Pediatric Stem Cell Transplant Patients Research Articles

A Nursing Perspective on Inpatient Sleep and Circadian Disruptions for Pediatric Stem Cell Transplant Patients

A Nursing Perspective on Inpatient Sleep and Circadian Disruptions for Pediatric Stem Cell Transplant Patients

Novel Implementation of Photobiomodulation Therapy Decreases Oral Mucositis Severity in Pediatric Stem Cell Transplant (SCT) Patients

Novel Implementation of Photobiomodulation Therapy Decreases Oral Mucositis Severity in Pediatric Stem Cell Transplant (SCT) Patients

Pre-transplant glomerular hyperfiltration is not a risk factor for increased renal morbidity and mortality in pediatric stem cell transplant patients.

Low glomerular filtration rate (GFR) prior to stem cell transplant (SCT) is associated with increased morbidity and mortality. The implications of abnormally high GFRs, or glomerular hyperfiltration, prior to SCT are unknown. Twenty-two of 74 consecutive pediatric SCT patients over 2years old at a single center were hyperfiltrating prior to SCT, median nuclear medicine GFR 154mL/min/1.73m2 [interquartile range: 146-170]. There was no association between hyperfiltration and any transplant demographics, nor between hyperfiltration and acute kidney injury (p=.8), renal replacement therapy (p=.63), 1-year event-free survival (p=1), or abnormal creatinine-based estimated GFR at a median follow-up of 4.7years (p=.73).

A nursing perspective on inpatient sleep and circadian disruptions for pediatric stem cell transplant patients.

Children treated with stem cell transplant (SCT) are routinely hospitalized for long periods where they are exposed to significant sleep and circadian disruptions. As nurses play a primary role in symptom management during SCT, we sought to understand their perspective on patient sleep and circadian disruptions, perceived barriers to a good sleep and circadian environment, and suggestions for improvement. Four focus groups were conducted with pediatric SCT nurses (N=25 participants). A semistructured focus group guide was administered, with the discussions recorded and transcribed. A multistage thematic analysis combining prefigured and emergent dimensions was conducted. Our analysis focused on drawing comparisons within and across focus groups to understand the unique work experiences that participants had related to the patient's sleep and circadian environment. Three key themes emerged. First, nurses expressed a high awareness of how disruptive the hospital environment is for patients. Second, nurses described their extensive efforts to try to minimize the impact of these disruptions. Finally, they provided clear recommendations for how to improve upon these concerns, along with barriers that they perceive could impede implementation. Front-line caregivers on a pediatric SCT unit describe key contributors to sleep/circadian disturbances for patients. Within the constraints of the considerable medical needs of this patient population and the physical room/hospital environment, nurses strive to minimize these disruptions to the best of their ability. It is crucial that hospitals assess and remediate these disturbances for these children that have important implications for overall health.

Impact of a Trampoline-Based Exercise Program on Strength and Endurance in Pediatric Stem Cell Transplant Patients

P Glogowski and L Thérond contributed equally to this work. Background Pediatric patients receive physiotherapy support during hematopoietic stem cell transplantation (HSCT) to prevent the deterioration of condition and musculature and to promote rehabilitation. Despite the good arguments in favor of physiotherapy, children often do not enjoy the exercises, or even refuse to participate. In our prospective study we show that our unique training program on the trampoline is convincing and superior to the standard physical therapy during HSCT. Patients and Methods In this monocentric, randomized, prospective study of the University Children's Hospital Tübingen, 52 HSCT patients between 5 and 22 years of age were followed during the in-patient stay in the context of HSCT, as well as in the post-transplant period until day +200 after HSCT. The therapy group (TG; n=26; TG) received a specially created exercise program five days a week with elements of strength and endurance training using a trampoline and an exercise ball. The TG was compared with a control group (CG; n=26) that received standard physical therapy. After in-patient discharge, TG patients were given an exercise plan and an exercise diary to complete independently at home. On six predefined approximate observation days (baseline: day of in-patient admission before HSCT, between day +3 to +8 after leukocyte/granulocyte “take”, after HSCT, day +60, day +100, day +150, and day +200 after HSCT), patients in both groups were assessed for muscle strength (full-ball bump, triple hop), stamina and endurance (timed-up-and-go, 6-minute walking), muscle development (muscle circumferences of M. triceps surae and M. quadriceps), emotional state and quality of life (questionnaires: SAM, KINDL-Onco-module). Data from the training tests, as well as from the questionnaires was used to fit linear mixed models. The equation used to fit the models can be described by DV ijk = β 0j + β 1j * day k + ϑ 0i + ϑ 1i + ε ijk. In this model equation DV ijk denotes the dependent variable of patient i = 1, ..., 52, in group j = 1 (CG) or 2 (TG), at day k = -53, ..., 367 after HSCT. β 0j and β 1j denote the fixed effects where β 0j is the intercept estimate (i.e. the dependent variable at day 0 after HSCT) and β 1j is the slope estimate (i.e. how much the dependent variable decreases or increases each day) for the respective group j. ϑ 0i and ϑ 1i describe the individual specific random intercept and slopes, while ε ijk is the error term. Results A total of 52 patients with a median age of 9.8 years (range 5.2 to 20.3 years), 29 of whom were females (55.8%), were included in this study. Of the patients, 45 (86.5%) and 7 (13.5%) underwent allogeneic or autologous HSCT, respectively. The underlying diseases were malignant in 63.5% of the cases (e.g., acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma) and non-malignant in 36.5% of the cases (e.g., beta-thalassemia, sickle cell disease). The granulocyte and leukocyte take were each reached at a median of day +17 (range day +8 to day +30). The estimated fixed effects of the slopes of the analyzed data for the training tests and questionnaires can be found in the table. In the TG, there was a significant increase in the results of the walking test, the triple hop, the full ball bump, and triceps and quadriceps circumferences. No significant improvement over time was found in the CG. Looking at the difference between groups, the improvement in the TG was significantly greater for the walking test, the triple hop, and the quadriceps circumferences. For the questionnaire data, it was shown that both the CG and the TG had a significant decrease in debilitating physical, as well as debilitating psychological symptoms over time (KINDL body and KINDL mind). There was no significant difference between groups in these scales. For self-reported anxiety (SAM) and illness-related worries (KINDL disease) there was a significant decrease, while the scales KINDL friends and KINDL school increased significantly in the TG but not in the CG. For anxiety and the KINDL school scale this improvement was significantly greater in the TG than in the CG. Conclusions Our unique and new trampoline-based exercise program was able to counter standard physical therapy with significant improvements in muscle strength, endurance, as well as a reduction in anxiety and worry and an improved quality of life for the patients. And most importantly, our patients had an incredible amount of fun doing it.

MapperPlus: Agnostic clustering of high-dimension data for precision medicine.

One of the goals of precision medicine is to classify patients into subgroups that differ in their susceptibility and response to a disease, thereby enabling tailored treatments for each subgroup. Therefore, there is a great need to identify distinctive clusters of patients from patient data. There are three key challenges to three key challenges of patient stratification: 1) the unknown number of clusters, 2) the need for assessing cluster validity, and 3) the clinical interpretability. We developed MapperPlus, a novel unsupervised clustering pipeline, that directly addresses these challenges. It extends the topological Mapper technique and blends it with two random-walk algorithms to automatically detect disjoint subgroups in patient data. We demonstrate that MapperPlus outperforms traditional agnostic clustering methods in key accuracy/performance metrics by testing its performance on publicly available medical and non-medical data set. We also demonstrate the predictive power of MapperPlus in a medical dataset of pediatric stem cell transplant patients where a number of cluster is unknown. Here, MapperPlus stratifies the patient population into clusters with distinctive survival rates. The MapperPlus software is open-source and publicly available.

0306 Circadian Disrupting Light Exposure within Pediatric Hospital Rooms

Abstract Introduction Pediatric patients undergoing stem cell transplant (SCT) often experience extended hospitalizations. Inappropriate lighting during admissions is known to disrupt sleep and circadian health, which can result in worse health outcomes. This study aimed to describe patterns of light across 24-hour periods in two inpatient rooms of children undergoing SCT. Methods Wall-mounted light meters (Extech SDL400) continuously tracked noise and light levels at one-minute intervals in two patient rooms over six months. We determined the percent of time that patients were exposed to non-optimal light levels (< 448 lux during the daytime, >18 lux in the evening, >2 lux at night); thresholds were based on converting recent consensus-based melanopic equivalent daylight illuminance guidelines to vertically measured illuminance thresholds. We assessed the frequency that light exceeded thresholds associated with night wakings (>150 lux). Wilcoxon rank-sum tests compared light levels between the two rooms. Room A had a single northwest-facing window overlooking a narrow courtyard. Room B had an unobstructed window facing north. Results On average, hospitalized pediatric SCT patients spent 50% of their time in inappropriate light conditions. They were exposed to light spikes >150 lux on 2% of nights, with overnight light peaking at 513 lux. When comparing average daytime and nighttime light levels between the two rooms, Room A was significantly dimmer than Room B, p <.001. In the dimmer room, light levels never reached the recommended threshold during the daytime, and the light was too bright for 19% of the evening and 17% of the nighttime. In the brighter room, light levels were too dim during 97% of the daytime and too bright during 59% of the evening and 30% of the nighttime. Conclusion During the day, pediatric SCT patients are rarely exposed to light bright enough to preserve a healthy circadian rhythm. Hospitals have an opportunity to significantly improve the sleep and circadian health for children already at elevated risk for health morbidities during transplant. Support (if any) This research was generously supported by grant funding from Pedals for Pediatrics (PI: Zhou) and an institutional research training grant (T32DK063929).

Haploidentical vs. HLA-matched donor hematopoietic stem-cell transplantation for pediatric patients with acute lymphoblastic leukemia in second remission: A collaborative retrospective study of the Spanish Group for Bone Marrow Transplantation in Children (GETMON/GETH) and the Spanish Childhood Relapsed ALL Board (ReALLNet).

Studies addressing the role of haploidentical as alternative to HLA-matched donors for stem cell transplantation (SCT) often include patients with diverse hematological malignancies in different remission statuses. We compared outcomes of children with acute lymphoblastic leukemia (ALL) undergoing SCT in second complete remission (CR2) from haploidentical (n = 25) versus HLA-matched donor (n = 51). Patients were equally distributed across both groups according to age, immunophenotype, time to and site of relapse, relapse risk-group allocation, and minimal residual disease (MRD) before SCT. Incidence of graft failure, acute graft versus host disease (GVHD), and other early complications did not differ between both groups. We found no differences in overall survival (58.7% versus 59.5%; p = .8), leukemia free survival (LFS) (48% versus 36.4%; p = .5), event free survival (40% versus 34.4%; p = .69), cumulative incidence (CI) of subsequent relapse (28% versus 40.9%; p = .69), treatment related mortality (24% versus 23.6%; p = .83), CI of cGVHD (4.5% versus 18.7%; p = .2), and chronic GVHD-free and leukemia-free survival (44% versus 26.3%; p = .3) after haploidentical donor SCT. Chronic GVHD (HR = 0.09; p=.02) had protective impact, and MRD ≥ 0.01% before SCT (HR = 2.59; p=.01) had unfavorable impact on LFS. These results support the role of haploidentical donor SCT in children with ALL in CR2.

Applying a risk prediction model for bloodstream infection in a febrile, nonseverely neutropenic cohort of pediatric stem cell transplant patients.

The optimal management of febrile stem cell transplant (SCT) patients presenting without severe neutropenia (absolute neutrophil count [ANC]≥500/µL) is unclear. The authors have developed iterative risk prediction models (Esbenshade Vanderbilt [EsVan] models) that reliably predict bloodstream infections (BSIs) in the febrile general pediatric oncology population without severe neutropenia, but SCT-specific data are limited. All SCTs occurring from May 2005 to November 2019 at a single institution were identified. Episodes of fever with a central venous catheter and ANC values ≥ 500/µL were abstracted. All previous versions of the EsVan model were applied to the SCT data, and c-statistics were generated. The models were additionally applied to each type of transplant (autologous/allogeneic), and a new allogeneic model that further adjusted for metrics of immunosuppression, Esbenshade Vanderbilt Allogeneic SCT Model(EsVanAlloSCT), was developed and internally validated. For 429 SCT episodes (221 autologous and 208 allogeneic), the BSI incidence was 19.6% (84 of 429), and it was higher in allogeneic transplant patients (25.5%) than autologous transplant patients (14.0%; p< .01). All versions of the EsVan model performed well for the overall SCT cohort (c-statistics, 0.759-0.795). The EsVan models performed better for the autologous episodes (c-statistics, 0.869-0.881) than the allogeneic SCT episodes (c-statistics, 0.678-0.717). The new allogeneic transplant-specific model, EsVanAlloSCT, which added an adjustment for the extent of immunosuppression, yielded a c-statistic of 0.792 (bootstrap-corrected, 0.750). The EsVan models work exceptionally well when they are applied to autologous SCT, but they work less well for allogeneic SCT. EsVanAlloSCT appears to improve the predictive ability in allogeneic SCT, but it will need additional external validation.

478 - Sleep and Circadian Health Disruptors to Inpatient Pediatric Stem Cell Transplant Patients: A 6-Month Objective Observation

478 - Sleep and Circadian Health Disruptors to Inpatient Pediatric Stem Cell Transplant Patients: A 6-Month Objective Observation

167 - Earlier Oral Intake in Pediatric Stem Cell Transplant Patients Receiving Time-Restricted Feeding: A Prospective, Randomized Trial

167 - Earlier Oral Intake in Pediatric Stem Cell Transplant Patients Receiving Time-Restricted Feeding: A Prospective, Randomized Trial

Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients.

Racial/ethnic disparities in utilizing inpatient palliative care services are well documented in the adult literature. However, the impact of racial/ethnic disparities in the context of pediatric palliative care is less well understood even in high-acuity patient populations such as stem cell transplant patients. We investigated racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs) for pediatric stem cell transplant patients. A retrospective cohort study was conducted using the Pediatric Health Information System database. A generalized linear mixed effects model was developed to assess demographic and clinical characteristics associated with the likelihood of receiving IPCC. Thirty-eight tertiary pediatric hospitals in the United States. Pediatric patients undergoing stem cell transplantation for any indication from January 2017 to December 2019. None. Of the 1,193 inpatient encounters studied, 12% (n = 143) included a palliative care consult. IPCC rates varied across hospitals with a median rate of 5.97% (interquartile range, 0.00-20.71). In multivariable analyses, Hispanic/Latinx patients were 59% less likely to receive IPCC compared with non-Hispanic White patients (odds ratio [OR], 0.41; 95% CI, 0.21-0.78). This difference persisted after adjusting for all other sociodemographic and clinical factors. In terms of the other clinical characteristics, having a malignant condition and mechanical ventilation were associated with significantly increased odds of receiving IPCC for the entire cohort (OR Malignancy: 1.93; 95% CI: 1.07-3.51; OR Mechanical Ventilation: 2.37; 95% CI: 1.36-4.13). The remainder of the variables were not found to be significantly associated with IPCC. Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.

421 - Dosing of Cidofovir in Pediatric Stem Cell Transplant Patients Requiring Continuous Renal Replacement Therapy (CRRT)

421 - Dosing of Cidofovir in Pediatric Stem Cell Transplant Patients Requiring Continuous Renal Replacement Therapy (CRRT)

1162. Engraftment fever (EF) in Pediatric stem cell transplantation (SCT): Risk Factors, Etiology and Outcomes

BackgroundEngraftment fever (EF) during stem cell transplantation (SCT) is likely due to non infectious causes like immune reconstitution syndrome (IRS) or engraftment syndrome (ES). Few studies have looked at the rate of infection causing fever during engraftment. There is no good evidence to guide the approach to evaluation and empiric treatment of infections during EF.MethodsRetrospective record review of pediatric SCT (autologous and allogenic) patients with a diagnosis of febrile neutropenia (FN) during engraftment period (days +7 to +30 post transplant). FN episodes classified as either EF or non-engraftment fever (NEF). EF = new onset fever in temporal relationship to neutrophil recovery (4 days before through 1 day after neutrophil engraftment (ANC >500/mm3). NEF = fever without signs of neutrophil recovery (ANC < 100/mm3 without significant rise ±4 days of fever onset). Only first FN during engraftment was included. Episodes meeting neither criteria were excluded.Results112 patients had 115 FN episodes (FNEs) identified: NEF 81 (71.5%); EF 34 (29.5%). In multivariable analysis: Neuroblastoma as underlying diagnosis (odds ratio [OR]=3.2, 95% CI 2.31-6.54, P< 0.01), G-CSF administration before day +7 (OR=2.8, 95% CI 1.92-4.65, P=0.03), absolute monocyte count (AMC) >100/mm3 at FN presentation (OR=2.9, 95% CI, 1.11 to 7.55, P=0.02), were associated with an increased risk of EF compared with NEF. Most EF episodes (26/34, 76%) had no specific infectious etiology identified; 8 had IFIs (24%) [3 proven, 2 probable, 3 possible). IFI rate was higher in EF than NEF group (24% vs 5%) (OR=4.5, 95% CI, 2.11 to 9.55, P< 0.01. EF episodes were more likely to be admitted to the intensive care unit (OR=2.3, 95% CI, 1.88 to 6.35) and had higher 30-day mortality (OR =4.52, 95% CI, 0.37 to 6.55) than NEF.Table 3 table 2 ConclusionEngraftment fever may have an infectious component. Work-up to exclude IFI and empirical antifungal therapy should be considered especially with prolonged fever and supportive clinical or radiological data. Large multi-center prospective studies are needed to further define infectious complications and determine the approach to engraftment fever. Early detection of IFI in this high-risk group may lead to improved morbidity and mortality.Disclosures All Authors: No reported disclosures

A decision support tool to find the best cyclosporine dose when switching from intravenous to oral route in pediatric stem cell transplant patients.

Managing the pharmacokinetic variability of immunosuppressive drugs after pediatric hematopoietic stem cell transplantation (HSCT) is a clinical challenge. Thus, the aim of our study was to design and validate a decision support tool predicting the best first cyclosporine oral dose to give when switching from intravenous route. We used 10-years pediatric HSCT patients' dataset from 2008 to 2018. A tree-augmented naïve Bayesian network model (method belonging to artificial intelligence) was built with data from the first eight-years, and validated with data from the last two. The Bayesian network model obtained showed good prediction performances, both after a 10-fold cross-validation and external validation, with respectively an AUC-ROC of 0.89 and 0.86, a percentage of misclassified patients of 28.7% and 35.2%, a true positive rate of 0.71 and 0.65, and a false positive rate of 0.12 and 0.14 respectively. The final model allows the prediction of the most likely cyclosporine oral dose to reach the therapeutic target specified by the clinician. The clinical impact of using this model needs to be prospectively warranted. Respecting the decision support tool terms of use is necessary as well as remaining critical about the prediction by confronting it with the clinical context.

COVID-19 in New York City Pediatric Hematology and Oncology Patients

Background: Little is known about the effect of COVID-19 disease on pediatric hematology, oncology and hematopoietic stem cell transplant (HCT) patients brbr

Granulocyte Transfusions Are Safe and Feasible in High-Risk Pediatric Allogeneic Transplant Patients

<h3>Introduction</h3> Patients undergoing stem cell transplantation (SCT) are at high risk of bacterial and fungal infections prior to engraftment. Those with a significant infectious history are especially high-risk. Granulocyte transfusion (GT) may help prevent infectious complications during the pre-engraftment period, but feasibility and safety data on GT are limited in pediatric SCT patients. <h3>Objective</h3> We evaluated the safety and feasibility of volunteer-donor GT for pediatric SCT patients. <h3>Methods</h3> We retrospectively reviewed records of allogeneic SCT patients at UPMC Children's Hospital of Pittsburgh (Pittsburgh, PA) who received pre-engraftment GT from unrelated volunteers between August 2012 and October 2016. Granulocyte donors were ABO-matched and stimulated with oral corticosteroids. Patients received pretreatment with acetaminophen, diphenhydramine, and methylprednisolone before each infusion. <h3>Results</h3> Eleven patients (3 female) of median age 7.5 years (0.7 – 40.3) received a total of 53 GT (median 4 per patient). All patients had a history of bacterial and/or fungal infection (Table 1); 4 patients (36%) had received at least 1 prior allogeneic SCT. Mean cell dose per GT was 1.7 ± 0.7 × 10¹⁰. Mean rise in white blood cell (WBC) count after GT was 1 ± 1.6 × 10⁹, which significantly correlated with cell dose (Figure 1). Fever occurred during 4 GT (7.6%), and transient dyspnea occurred during 3 GT (5.7%). No severe reactions were reported. During the course of GT, blood cultures from 3 patients (27%) grew coagulase-negative Staphylococcus, and 1 of these patients developed acute-on-chronic bacterial pneumonia. Overall survival was 82% at 100 days and 64% at 365 days post-SCT. Infection-related mortality was only 9% (1 patient died of disseminated cytomegalovirus). <h3>Conclusions</h3> In a high-risk group of pediatric allogeneic SCT patients with prior infections, GT did not cause any serious complications, and infection-related mortality was low. Corticosteroid-stimulated volunteer donors provided adequate cell doses. GT appears safe and feasible in high-risk pediatric SCT patients, and it may be underutilized as adjunctive treatment for those with a history of serious infections. The efficacy of GT deserves further study.

Sinusoidal Obstructive Syndrome Among Pediatric and Adolescent and Young Adult Patients: Analysis of Pediatric EBMT Diagnostic and Severity Criteria at MD Anderson

Background: Sinusoidal obstructive syndrome (SOS) is a potentially catastrophic complication of stem cell transplantation (SCT) which disproportionately affects younger patients. The incidence of SOS may vary widely depending on the diagnostic criteria (Baltimore versus Seattle), and delays in initiation of definitive treatment remains the most important predictor of outcome. Recently proposed pediatric diagnostic and severity grading criteria by the European Society of Blood and Marrow Transplantation (EBMT) may offer increased sensitivity and allow for more prompt diagnosis, but the extent to which these have been adopted and/or validated by centers in the United States is unclear. Methods: This is a retrospective analysis of all patients undergoing SCT on the Pediatric service at MD Anderson Cancer Center from 2009-2019. Patient records were reviewed for diagnosis of SOS. Among patients identified with SOS, application of Baltimore, Seattle and pediatric EBMT (pEBMT) criteria were compared. Descriptive statistics were used for data analysis where appropriate. Results: A total of 248 patients received 268 transplants during the study period. Patient characteristics are summarized in Table 1. When Baltimore criteria was used the incidence of SOS was 4.5% (n=12) as compared to 8.2% (n=22) when the Seattle or pEBMT criteria were applied. At diagnosis, the majority of these patients had moderate to very severe disease according to pEBMT criteria. The median time to diagnosis of SOS varied according to diagnostic criteria used, with a trend to earlier diagnosis with pEBMT criteria (13 days post-SCT with pEBMT versus 15 days with Seattle/Baltimore) as shown in Table II. Prior exposure to inotuzumab and gemtuzumab were associated with high rates of SOS (75% and 86% respectively). Anicteric SOS, refractory thrombocytopenia and rising bilirubin from a baseline value on 3 consecutive days or bilirubin ≥2 mg/dL within 72 hours were present in 63.6%, 77.3% and 91% of patients with SOS, when pEBMT criteria were applied. Late-onset SOS (diagnosed after 21 days post-SCT) was present in 22.7% of patients when Seattle or pEBMT criteria were applied (n=5) and could not be diagnosed per Baltimore criteria. Severe SOS was eventually observed in 95% of patients. Severe ascites requiring paracentesis (23%), impaired coagulation (77%), respiratory distress requiring supplemental oxygen and/or invasive pulmonary ventilation ( 55%), delirium (32%), acute kidney injury/KDIGO Stage 3/requiring renal replacement therapy (50%) were observed. Defibrotide treatment was initiated in 55% of patients with a median duration of treatment of 26 (3-74) days and complete resolution of SOS was observed in 42% of these patients. For patients who were initiated on defibrotide on the day of diagnosis (n=7) versus those who were not (range 1-11 days) the median time to complete resolution of SOS was 35 and 20 days respectively (p=0.2). Conclusions: To our knowledge, this is the first reported retrospective analysis of SOS among pediatric and adolescent young adult SCT patients in the United States using pEBMT SOS diagnostic and severity criteria. Our study was limited by small sample size associated with single center analyses. Use of the pEBMT criteria showed a trend to earlier time to diagnosis by a median of two days. This is a potentially clinically significant finding, as a delay in initiation of defibrotide among children with severe SOS, has been associated with statistically significant decreased rates of complete resolution. Inherent flaws of the Baltimore and Seattle criteria are the time restriction and reliance of hyperbilirubinemia for the diagnosis in children and adolescents and young adults. Our retrospective analysis suggests that pEBMT criteria for the diagnosis of SOS among children and young adults may be appropriate, especially given the rates of anicteric and late-onset SOS seen in this population. Disclosures Petropoulos: Foundation for the Accreditation of Cellular Therapy (FACT): Membership on an entity's Board of Directors or advisory committees, Other: Foundation for the Accreditation of Cellular Therapy (FACT). Kebriaei:Amgen: Research Funding; Jazz: Consultancy; Pfizer: Honoraria; Kite: Honoraria. Wierda:Xencor: Research Funding; Janssen: Research Funding; Loxo Oncology Inc.: Research Funding; KITE pharma: Research Funding; Juno Therapeutics: Research Funding; Gilead Sciences: Research Funding; Acerta Pharma Inc: Research Funding; Pharmacyclics LLC: Research Funding; Genentech: Research Funding; GSK/Novartis: Research Funding; AbbVie: Research Funding; Cyclcel: Research Funding; Oncternal Therapeutics Inc.: Research Funding; Miragen: Research Funding; Sunesis: Research Funding. Mahadeo:Recipient of unrestricted medical education grant from Jazz: Research Funding; PI for ATARA EBV CTL Trials: Other: Other .

Dietary and Exercise Interventions for Pediatric Oncology Patients: The Way Forward.

This review focuses on diet and exercise interventions that have been conducted in pediatric cancer and pediatric stem cell transplant patients. It examines the different reasons for conducting lifestyle interventions with attention to the different outcome measurements and feasibility of these measures with an argument toward a need for standardization to move the field forward.

Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit

Objective:This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM).Methods:Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed.Results:At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ2 = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01).Conclusions:One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients’ outcomes.