively for the presence of the factor V G1691A mutation , the prothrombin G20210A mutation , the 5,10-methylenetetrahydrofolate-reductase ( MTHFR ) C677 T mutation , the glycoprotein IIIa PIa1/a2 polymorphism , the fibrinogen-β-chain 455G/A polymorphism , the plasminogen activator inhibitor-1 −675 4G/5 G polymorphism , and the angiotensin-converting enzyme intron 16 I/D polymorphism . These mutations/polymorphisms and GvHD parameters were correlated to hemostatic and toxic complications after transplantation . The data were compared with those of 128 healthy controls . Results . The PAI-1 4G/4 G polymorphism increases the risk for catheter thrombosis after HSCT 5.7-fold ( 32.2 % vs. 71.4 % , P<0.05 ) . In patients with hepatic veno-occlusive disease , the frequency of the PAI-1 4 G allele is also increased ( 83.3 % vs. 55.1 % , NS ) . Thrombophilic mutations/polymorphisms in donors do not influence complications in the corresponding recipients . The MTHFR TT genotype does not modify severity and duration of mucositis and aplasia in patients receiving methotrexate prophylaxis . Patients with chronic GvHD have a higher risk of thromboembolism ( 12.9 % vs. 1.7 % , P<0.05 ) . Conclusion . Thrombophilic gene mutations have only a moderate influence on hemostatic complications in patients undergoing HSCT . This may be because of the overwhelming immunologic impact of GvHD on hemostasis in the allogeneic transplantation setting INTRODUCTION Pulmonary infiltrates are common within the hematopoietic stem cell transplant ( HSCT ) population and unfortunately portend an increased mortality . Bronchoscopy is often utilized as an initial diagnostic tool , but the literature supporting its diagnostic utility and effect on clinical management varies significantly . The aim of this study was to investigate the diagnostic ability , complication rate , and clinical impact of flexible bronchoscopy ( FB ) in evaluating pulmonary infiltrates in a large HSCT population . PATIENTS AND METHOD Retrospective review of all patients undergoing FB after HSCT in the Bone Marrow Transplant Unit from 1996 to 2009 . RESULTS FB was performed 162times in 144 patients with pulmonary infiltrates yielding positive results in 52.5 % . The most common positive results were bacterial pneumonia ( 31 % ) , fungal pneumonia ( 15 % ) , and alveolar hemorrhage ( 11 % ) . Treatment changes occurred in 44 % of patients after FB . Treatment changes included antibiotic modification ( 59 % ) , addition of corticosteroids ( 21 % ) , antifungal modification ( 12 % ) , and antiviral modification ( 7 % ) . The overall complication rate associated with FB was 30 % , although 84 % of these complications were considered minor . CONCLUSIONS FB in patients with pulmonary infiltrates after HSCT should still be considered a valuable tool in the evaluation and management of pulmonary infiltrates in the HSCT population . Future prospect i ve , multicenter r and omized studies are needed to evaluate the overall clinical impact that bronchoscopic results and management changes have in this unique population
Only three multi-item and two single-item instruments were identified as being reliable and valid among pediatric cancer or HSCT patients and would therefore be appropriate to measure anxiety in this population
Purpose The primary objective was to describe anxiety measurement instruments used in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation ( HSCT )  and summarize their content and psychometric properties .