An Integrated Literature Review on Supportive Care Interventions for Hematopoietic Stem Cell Transplant Patients

Resetting the immune system in refractory Crohn’s disease: Is autologous hematopoietic stem cell transplantation the way forward?

To determine whether gallbladder sonographic findings in hematopoietic stem cell (HSC) transplant patients can distinguish among hepatobiliary complications of HSC transplants (graft-versus-host disease [GVHD] and veno-occlusive disease) and biliary events (cholecystitis, cholangitis, and choledocholithiasis). All HSC transplant patients who underwent gallbladder sonography from 2009 through 2012 were identified. Complications and sonographic findings were recorded. Of 124 patients, 66 (53.2%) had an event: 33 (50.0%) had GVHD; 22 (33.3%) had veno-occlusive disease; 6 (9.0%) had a biliary event; 4 (6.0%) had veno-occlusive disease and GVHD; and 1 (1.5%) had veno-occlusive disease and a biliary event. Of all patients, 115 (92.7%) had 1 or more sonographic findings in the gallbladder, with sludge being most common in all groups. In patients with veno-occlusive disease, the second and third most common findings were pericholecystic fluid and wall thickening. In patients with GVHD, distension was the second most common. Patients with biliary events all had distension, and half had pericholecystic fluid. Patients with veno-occlusive disease were significantly more likely to have wall thickening than those with GVHD or no event (77.2% versus 36.3%; P= .005; and 77.2% versus 37.9%; P= .002) and more likely to have pericholecystic fluid than patients with GVHD (95.5% versus 45.5%; P = .0001), a biliary event (95.5% versus 50%; P = .02), or no event (95.5% versus 29.3%; P = .0001). The positive predictive value of any finding was low for all groups because findings were common in patients with no event. Sonographic abnormalities of the gallbladder after HSC transplants are common in patients with and without HSC transplant complications and in those with biliary events. No sonographic finding is useful to distinguish among complications in HSC transplant patients.

1504 Background: Patients with hematologic malignancies undergoing HSCT experience immense physical and psychological symptom burden during their extended transplant hospitalization. Interventions that help manage patients’ psychological distress and improve their quality of life (QOL) during this inpatient stay are limited. Virtual reality (VR), with its three-dimension capabilities for user engagement, offers a novel delivery modality for scalable, targeted, and patient-centered supportive care interventions aiming to address the persistent unmet psychosocial needs of these patients. Methods: We conducted a pilot randomized clinical trial (RCT) of a VR supportive care intervention (BMT-VR). Patients undergoing HSCT were randomly assigned to BMT-VR or usual care during their 3-4-week hospitalization. BMT-VR consisted of five self-directed modules addressing 1) supportive psychoeducation and managing expectations during HSCT; 2) effective coping; and 3) acceptance and gratitude while dealing with uncertainty. The primary endpoint was feasibility (≥60% of eligible patients enrolling, and ≥60% of BMT-VR participants completing ≥3/5 modules). To assess BMT-VR’s acceptability, we used the System Usability Scale ( > 80 = excellent acceptability). We assessed psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-BMT), post-traumatic stress symptoms (PTSD-Checklist), coping (Measure of Current Status-A), and self-efficacy (Cancer Self-Efficacy Scale) at baseline (i.e., 3 days post-HSCT) and 4-, 12-, and 24-weeks post-HSCT. We used analysis of covariance (ANCOVA) to explore the preliminary effects of BMT-VR on outcomes. Results: We enrolled 58.3% (81/139) of eligible patients (BMT-VR (n = 40); usual care (n = 41)) with a mean age of 57.9 (SD = 14.7) and 51.9% women. 74.4% of BMT-VR participants completed ≥3/5 modules and 65.1% completed 5/5 modules, with median acceptability score = 81.2. At 4-weeks, BMT-VR vs. usual care participants reported improved anxiety (5.3 vs. 3.6, P = 0.016), QOL (108.2 vs. 96.8, P = 0.014), coping (36.6 vs. 32.4, P = 0.023), and self-efficacy (144.6 vs. 131.9, P = 0.019). Although BMT-VR vs. usual care participants reported sustained improvements in QOL (B = 3.8, P = 0.002), coping (B = 1.8, P = 0.011), and self-efficacy (B = 4.5, P = 0.017), BMT-VR effects became more pronounced for depression (B = -0.5, P < 0.001), and PTSD (B = -1.7, P < 0.001) symptoms longitudinally across all time points. Conclusions: A novel VR-delivered supportive care intervention tailored to the psychosocial needs of HSCT recipients is feasible and acceptable and demonstrated preliminary efficacy for improving psychological distress and QOL. A subsequent multi-site RCT will evaluate BMT-VR’s efficacy for improving outcomes in diverse HSCT settings. Clinical trial information: NCT05629676 .

Objective To explore and describe real experience ot hematopoietic stem cell transplantation(HSCT) patients during pre-processing period,in order to provide basis for psychological nursing and health education.Methods Semi-structured in-depth interviews were conducted on 7 cases of HSCT patients by phenomenological research method in qualitative research.Results Real experience of HSCT patients during pre-processing period included:pessimism,over-sensitive,excessive anxiety,health information needs,economic burden,pressure of the disease and experience of self-value.Conclusions Clinical care should pay attention to the experience and psychological needs of HSCT patients during pre-processing period,deepen the content of holistic nursing,provide deeper and more comprehensive care and emotional support for the patients,so that patients can better cope with the pre-processing period. Key words: Hematopoietic stem cell transplantation; Pre-processing period; Experiences; Qualitative research

Late-Onset Hemorrhagic Cystitis in Children after Hematopoietic Stem Cell Transplantation for Thalassemia and Sickle Cell Anemia: A Prospective Evaluation of Polyoma (BK) Virus Infection and Treatment with Cidofovir

Evaluation of Platelet and Clotting Parameters in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation Patients with Candidemia

Efficacy of Oral Ribavirin in Respiratory Syncytial Virus Infection in Hematopoietic Stem Cell Transplant Patients: A Single-Centre Experience

Vaccination of Children following Allogeneic Stem Cell Transplantation

A Model Estimating Indirect Costs of Premature Death Associated with Severe Hepatic Veno-Occlusive Disease (sVOD) Among Hematopoietic Stem Cell Transplant (HSCT) Patients in the United States (U.S.)

Increasing Palliative Care Team Involvement in Pediatric Hematopoietic Stem Cell Transplant Patients

449 - Efficacy of Oral Ribavirin in Respiratory Syncytial Virus Infection in Hematopoietic Stem Cell Transplant Patients: A Single-Centre Experience

PurposeTo evaluate the high-resolution CT (HRCT) findings of pulmonary infections in patients with hematologic malignancy and compare them between patients with or without hematopoietic stem cell transplantation (HSCT).Materials and methodsA total of 128 patients with hematologic malignancy and pulmonary infection were included in this study. The diagnoses of the patients consisted of bacterial pneumonia (37 non-HSCT cases and 14 HSCT cases), pneumocystis pneumonia (PCP) (29 non-HSCT cases and 11 HSCT cases), and fungal infection other than PCP (20 non-HSCT cases and 17 HSCT cases). Two chest radiologists retrospectively evaluated the HRCT criteria and compared them using chi-squared tests and a multiple logistic regression analysis.ResultsAccording to the multiple logistic regression analysis, nodules were an indicator in HSCT patients with PCP (p = 0.025; odds ratio, 5.8; 95% confidence interval, 1.2–26.6). The centrilobular distribution of nodules was the most frequent (n = 4, 36%) in HSCT patients with PCP. A mosaic pattern was an indicator of PCP in both HSCT and non-HSCT patients. There were no significant differences in other infections.ConclusionThe mosaic pattern could be an indicator of PCP in both HSCT and non-HSCT patients. Nodules with centrilobular distribution might be relatively frequent HRCT findings of PCP in HSCT patients.

Risk of Bacterial Infection in Pediatric Hematopoietic Stem Cell Transplant Patients Receiving Cephalosporin Prophylaxis

Serum Citrulline As a Biomarker for Blood Stream Infections in Pediatric Hematopoietic Stem Cell Transplant Patients

The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.