History Of Allogeneic Transplantation Research Articles

Patterns of follow-up care in adult blood cancer survivors-Prospective evaluation of health-related outcomes, resource use, and quality of life.

Information about follow-up care in blood cancer survivors is limited. The questionnaire-based "Aftercare in Blood Cancer Survivors" (ABC) study aimed to identify patterns of follow-up care in Germany and compare different types of follow-up institutions. The study's 18-month prospective part compared the follow-up institutions identified in the preceding retrospective part (academic oncologists, community oncologists, primary care physicians). The questionnaires were completed by the follow-up physicians. Of 1070 physicians named by 1479 blood-cancer survivors, 478 (44.7%) consented to participate. For provision of care, most oncologists relied on published guidelines, while most primary care physicians depended on information from other physicians. Survivors with a history of allogeneic transplantation or indolent lymphoma were mainly seen by academic oncologists, whereas survivors with monoclonal gammopathy, multiple myeloma, or myeloproliferative disorders were often seen by community oncologists, and survivors with a history of aggressive lymphoma or acute leukemia by primary care physicians. Detection of relapse and secondary diseases was consistently viewed as the most important follow-up goal. Follow-up visits were most extensively documented by academic oncologists (574 of 1045 survivors cared for, 54.9%), followed by community oncologists (90/231, 39.0%) and primary care physicians (51/203, 25.1%). Relapse and secondary disease detection rates and the patients' quality of life were similar at the three institutions. Laboratory tests were most often ordered by academic oncologists, and imaging by primary care physicians. Psychosocial issues and preventive care were more often addressed by primary care physicians than by oncologists. Patients at high risk of relapse or late complications were preferentially treated by academic oncologists, while patients in stable condition requiring continuous monitoring were also seen by community oncologists, and patients with curable diseases in long-term remission by primary care physicians. For the latter, transfer of follow-up care from oncologists to well-informed primary care providers appears feasible.

Impairment of vocational activities and financial problems are frequent among German blood cancer survivors

Little is known about changes in the personal living conditions of long-term blood cancer survivors in Germany. To gather information about social relationships, work life, overall well-being, and religion, we performed a questionnaire-based retrospective study on 1551 survivors who had been on follow-up for ≥ 3 years (median, 9 years). Most survivors reported that marital status and relationships with relatives and friends remained constant before and after blood cancer. Vocational activities were temporarily impaired for 47.5%, with a median time of 11 months to return to work. More than a third of the patients (35.6%) discontinued work permanently, with disability and retirement pension rates of 7.9% and 38.1%, respectively, at the time of the survey. Financial problems due to reduced income were reported by 26.2%, in particular after relapse or allogeneic transplantation. Patient reports addressing their quality of life showed large variations. It was best in acute leukemia survivors without a history of allogeneic transplantation and worst in patients with myeloproliferative disorders. Religion tended to become more important after blood cancer. In conclusion, vocational impairment and financial problems are frequent among German blood cancer survivors. Efforts should be made at an early stage to reestablish the patients’ ability to work.

A retrospective analysis on mucormycosis in patients with hematological diseases: a single center experience from Turkey

Aim: Mucormycosis is an acute, invasive, devastating and highly fatal fungal infection, affecting particularly immunocompromised patients; fortunately, it is rare. This study aimed to describe the attitude of mucormycosis in patients with a hematological disease, and to evaluate the risk factors associated with mortality.
 Material and Method: We retrospectively assessed the demographic and clinical data of patients who were diagnosed with mucormycosis in Erciyes University Hematology and Bone Marrow Transplantation Center, between 2010 and 2020. The study was included 34 patients with a history of either hematological malignancy or hematopoietic stem cell transplantation. 
 Results: Twenty-seven patients had proven infection, and the others had possible infection. The most frequent underlying disease was acute leukemia. Seven-teen patients had a history of allogeneic transplantation, and frequency of mucormycosis was 3.5% among allogeneic transplant recipients. The most frequent site of infection was the rhino-orbital region (85.3%). Forty-seven percent of patients presented with acute orbital symptoms. Fifteen patients were on a mucor-active antifungal (posaconazole and liposomal Amphotericin B) prophylaxis or treatment at the time of diagnosis. All patients received liposomal Amphotericin B and seven patients received posaconazole additionally as initial therapy. Surgical debridement was performed in 91.1% of patients. The two-year mucor-related mortality rate was 44.1%. The survival curves were significantly lower in patients with concomitant fungal pneumonia, allogeneic transplantation and also in patients who were receiving mucor-active antifungal drugs at the time of diagnosis.
 Conclusion: Mucormycosis remains a significant problem for hematology clinicians despite the expanding use of antifungal prophylaxis. Moreover, breakthrough infections indicate rising danger regarding resistant agents. We also highlight that, most of the patients receiving broad-spectrum antifungal prophylaxis are more fragile and more complicated patients, which put them at increased baseline risk for mucormycosis, and deserve more attention.