The lived experience post-autologous haematopoietic stem cell transplant (HSCT): a phenomenological study.

Autologous haematopoietic stem cell transplant (HSCT) has a high physical and emotional morbidity. This study using Husserlian phenomenological methodology and using Giorgi's (Phenomenology and Psychological Research, Dusquesne University Press, Pittsburgh, 1985) method of analysis was undertaken to attempt to gain some understanding of the patient's experience. Five adult patients who had previously undergone autologous transplantation for a haematological malignancy at least 6 months before participated in the study. Interviews with the participants were audio taped and then transcribed verbatim. Nine themes emerged from the participants' stories and included psychological cost, physical and psychological adaptation, reprioritisation and a sense of isolation. The transplant experience can be separated into a discrete period of time and the findings illustrate that the experience of transplantation impacts on the life of the person for an undetermined period of time. The changes experienced may be permanent and the post-transplant person, emotionally, psychologically and physically, is not the same person who entered into transplant. For nurses and other health care professionals to improve practice it is imperative that they understand the lived experience their patients have undergone. Pretransplant preparation and post-transplant rehabilitation can be enhanced by having a greater depth of understanding.     

Mucormycosis after allogeneic haematopoietic stem cell transplantation: a French Multicentre Cohort Study (2003-2008)

Clin Microbiol Infect 2012; 18: E396-E400 ABSTRACT: We conducted a nationwide retrospective study to evaluate clinical characteristics and outcome of mucormycosis among allogeneic haematopoietic stem cell transplant recipients. Twenty-nine patients were diagnosed between 2003 and 2008. Mucormycosis occurred at a median of 225?days after allogeneic haematopoietic stem cell transplant, and as a breakthrough infection in 23 cases. Twenty-six patients were receiving steroids, mainly for graft-versus-host disease treatment, while ten had experienced a prior post-transplant invasive fungal infection. Twenty-six patients received an antifungal treatment; surgery was performed in 12. Overall survival was 34% at 3?months and 17% at 1?year.     

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Goals of work  Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common, and patients’ symptom experience has not been well documented. Purpose  To characterize the symptom experience of adult patients pre-transplantation and days 0, 30, and 100 after allogeneic HSCT. Methods  Data from 76 participants enrolled in a prospective health-related quality of life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS). Results  Participants were on average 40 years old (SD ± 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline, appetite change (88%) at day 0, and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [day 0], appetite change (22%) [day 30], and fatigue (11%) [day 100]. The total SDS score was highest at day 0 (M = 26.6 ± 7.6) when the highest number of symptoms were reported [median = 8 (1–11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia, and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL. Conclusion  Allogeneic HSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.     

儿童造血干细胞移植术后出血性膀胱炎的临床护理研究

目的 探讨儿童造血干细胞移植术后出血性膀胱炎(Hemorrhagic cystitis,HC)的临床护理.方法 2005年～2008年,在本院进行造血干细胞移植23例.根据儿童护理的特点,结合采用充分水化、利尿、碱化尿液、美斯纳解毒等方法预防HC.并在出现HC后,加强支持疗法、膀胱冲洗、雌激素应用等对症治疗和心理、饮食护理.结果 23个病例中仅6例发生出血性膀胱炎(26.0%).其中,Ⅰ度2例;Ⅱ度2例;Ⅲ度1例;Ⅳ度1例.除1例因移植抗宿主反应(graft-versus-host disease,GVHD)死亡外,其余病例均治愈,且病程控制在20 d内.结论 充分水化、碱化尿液、利尿、美斯纳解救、膀胱冲洗和雌激素应用等是有效的预防和治疗出血性膀胱炎的方法.而重视儿童患者特点,加强心理护理和家庭教育等护理措施是协助治疗的不可忽视的手段.

Abstract：

Objective To investigate the clinical nursing of hemorrhagic cystitis (HC) in children after hematopoietic stem cell transplantation (HSCT) .Methods During 2005 to 2008, there were 23 cases of HSCT in our hospital.All the cases were treated by hyperdration, forceful diuresis, urine alkalinization, adding mesna and combined the child care characteristics to prevent HC.And they were given supportive therapy, bladder irrigation, Estrogen and so on to treat HC..Results Only 6 cases had HC (26.0% ) .Among them, there 2 cases of grade Ⅰ , 2 cases of grade Ⅱ , 1 case of grade Ⅲ and 1 case of grade Ⅳ.Except 1 case died of graft-versus-host disease, all of the other cases were cured.Conclusions Hyperdration, forceful diuresis, urine alkalinization, adding mesna, bladder irrigation and Estrogen are the effective methods to prevent and treat HC.In additional, children psychological nursing and family education are very important in the clinical nursing.     

重视儿童造血干细胞移植(HSCT)术后并发症影像学表现

造血干细胞移植(HSCT)在治疗各种儿科难治性良性疾病和恶性肿瘤中具有越来越重要的作用,而诊断和干预HSCT术后并发症影响疗效和预后.目前针对HSCT术后并发症虽已取得可喜成果,但仍面临着不能尽早准确诊断并及时治疗的困境.医学影像学的发展为此提供了助力.HSCT术后常见中枢神经系统感染和可逆性后循环脑病、肺部感染、累及...     

ABO血型不合异基因造血干细胞移植后不同血型混合红细胞的分离鉴定

目的 建立不同血型混合红细胞的分离鉴定方法,应用于ABO血型不合造血干细胞移植患者的混合红细胞分离鉴定及植活红细胞研究.方法 应用红细胞血型抗原与相应抗体反应凝集,800×g和50×g分步离心,分离并收集凝集的和未凝集的红细胞进行计数和鉴定.结果 18例ABO血型不合造血干细胞移植后均成功分离鉴定出植活红细胞和患者自身红细胞.初次分离鉴定出植活红细胞的时间为移植后第11天至第72天.植活红细胞数量随移植后时间改变.本分离方法的灵敏度为1%,准确度为100%,回收率为92.5%,重复性为100%.结论 本方法可广泛用于不同血型混合红细胞的分离鉴定,为进一步研究干细胞移植患者2种不同红细胞变化的临床意义提供可靠的实验方法.     

替加环素治疗48例异基因造血干细胞移植后感染的安全性

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心理干预对造血干细胞采集亲缘供者心理状态的影响

目的探讨心理干预对造血干细胞亲缘供者心理状态的影响。方法将64例造血干细胞亲缘供者随机分为干预组（n=32）和对照组（n=32）,对照组采用常规的术前健康教育,干预组在此基础上行心理干预。干预前后采用Zung抑郁自评量表（SDS）、焦虑自评量表（SAS）对两组供者的心理状态进行评分,同时记录两组供者的心率、血压并进行相关分析。结果干预组血压、心率与干预前比较差异无统计学意义（P〉0．05）,与对照组比较差异均有统计学意义（P〈0．01）。干预组抑郁、焦虑得分与干预前比较均下降（P〈0．05）,与对照组比较差异均有统计学意义（P〈0．05）。结论对造血干细胞亲缘供者实施心理干预,可减轻其焦虑、抑郁心理和维持血压、心率的稳定。     

Haploidentical allogeneic haematopoietic stem cell transplantation as salvage therapy for engraftment failure after unrelated and autologous stem cell transplantation: a case report and review of the literature

Engraftment failure is a rare but life-threatening complication of haematopoietic stem cell transplantation (HSCT) and treatment of this condition is often challenging. This case report describes a patient with acute myeloid leukaemia and engraftment failure after unrelated donor allogeneic stem cell transplantation. Rescue treatment with granulocyte-colony stimulating factor and reinfusion of autologous 'back-up' stem cells failed, but transplantation of haploidentical donor stem cells following a fludarabine and antithymocyte globulin (ATG)-based conditioning regimen resulted in haematological reconstitution and long-term disease-free survival. The use of haploidentical donor stem cell transplantation as salvage therapy after engraftment failure in adult patients has not, to the authors' knowledge, been previously reported. Additionally, a review of the relevant literature is presented. This case report and literature review suggest that reinfusion of cryopreserved 'back-up' haematopoietic stem cells is a safe and effective salvage therapy for engraftment failure after allogeneic HSCT. Haploidentical donor stem cell transplantation after a fludarabine and ATG-based conditioning regimen could provide effective second-line therapy in adult patients.     

慢性粒细胞白血病患者异基因造血干细胞移植后不同干预方案疗效的比较研究

目的 了解免疫调节治疗和伊马替尼用于慢性粒细胞白血病(CML)异基因造血干细胞移植后早期预防复发的有效性、安全性.方法 2004年11月至2008年11月行造血干细胞移植的CML患者64例,根据bcr-abl监测结果,在移植后早期进行了干预治疗,方案为免疫调节、伊马替尼单独及与免疫调节联合.免疫调节干预包括减停免疫抑制剂和采用改良的供者淋巴细胞输注(mDLI).伊马替尼干预组13例,免疫凋节治疗组20例、联合治疗组31例.比较不同治疗组的近期疗效和远期疗效及不良反应.结果 伊马替尼治疗组、免疫调节治疗组、联合治疗组患者bcr-abl融合基因转阴率分别为86.0%、90.0%和83.9%(P=0.126);4年累计白血病血液学复发率分别为32.3%、0和16.1%(P=0.130),单独应用伊马替尼组比免疫调节治疗组复发率有增高的趋势(P=0.052);三组患者4年存活率分别为90.0%、89.7和83.0%(P=0.696).三组间的不良反应有明显差异,伊马替尼治疗组的血液学不良反应发生率高于免疫调节治疗组,与联合治疗组相近(分别为30.8%、5.0%和38.7%,P=0.001),而GVHD发生率在三组患者中的任意两组间均有差异,免疫调节治疗组、伊马替尼治疗组和联合治疗组分别为95.0%、0和67.7%(P=0.000).减停CsA患者中1例发生排斥,2例死于重度GVHD或GVHD后感染,治疗相关死亡率10%.其他两组无治疗相关的直接死亡者.结论 三种治疗方案可以达到相似的疗效,但不良反应不同,应权衡并进行个性化选择,减停CsA对早期患者风险较大不宜作为初始治疗的首选,单独采用伊马替尼治疗的长期效果有待进一步观察.治疗方案的细化和优化有待进一步前瞻性对照研究.     

Pharmacokinetics of cyclosporine A at a high-peak concentration of twice-daily infusion and oral administration in allogeneic haematopoietic stem cell transplantation

What is known and Objective: The most appropriate immunosuppressive strategy with calcineurin inhibitors for the prevention of acute graft‐versus‐host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT) has not yet been established. To estimate the safety and efficacy of a new strategy, we investigated the pharmacokinetics of cyclosporine A (CyA) delivered by twice‐daily infusion and oral administration maintained with a peak level above 1000 ng/mL to keep 24 h area under the concentration–time curve (AUC0–24) higher than 10 000 ng·h/mL in 12 patients. Methods: Cyclosporine A was started as a twice‐daily infusion at 1·5 mg/kg and then orally administered at twice the infusion dose to maintain the trough blood concentration between 200 and 500 ng/mL, and with a peak level above 1000 ng/mL. Serial blood samples were collected at 0, 1, 2, 3, 5, 8 and 12 h after CyA dosing (C0, C1, C2, C3, C5, C8 and C12) on days 14–21 after transplantation and on days 7–14 after switching to oral administration, and the AUC was calculated. Results: In all patients, the AUC0–24 for both twice‐daily infusion and oral administration was higher than 10 000 ng·h/mL. Two close relationships were observed between AUC0–12 and the C3 for infusion and between AUC0–12 and the C8 for oral administration. None of the patients had grades 3–4 aGVHD or other serious complications. What is new and Conclusion: This strategy was well tolerated, and the C3 for twice‐daily infusion and the C8 for oral administration were the optimal points for monitoring of CyA concentration in the early phase of transplantation.     

自体骨髓干细胞移植治疗心肌梗死6例报告

目的：观察自体骨髓干细胞移植治疗急性心肌梗死的临床可行性、安全性和有效性。 方法：选择2003-11／2004-06在北京同仁医院住院的急性ST抬高性心肌梗死患者6例，年龄18-75岁，急性ST抬高性心肌梗死患者6例。患者接受自体骨髓干细胞移植治疗前签署同意书。患者入院后行经皮冠状动脉介入治疗使梗死相关血管再通后，即开始使用粒细胞集落刺激因子10μg（kg&;#183;d）进行干细胞动员，6d后进行患者外周血单个核细胞分离，进一步纯化后经球囊导管输入梗死相关冠状动脉内。治疗后对患者进行6个月的随访。 结果：心肌梗死患者6例均进入结果分析。①经单光子断层发射扫描和正电子断层发射扫描等检查证实，6例患者治疗后3个月，梗死面积平均下降42．7％；其中2例患者治疗后6个月，梗死面积下降68％，另外4例患者治疗后3个月，梗死面积下降31．5％。②治疗后3个月患者左室射血分数由平均35．6％增加到50．8％，增加了15．2％。③移植手术过程中患者无不适，术后随访观察过程中无异常发现。 结论：自体骨髓干细胞经动员后，再分离纯化外周血单个核细胞治疗心肌梗死，可改善心肌梗死患者心功能，减小梗死面积，且较为安全。     

自体骨髓干细胞移植治疗心肌梗死6例报告

目的:观察自体骨髓干细胞移植治疗急性心肌梗死的临床可行性、安全性和有效性。方法:选择2003-11/2004-06在北京同仁医院住院的急性ST抬高性心肌梗死患者6例,年龄18～75岁,急性ST抬高性心肌梗死患者6例。患者接受自体骨髓干细胞移植治疗前签署同意书。患者入院后行经皮冠状动脉介入治疗使梗死相关血管再通后,即开始使用粒细胞集落刺激因子10μg(kg·d)进行干细胞动员,6d后进行患者外周血单个核细胞分离,进一步纯化后经球囊导管输入梗死相关冠状动脉内。治疗后对患者进行6个月的随访。结果:心肌梗死患者6例均进入结果分析。①经单光子断层发射扫描和正电子断层发射扫描等检查证实,6例患者治疗后3个月,梗死面积平均下降42.7%;其中2例患者治疗后6个月,梗死面积下降68%,另外4例患者治疗后3个月,梗死面积下降31.5%。②治疗后3个月患者左室射血分数由平均35.6%增加到50.8%,增加了15.2%。③移植手术过程中患者无不适,术后随访观察过程中无异常发现。结论:自体骨髓干细胞经动员后,再分离纯化外周血单个核细胞治疗心肌梗死,可改善心肌梗死患者心功能,减小梗死面积,且较为安全。     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation

Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.