Yasemin Karacan

Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: A single center experience

Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning.

Naturally acquired hepatitis A antibodies after haematopoetic stem cell transplantation

Haematopoietic stem cell transplant (HSCT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated throughout their lifetime and therefore need to be revaccinated. We aimed to evaluate the influence of different factors on hepatitis A virus (HAV) immunity in both child and adult HSCT recipients living in an intermediate endemic region, Turkey. Eighty patients (age range 2·5-57 years) who had HAV serology prior to HSCT were evaluated. The prevalence of HAV seropositivity was 85% (n=68) before HSCT. There was no history of HAV vaccination before HSCT in children and HAV vaccine was not available in Turkey 10 years ago, so it was assumed that all seropositive patients reflected natural immunity. After the exclusion of six patients with autologous HSCT, the remaining 62 seropositive and allogeneic patients were included in this retrospective study. The duration of HAV seropositivity was estimated using the Kaplan-Meier method, log-rank analysis and Cox regression models. Estimated mean time to loss of HAV seropositivity was 48·6 months after transplantation. Patients who were older (⩾18 years) at transplantation and who had older (⩾18 years) donors became seronegative later (P<0·05). Cox backward-stepwise regression confirmed that older age of recipient at transplantation was the only significant parameter for HAV seropositivity (P<0·05). HAV-inactivated vaccine might be recommended later to older HSCT recipients in intermediate endemic regions.

Eculizumab before and after allogeneic hematopoietic stem cell transplantation in a patient with paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by the triad of intravascular hemolysis, venous thrombosis, and cytopenia. Treatment of PNH is generally supportive. Bone marrow transplantation is the only curative therapy for PNH, but is associated with significant morbidity and mortality. Herein, we present a patient with PNH that received eculizumab, a humanized monoclonal antibody that blocks activation of the terminal complement at C5, before and immediately following allogeneic peripheral stem cell transplantation. Prior to hematopoietic stem cell transplantation eculizumab treatment markedly reduced hemolysis and transfusion requirement; however, 1 d post transplantation a hemolytic episode occured, which was successfully stopped with eculizumab re-treatment. Afterwards the patient did not require additional transfusions. The results of this study indicate that early administration of eculizumab may be a safe and effective therapy for hemolytic episodes associated with allogeneic peripheral stem cell transplantation in patients with PNH.

PERİFERİK KÖK HÜCRE NAKLİNDE HASTALARDA GÖRÜLEN ANKSİYETE VE DEPRESYON / Anxiety and Depression in Patıents Undergoing Peripheral Blood Stem Cell Transplantaiıon

OZET Periferik kok hucre nakli yapilan hastalarda nakil sonrasi donemde anksiyete ve depresyon gorulme riski yuksektir. Hastanin anksiyete ve depresyon yasama nedenleri arasinda hastaligin evresi ve tekrari, nakil sonrasi komplikasyonlar ( graft versus host hastaligi , notropeni, agri, mide bulantisi ve kusma gibi kemoterapi yan etkileri), kontrol kaybi, olum korkusu, belirsizlik, aile ve arkadaslarindan ayri kalma, izolasyon, cinsel yetersizlik yer alir. Hemsire hastanin bakiminda hastanin anksiyete ve depresyonla bas etme yontemlerini kullanmayi, hastalik ve tedaviye uyumunu, kemoterapi, radyoterapi ve hastaneye iliskin onceki deneyimini, kok hucre nakli hakkinda bilgisini, donorun istekliligini, aile gibi destek sistemlerini goz onune almasi gereklidir. Anahtar Kelimeler: Periferik kok hucre nakli, anksiyete, depresyon, hemsirelik ABSTRACT Risk of anxiety and depression encountering patients undergoing peripheral blood stem cell transplantation is high at period after transplantation. Among causes of the patient’s anxiety and depression take place their disease phase and fearing relapse, feeling pain, side effect of chemotherapy such as nausea and vomiting, lose of self-control, fearing death, uncertainty, separeting their family or friends, isolation, sexual deficiency. The nurse should consider issues that patient uses method of cope with anxiety and depression, to adaptives her/his treatment and disease, to has previous experience related to chemotherapy, radyotherapy and hospital, to has knowledge about peripheral blood stem cell transplantation, to has support systems as family that donor desire for her/his giving blood stem cell . Keywords: Periferial blood stem cell transplantation, anxiety and depression, nursing