Patterns of Signs, Symptoms, and Cytokines During the Engraftment Phase of Autologous Stem Cell Transplantation
Creators: name: Rice, Robert David
Publisher: name: University of Utah
Year: 2012
Subjects: Autotransplantation
Stem Cells

description: Autologous stem cell transplant is a potentially  curative treatment for certain cancers, yet there is  significant risk of complications. Among these is  engraftment syndrome, a constellation of physical signs and  symptoms that occurs during the stem cell engraftment phase  of treatment. Given the high volume of transplants  performed worldwide, the cost of illness, loss of life and  healthcare resource utilization, the complication of  engraftment syndrome is an important clinical problem.  The purpose of this study was to evaluate the patterns  of physical signs and symptoms and proinflammatory serum  cytokines associated with the engraftment phase in a  population of 66 patients with hematologic malignancies who  underwent high-dose therapy and autologous stem cell  transplantation. Secondary data analysis was performed  utilizing patients' medical records. Using Two-step  Cluster Analysis, the physical signs and symptoms were  evaluated to determine naturally forming clusters. Two  distinct subgroups were identified based on five input  variables (white blood count recovery, hypoxia, renal  function, liver function, and fluid balance). The subgroup Autologous stem cell transplant is a potentially  curative treatment for certain cancers, yet there is  significant risk of complications. Among these is  engraftment syndrome, a constellation of physical signs and  symptoms that occurs during the stem cell engraftment phase  of treatment. Given the high volume of transplants  performed worldwide, the cost of illness, loss of life and  healthcare resource utilization, the complication of  engraftment syndrome is an important clinical problem.  The purpose of this study was to evaluate the patterns  of physical signs and symptoms and proinflammatory serum  cytokines associated with the engraftment phase in a  population of 66 patients with hematologic malignancies who  underwent high-dose therapy and autologous stem cell  transplantation. Secondary data analysis was performed  utilizing patients' medical records. Using Two-step  Cluster Analysis, the physical signs and symptoms were  evaluated to determine naturally forming clusters. Two  distinct subgroups were identified based on five input  variables (white blood count recovery, hypoxia, renal  function, liver function, and fluid balance). The subgroup with more dysfunction had significantly worse treatment  related outcomes, reflected by more transfers to intensive  care, infections and positive radiographic findings, blood  component transfusions, antibiotic therapy, antifungal  therapy, and longer hospital stays. Interestingly, classic  signs such as rash and fever were not significant.  In a subset of 31 patients, an analysis of  proinflammatory cytokines was also conducted using Two-step  Cluster Analysis. Based on the Interleukin 12 to  Interleukin 6 ratio, two distinct subgroups formed where  the group with suppressed ratio recovery had worse  outcomes, reflected by greater blood component  transfusions, antibiotic therapy, antifungal therapy, and  longer hospital stays.  Patterns of physical signs and symptoms, as well as  cytokine biomarkers, may suggest patients who are at higher  risk of treatment related morbidity and worse outcomes. It  is therefore important that clinical and advanced practice  nurses carefully assess patients so as to identify patterns  of clinical deterioration and intervene to prevent organ  damage associated with engraftment syndrome. Future  studies should prospectively test a risk model to update  the critical components of engraftment syndrome that  predict worse outcomes.