K. Hałaburda

Strategies of pain reduction during the bone marrow biopsy

Examination of the bone marrow biopsy and aspirate allows diagnosis and assessment of various conditions such as primary hematologic and metastatic neoplasms, as well as nonmalignant disorders. Despite being performed for many years, according to many different protocols, the procedure still remains painful for the majority of patients. This paper summarizes the current knowledge of pain reduction measures in the bone marrow biopsy and aspiration.

The significance of oral labial biopsy in hepatic graft-versus-host disease diagnosis in patients following allogeneic hematopoietic stem cell transplantation – a preliminary report

BACKGROUND Graft-versus-host disease (GvHD) is the most important complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) responsible for increased mortality. Recent studies have discussed the use of oral GvHD screening tests in the diagnosis of systemic GvHD. This is the first study of the significance of oral labial biopsy in diagnosis of hepatic graft-versus-host disease (H-GvHD) following allo-HSCT. MATERIAL/METHODS Twenty-one patients after alloHSCT were selected: 12 patients with H-GvHD established clinically and in laboratory tests, and 9 patients without features of GvHD (control group). Histopathological and immunohistochemical evaluations of tissue samples included the following: 15 samples of oral mucosa (OM), 19 of lip salivary glands (LSG), and 5 of the liver, were performed in both groups. RESULTS All patients had clinically normal oral mucosa and 4 patients with H-GvHD manifested with xerostomia symptoms. Histological examination of LSG and/or OM confirmed the GvHD diagnosis in 9 of 12 patients with H-GvHD. The microscopic changes included: mild inflammatory lymphocytic infiltrates and apoptotic bodies in OM, and inflammatory infiltrates of mild degree with minimal CD8+ T cells predominance in the invaded ducts epithelium in LSG. In the control group, 4 of 9 patients had mild chronic inflammation, which did not fulfill the criteria of GvHD. The histopathological image of liver biopsies correlated with the clinical GvHD diagnosis. CONCLUSIONS The microscopic evaluation of LSG and/or OM biopsy confirms the clinical diagnosis of H-GvHD, regardless of the absence of clinical oral symptoms of GVHD. The histopathological features of oral GvHD may be subtle; the diagnosis requires a clinico-pathological and laboratory approach to exclude the other diseases with similar histopathological features.

A multidisciplinary team approach to the management of patients with suspected or diagnosed invasive fungal disease

Implementation of evidence-based guidelines for the treatment of invasive fungal disease (IFD) requires collaboration among numerous clinical and laboratory services, as partners in patient care. The multidisciplinary team (MDT) approach has emerged as a way of providing comprehensive medical care by bringing together professionals from a wide range of disciplines in a coordinated and effective manner. Here, we propose an MDT model for IFD management aimed at facilitating communication among consultants, adherence to clinical pathways and optimized use of resources available at each centre.

Oral health of adult patients undergoing hematopoietic cell transplantation. Pre-transplant assessment and care

Hematopoietic cell transplantation (HCT) is now one of the frequent procedures used for treatment of malignant and non-malignant blood diseases, autoimmune disorders, and certain solid tumors. Despite improvements of therapeutic protocols, HCT still carries a high risk of non-relapse mortality due to early and late complications. Side effects of the therapy regimen frequently occur in the oral cavity and often significantly decrease the patients’ quality of life. The complications may result from or may be exacerbated by improper oral preparation of the patient before transplantation. Therefore, it is mandatory that all patients referred to HCT undergo thorough dental examination and receive appropriate treatment before the procedure. It is also very important to develop an individual post-transplantation oral care protocol with special concerns to oral hygiene before implementation of the conditioning. This paper presents a review of dental management methods intended for patients before HCT proposed in literature as well as recommendations based on the experience of the Department of Comprehensive Dental Care and the Department of Conservative Dentistry of Warsaw Medical University and the Warsaw Institute of Hematology and Blood Transfusion. The article pays special attention to the problem of potential foci of infection and bleeding. It also presents protocol of oral hygiene in post-transplantation period, used by patients of Warsaw Medical University and Institute of Hematology and Blood Transfusion.

Lack of persistent remission following initial recovery in patients with type 1 diabetes treated with autologous peripheral blood stem cell transplantation

AIMS To assess metabolic control in patients with newly diagnosed type 1 diabetes mellitus who underwent immunoablation followed by autologous peripheral blood stem cell transplantation (APBSCT) as a treatment of diabetes. METHODS APBSCT was performed in 23 patients. Control group comprised 8 non-APBSCT patients in whom after diagnosis insulin therapy was initiated. Fasting plasma glucose, glycated hemoglobin, fasting and postprandial C-peptide were assessed in all subjects and continuous glucose monitoring was performed at 6th, 12th, 24th, 36th, 48th month after transplantation. The APBSCT group was observed for 72 months. RESULTS Six months after the procedure, 22 of 23 transplant patients remained insulin-free, but after 6 years, there was only one APBSCT insulin-free patient. Good glycemic control was observed in all patients throughout the observation period, although fasting plasma glucose in control group was significantly higher in comparison with the both transplanted groups up to the 36th month. HbA1c values were significantly lower in the insulin-free group only at the 24th and 36th month. Fasting and postprandial C-peptide concentrations were higher in APBSCT group as compared with control group. The most serious adverse event was a fatal case of Pseudomonas aeruginosa sepsis. CONCLUSIONS The effectiveness of APBSCT as a treatment for newly diagnosed DM1 seems to be limited in time. The metabolic control of APBSCT patients is similar to conventionally treated patients. The lower fasting plasma glucose and higher C-peptide achieved with APBSCT seem to not exceed the risks associated with the procedure.

Monitorowanie zakażenia HHV-7 u pacjentów po transplantacji krwiotwórczych komórek macierzystych – ocena przydatności klinicznej

A. Tomaszewska *, T. Dzieciątkowski , S. Rynans , M. Przybylski , K. Halaburda , G. Mlynarczyk , W.W. Jedrzejczak , B. Marianska 1,4 1 Instytut Hematologii i Transfuzjologii, Klinika Transplantacji Komorek Krwiotworczych, Warszawa, Polska Katedra i Zaklad Mikrobiologii Lekarskiej WUM, Warszawa, Polska Miedzywydzialowe Studium Biotechnologii SGGW, Warszawa, Polska Katedra i Klinika Hematologii, Onkologii i Chorob Wewnetrznych WUM, Warszawa, Polska *Autor prezentujący i do korespondencji. Adres email: agnieszka_tomaszewska@onet.eu

Bieżące poglądy dotyczące miejsca pleryksaforu w mobilizacji autologicznych krwiotwórczych komórek macierzystych

Streszczenie Pleryksafor jest swoistym antagonistą receptora chemokinowego CXCR4 wykorzystywanym do mobilizacji krwiotworczych komorek macierzystych ze szpiku do krwi obwodowej w celu ich pobrania i nastepnie autologicznego przeszczepienia. Europejskie wskazania rejestracyjne obejmują stosowanie pleryksaforu u pacjentow ze szpiczakiem plazmocytowym i chloniakami, ktorzy wykazują sie niedostateczną mobilizacją. Ze wzgledu na jego wysoką skutecznośc w polączeniu z G-CSF (czynnik wzrostu kolonii granulocytowych) wykorzystuje sie go glownie u chorych, u ktorych nie powiodla sie wcześniejsza mobilizacja (nieudani mobilizatorzy). Wskazania rejestracyjne umozliwiają stosowanie pleryksaforu rowniez u pacjentow o tzw. przewidywanej nieskutecznej mobilizacji (przewidywani źli mobilizatorzy) oraz u tych, u ktorych aktualnie prowadzona mobilizacja przebiega suboptymalnie (potwierdzeni źli mobilizatorzy). Istnieją dane, ze nawet u pacjentow, u ktorych skutecznie mobilizuje sie komorki krwiotworcze (dobrzy mobilizatorzy), stosowanie pleryksaforu mogloby w przyszlości znaleźc swoje uzasadnienie. W artykule przedstawiono mozliwości stosowania pleryksaforu w wyzej wymienionych przypadkach. Zasugerowano tez algorytm tzw. „ratunkowego” stosowania pleryksaforu w trakcie mobilizacji komorek krwiotworczych.