Undergoing Bone Marrow Transplantation Research Articles

Quality of Life for adult Clients Who Undergone Bone Marrow Transplantation at the Specialized Bone Marrow Transplantation Center in Baghdad City: A Cross Sectional Study

Evaluating the quality of life for adult clients who undergone bone marrow transplantation at the specialized bone marrow transplantation center in Baghdad City. A cross sectional design is carried out through the current study from 4th of March 2018 to 10th of November 2018. The study is conducted on adult clients who are visiting specialized bone marrow transplantation center in Baghdad city. A purposive sample ‟ non probability ” of (30) teenager (21) male (9) female and who are undergone bone marrow transplantation, six month after operation, with non-Hodgkin Lymphoma (NHL), Hodgkin Lymphoma (HL) and Multiple Myeloma (MM). The pilot study was conducted to determine the questionnaire reliability through the use of split-half techniques and the computation of Cronbach alpha correlation coefficient. The content validity of the instrument was established through penal of (18) experts. Data were analyzed by application of descriptive and inferential statistical methods. The results show poor quality of life (QOL) for adult clients after bone marrow transplantation (BMT). And the results show a significant relationship between adult clients’ age and their (QOL). And no significant relationship between gender, marital status and socio-economic status and their (QOL).

The Potential Benefits of PTH Analogs in Prevention of Pathological Fractures in Cerebral Palsy

Leukodystrophies are a rare group of genetic disorders that affect white matter of the central and peripheral nervous system. We present a clinical case of X-linked adrenoleukodystrophy (X-ALD) in a 9-year old male patient. The patient initially presented with neuropsychiatric symptoms characterized by impulsiveness, hyperactivity, and loss of reading and writing abilities. MRI scan showed a frontal involvement of both cerebral hemispheres. Based on this experience, we recommend that patients with hyperactivity and impulsiveness, and loss of previously acquired abilities such as reading and writing should be thoroughly evaluated to rule out the presence of X-ALD. After making the diagnosis with a complete serum fatty acid profile accompanied by the radiologic findings aforementioned, the patient underwent bone marrow transplant, without a favorable outcome after one year of follow-up.

Feasibility of a novel dose fractionation strategy in TMI/TMLI

BackgroundTo report our experience in planning and delivering total marrow irradiation (TMI) and total marrow and lymphatic irradiation (TMLI) in patients with hematologic malignancies.MethodsTwenty-seven patients undergoing bone marrow transplantation were treated with TMI/TMLI using Helical Tomotherapy (HT). All skeletal bones exclusion of the mandible comprised the treatment target volume and, for TMLI, lymph node chains, liver, spleen and/or brain were also included according to the clinical indication. Planned dose of 8Gy in 2 fractions was delivered over 1 day for TMI while 10Gy in 2 fractions BID was used for TMLI. Organs at risk (OAR) contoured included the brain, brainstem, lens, eyes, optic nerves, parotids, oral cavity, lungs, heart, liver, kidneys, stomach, small bowel, bladder and rectum. In particular, a simple method to avoid hot or cold doses in the overlapping region was implemented and the plan sum was adopted to evaluate dose inhomogeneity. Furthermore, setup errors from 54 treatments were summarized to gauge the effectiveness of immobilization.ResultsDuring the TMI/TMLI treatment, no acute adverse effects occurred during the radiation treatment. Two patients suffered nausea or vomiting right after radiation course. For the 9 patients treated with TMI, the median dose reduction of major organs varied 30–65% of the prescribed dose, substantially lower than the traditional total body irradiation (TBI). Meanwhile, average biological equivalent doses to OARs with 8Gy/2F TMI approach were not different from the conventional 12Gy/6F TMI approach. In the dose junction region, the 93% of PTV was covered by the prescribed dose without obvious hotspots. For the 27 patients, the overall setup corrections were lower than 3 mm except those in the SI direction for abdomen-pelvis region, demonstrating excellent immobilization.ConclusionThe present study confirmed the technical feasibility of HT-based TMI/TMLI delivering 8-10Gy in 2 fractions over 1 day. For patients undergoing hematopoietic cell transplantation the proposed 8Gy/2F TMI (or 10Gy/2F TMLI) strategy may be a novel approach to improve delivery efficiency, increase effective radiation dose to target while maintaining low risk of severe organ toxicities.

Proteomics Analysis Reveals Protein Panels That Are Associated with Prediction to Tyrosine Kinase Inhibitors Response, Bone Marrow Transplant, Survival and Disease Outcome of Chronic Myeloid Leukemia Patients

Clinical and molecular diagnosis of most hematological malignancies including Chronic Myeloid Leukemia (CML) can be accurately made. However, prediction of treatment response and estimation of disease survival period eludes the currently available tools for patient care. Quantitative expression proteomics can potentially be developed as effective tool to monitor therapy response towards achieving personalized medicine for CML patients.We have over 10 years follow up period for some of the CML patients, and the majorities of them are alive and doing well on Imatinib. On the other hand, a small fraction of the patients were switched to alternative Tyrosine Kinase Inhibitors (TKI) and some underwent bone marrow transplants (BMT).Our follow up results stratified all 37 analyzed newly diagnosed CP-CML patients into 5 distinct cohorts including 52% on Imatinib, 12% on Nilotinib, 9% on Dasatinib, and 15% BMT, while 12% of the patients had disease-related mortality. Kaplan-Meier survival curve showed no significant difference between all patients on TKI and BMT that were alive under a follow up period of 4-11 years compared. On the other hand 3 of 4 patients had disease related deaths less than 2 years of diagnosis. Only one patient survived for almost 10 years (Figure 1). Besides survival analysis, peripheral blood samples obtained from the patients at time of diagnosis were subjected to expression proteome analysis using label-free quantitative liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). A subset of significantly differentially expressed proteins was able to distinctively discriminate samples into their respective treatment response and disease outcome groups based on unique protein expression signatures (P<0.05 and > 2- ∞- fold change, (Figure 2). Some of the identified proteins were implicated in hematological diseases including CML as potential biomarkers using Ingenuity Pathway Analysis.These protein signatures once validated in larger sample cohorts might be capable of prediction of molecular response, choice of therapy and disease outcome for CML patients. Therefore; allowing for identification of would be high risk patients that might potentially benefit from aggressive treatment at point of diagnosis pre initiation of conventional therapy. Altogether our findings indicate that analysis of panel of protein markers have the potential of clinical utility for prediction of response to therapy, disease survival and objective prognostication of disease outcome, thus bringing personalized medicine closer to CML patients. DisclosuresNo relevant conflicts of interest to declare.

Trends in Hospital Utilization for Acute Illness in a Large Population-Based Cohort of Children and Adolescents with Sickle Cell Disease (SCD): 2010–2017

Disease severity and healthcare utilization varies widely among persons with sickle cell disease (SCD). Hydroxyurea (HU) has been demonstrated to reduce rates of pain and acute chest syndrome, the leading causes of inpatient utilization in patients with Hb SS and S β°-thalassemia in clinical trials. We recently reported that HU was clinically effective in reducing rates of pain and acute chest syndrome in patients who initiate treatment. Use of hydroxyurea in SS/S β°-thalassemia has increased markedly since 2010. Thus we sought to detemine trends of hospital utilization for acute illness during an 8 yr in which HU utilization increased markedly (2010-2017). Data from years 2010-201 were obtained from the SCD database and patient records at Children's Healthcare of Atlanta (CHOA). Utilization data were restricted to acute care admissions. Admissions for elective procedures, non-SCD related discharge diagnoses, rare SCD genotypes, and patients who had undergone bone marrow transplant were excluded. Patients were compared based on number of hospitalizations, age, sex, SCD genotype (SS/S β°-thalassemia vs Hb SC/S β+thalassemia), and discharge diagnosis. A total of 3,116 patients had at least one encounter between 2010 and 2017; 2,947 patients met inclusion criteria. From 2010-2017 the total number of active patients per year increased from 1,546 patients to 1,789 patients (+16%), while the total number acute care admissions increased from 1,295 admissions to 1,609 admissions (+24%). There were no significant differences in the proportion of patients with genotypes SS/S β° thalassemia genotypes (67.0% vs 63.9%, p=0.06). Overall patients with SS/S β° thalassemia had higher admission rates compared to SC/S β+ thalassemia patients (0.94 vs 0.57 admissions per patient per year). During the study period. overall admission rates in SCD (acute illness hospitalizations/patient/yr) increased from a low of 0.74 in 2011 to a high of 0.90 in 2017. The proportion of admissions attributed to SS/S β°-thalassemia patients decreased (79.2% in 2010 vs 72.3% in 2017, p<0.0001). However, admission rate in SC/S β+ thalassemia increased (0.53 to 0.69 admissions per patient per year). Overall, over 60% of patients were not admitted in any given year, and the proportion of patients with 0-1 admissions in a given year remained unchanged. However, the proportion of super high hospital utilizers (SHHU), patients with 8 or more admissions in a given year, increased by 185%. In 2001 this group made up 0.6% of all patients and accounted for 7.3% of admissions; in 2017 SHHU had increased 1.8% of patients and 24.3% of admissions. There was no difference in genotype or sex between SHHU and non-SHHU patients. SHHU were older (>90% of patients over age 8 years), and had greater percentages of admissions for pain and acute chest syndrome then non-SHHU. In conclusion, during a period in which HU utilization in SS/S β°-thalassemia increased significantly, hospital utilization for acute illness in SS/S β° thalassemia decreased as expected. However, during the same period there was an unexpected increase in overall hospital utilization for acute illness in SCD. This increase in hospital utilization was the result of 1) a marked increase in SHHU and 2) an overall increased utilization in SC/S β+ thalassemia. DisclosuresDampier:Pfizer: Research Funding.

Assessment of Quality of Life Following Allogeneic Stem Cell Transplant for Myelofibrosis

Background:Myelofibrosis (MF) is a bone marrow disorder characterized by anemia, splenomegaly and constitutional symptoms. There has been substantial work documenting quality of life (QoL) in patients with MF, however, very little data about patients following allogeneic stem cell transplant (alloSCT) for MF. Many patients decline alloSCT due to concerns secondary to QoL.Methods:Medical facts and patient reported outcomes (PRO) measures were collected within a month prior to transplant, at day 30, 100 and 1 year post alloSCT. PRO measures include Brief Fatigue Inventory, Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), global assessment of change and the Myeloproliferative Neoplasms Symptom Assessment Form (MPN-SAF). The group was measured as a whole, and the patients in the upper quartile of MPN-TSS (the aggregate score of the 10 core items of the MPN-SAF) were also considered.Results:Fifty patients were enrolled on this study, 47 who proceeded with transplant. The median age of the patients was 63, ranging from 35-74. The majority of the patients were male (29, 66%), and Caucasian (43 (96%)). Most patients had primary MF (26, 59%), 9 patients had post-PV MF, and 9 patients had post-ET MF. Twenty patients had DIPSS Intermediate 2 risk disease, and 16 had DIPSS high risk disease. Twenty-six (51%) had a matched unrelated donor, 12 (30%) had a matched related donor and 5 (12%) had a mismatched unrelated donor. The majority of the patients had RIC regimens (35, 88%). At baseline the mean MPN-TSS was 27.7 (out of possible 100), and at day 30, day 100 and 1 year it was 24.6, 32.0, and 25.0, which reflected no significant change between the time points. Interestingly, all the MPN specific symptoms (including fevers, night sweats, pruritis, abdominal pain) had a significant improvement at least one time point following alloSCT. Patients in the highest quartile based on baseline TSS score (12 patients with scores at baseline greater than or equal to 37), had significant improvement in TSS score at day 100, headache at day 30, insomnia at day 100, night sweats at day 100, itching at day 100 and overall QOL at day 100. With regards to the FACT BMT, as would be expected, there was a significant decline in the FACT BMT total score, as well as trial outcome index (TOI) at day 30, but a return to close to baseline by one year.In the global assessment of change, on day 30, 11 (27.5%) of patients reported feeling a little/moderately/very much better overall quality of life since their transplant and 27 (67.5%) felt a little/moderately/very much worse quality of life. At day 100, 11 (31.4%) reported better quality of life and 20 (57%) reported worsening since transplant. By one year, 17 (60.7%) reported feeling better and 7 (25%) reported worsening.These findings did not appear to have a correlation with presence or absence of graft versus host disease. We were unable to assess the impact of conditioning as the majority of the patients had RIC conditioning.Discussion/ Conclusions:Our study evaluated the quality of life in patients with myelofibrosis who have undergone bone marrow transplantation. We have shown that there is very little change in symptom burden over the first year following transplant in general; however, significant improvement was observed in MF specific symptoms, and in patients who had a high symptom burden at baseline. By one year 61% felt that their QoL was better than it was prior to transplant. Our findings suggest that many of the patients do not experience a significant decline in QoL at 1 year after alloSCT, and actually report that their QoL improves. Further investigation is required to validate these findings. DisclosuresPalmer:Novartis: Research Funding. Dueck:Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Mesa:Novartis: Consultancy; NS Pharma: Research Funding; Incyte Corporation: Research Funding; UT Health San Antonio - Mays Cancer Center: Employment; Pfizer: Research Funding; CTI Biopharma: Research Funding; Celgene: Research Funding; Promedior: Research Funding; Gilead: Research Funding; Genentech: Research Funding.

2340. Pneumococcal Colonization in Pediatric Patients Undergoing Bone Marrow Transplantation

BackgroundHematopoietic cell transplant (HCT) recipients are at a significantly greater risk for invasive pneumococcal disease than the general population. However, pneumococcal colonization in pediatric HCT recipients has not been widely studied. We evaluated the dynamics of pneumococcal colonization in pediatric patients undergoing HSCT from conditioning regimen to 100 days post HCT.MethodsMid-turbinate samples obtained from pediatric patients undergoing HCT at Children’s Mercy from September 2015 to January 2017 were tested for Streptococcus pneumoniae colonization via real-time PCR using lytA primer (autolysin-A-encoding gene). A cycle threshold value ≤35 was considered positive. First sample was obtained during conditioning regimen (week 1), second sample after HCT (week 2). Then, weekly samples were obtained for the first 100 days after HSCT.ResultsTwenty-two patients were included, representing 266 mid-turbinate samples. The median age at the time of HSCT was 9.5 years (IQR 3–16), and 14 patients were male (63.6%). The indication for HSCT was oncologic (15, 68.2%), hematologic (5, 22.7%) and immune deficiency (2, 9.1%). Fourteen patients (63.6%) underwent allogenic HSCT. Six patients had documentation in our electronic medical record system of receiving ≥ 1 pneumococcal conjugate vaccine prior to conditioning regimen. Nine (40.9%) of 22 patients were colonized with S. pneumoniae, their median age was 14 years (IQR 2.5–16). Pneumococcal colonization during conditioning regimen was 9% (2/22). Pneumococcal colonization from week 14 to week 16 was 42% (5/12).ConclusionA third of pediatric HCT recipients were colonized with S. pneumoniae. Pneumococcal colonization was mainly identified either at the time of conditioning regimen or toward the end of the first 100 days after HCT, with the latter being the most common. Disclosures All authors: No reported disclosures.

Retrospective analysis of the correlation between tacrolimus concentrations measured in whole blood and variations of blood cell counts in patients undergoing allogeneic haematopoietic stem cell transplantation.

Tacrolimus is administered to patients undergoing haematopoietic stem cell transplantation (HSCT) as prophylaxis for graft-versus-host disease. As a high blood tacrolimus concentration within a narrow therapeutic range must be maintained after HSCT, therapeutic drug monitoring (TDM) is necessary. We investigated the correlation between blood tacrolimus concentration and blood cell count in HSCT patients to assess how changes in blood cell count affect tacrolimus TDM. A retrospective analysis was performed for 24 patients who underwent allogeneic HSCT and received tacrolimus. The correlation between variations in blood tacrolimus concentration and blood cell count was evaluated for three consecutive weeks, starting 1 week after HSCT. Variations in blood tacrolimus concentration were significantly correlated with variations in red blood cell (RBC) count, haemoglobin level and haematocrit value, but not with variations in white blood cell or platelet counts. Further, the above variations were significantly correlated in patients undergoing cord blood transplantation and peripheral blood stem cell transplantation, but not in those undergoing bone marrow transplantation. These findings demonstrate that RBC count is associated with variations in blood tacrolimus concentration, with the relevance of this association depending on the source of transfused stem cells. Thus, variations in RBC count might be useful for tacrolimus TDM.

Abstract 17244: Atrial Fibrillation is Associated With Day 90 Mortality in Patients Undergoing Bone Marrow Transplant

Introduction: Atrial fibrillation often occurs after bone marrow transplant (BMT) and has been shown to increase hospital stay and other morbidity. Treatment can be complicated due to contraindications to anticoagulation therapy. Our objective was to describe the incidence of atrial fibrillation in patients within the first 90 days after BMT and risk predictors for overall mortality. Methods: Patients with active malignancy undergoing BMT in 2016 at the Medical College of Wisconsin were included (n=259). Medical records were reviewed for baseline patient characteristics, atrial fibrillation risk factors, incidence of atrial fibrillation, and other complications. Patients were categorized based on survival at 90 days post-BMT. Baseline characteristics and risk factors were analyzed to determine if there was an association with the development of atrial fibrillation and all cause mortality at 90 days. Results: Overall, 10.4% developed atrial fibrillation within the first 90 days after BMT. Of those that died before 90 days, 33.3% developed atrial fibrillation compared to 9.6% in those who survived (OR 4.7, 1.11-20.13 p=0.04). Those that died before 90 days were also more likely to have heart failure with reduced ejection fraction, prior radiation therapy (XRT), undergo cardioversion, and to be started on an antiarrhythmic drug (Table 1). When all significant univariate variables were included in a multivariate regression, only XRT was independently predicative of mortality (OR 11.5, 2.4-54.9, p=0.002). The development of atrial fibrillation significantly predicted early mortality (Log Rank p=0.009). Conclusion: This analysis demonstrated that the development of atrial fibrillation was predictive of early post-transplant all cause mortality. XRT and antiarrhythmic drug use also significantly predicted mortality. Further studies are required to determine if there is a mortality benefit to the prevention of atrial fibrillation in patients after BMT.

Islam, The Holy Qur'an, and Medical Decision-Making: The Experience of Middle Eastern Muslim Families with Children Undergoing Bone Marrow Transplantation in the United States.

Some Arabic-speaking Muslim family members of children requiring bone marrow transplantation receive medical care for their children in the United States. Muslim family members' use of Islam in the course of their child's bone marrow transplantation was studied using grounded theory, a qualitative research method. Eighteen members of Middle Eastern Muslim families with a total of 13 children receiving bone marrow transplantation were interviewed by an Arabic-speaking healthcare provider. Interviews were coded by an interdisciplinary team. Seven key themes were identified.

Long-Term Follow-Up of Sexual Dysfunction in Women Following Allogeneic Hematopoietic Stem Cell Transplantation

Chronic graft-versus-host disease is the most common late complication following allogeneic hematopoietic stem cell transplantation. The aim of this study was to present the outcomes of two successful vaginal reconstructions. Patient 1 received chemotherapy for leukemia and underwent bone marrow transplantation (BMT). The patient was sexually inactive for 9 years. In 2012, she was diagnosed with complete vaginal obliteration and underwent vaginal reconstruction. Patient 2 underwent chemotherapy (myeloablative therapy), was sexually inactive for 3 years and was then diagnosed with complete vaginal obliteration. In January 2013, she had vaginal reconstruction with cervical dilatation. Hormonal replacement therapy was administered to both patients. The results of dedicated questionnaires revealed decent quality-of-life and normal sexual functioning and continence status after surgery. Obliteration of the vagina after BMT can be prevented, but if it occurs, vaginal reconstruction surgery should be offered to any patients suffering from obliteration. Our results show that this therapy enables patients to have normal sexual lives without compromising their continence status.

Effects of music therapy on mood and pain with patients hospitalized for bone marrow transplantation: a randomized effectiveness pilot study

ABSTRACTPatients undergoing bone marrow transplantation (BMT) experience heightened anxiety and depression, which can negatively impact treatment outcomes. Music therapy is a non-invasive method of care that has helped support psychological health. The purpose of this pilot study was to determine whether a single-session of music therapy utilizing patient-preferred live music (PPLM) can improve mood in BMT patients. Participants (N = 13) were randomly assigned to a PPLM or a wait-list control group and completed pre- and posttests in a single session design. Although no result was significant, there were positive changes resultant of PPLM in pain, relaxed/anxious, wide awake/drowsy, and cheerful/depressed in the experimental group. Limitations, implications for clinical practice, and suggestions for future research are provided.

Ovarian Hormones Regulate the Production of Adipocytes From Bone Marrow-Derived Cells.

Sex differences in body fat distribution and menopause-associated shifts in regional adiposity suggest that sex hormones play an important role in regulating the differentiation and distribution of adipocytes, but the underlying mechanisms have not been fully explained. The aim of this study was to determine whether ovarian hormone status influences the production and distribution of adipocytes in adipose tissue arising from bone marrow-derived cells. Nine- to ten-week-old ovariectomized (OVX), surgery naïve (WT), and estrogen receptor alpha knockout (αERKO) mice underwent bone marrow transplantation from luciferase or green fluorescent protein expressing donors. A subset of OVX animals had estradiol (E2) added back. Eight-weeks posttransplant, whole body and gonadal fat BM-derived adipocyte production was highest in OVX and αERKO mice, which was attenuated in OVX mice by E2 add-back. All groups demonstrated the highest bone marrow derived adipocyte (BMDA) production in the gonadal adipose depot, a visceral fat depot in mice. Taken together, the loss of ovarian hormones increases the production of BMDAs. If translatable across species, production of BMDA may be a mechanism by which visceral adiposity increases in estrogen-deficient postmenopausal women.

Hepatic Dysfunction in a Child Post Bone Marrow Transplantation

A 10-year-old female child, a known case of Beta-Thalassemia major with superimposed chronic Hepatitis C Viral (HCV) infection, underwent bone marrow transplantation and presented, 7 months later, with worsening hepatic functions and skin rash. Considering the wide variety of possible etiologies, she was evaluated and later confirmed as a case of hepatic dysfunction secondary to HCV related hepatic injury with concomitant chronic graft versus host disease (dermatological involvement only).

Advance directives for adolescents and young adult patients undergoing bone marrow transplant

Advance directives for adolescents and young adult patients undergoing bone marrow transplant

Advance directives for adolescents and young adult patients undergoing bone marrow transplant

Introduction: Adolescents and young adults (AYA) with cancer represent a distinct patient population with unique medical and psychosocial needs. Bone marrow transplant (BMT) is a potentially curative therapy for AYA patients with cancer and certain non-malignant diseases. Despite recommendations that end-of-life (EOL) discussions occur earlier in AYA patients with life-limiting illnesses, providers often hesitate to engage AYA patients approaching BMT in establishing goals of care and advance directives. This case demonstrates the utility of advance directives in facilitating EOL decision-making in a case with prognostic uncertainty following …

Fertility preservation in pediatric female cancer patients

To describe and demonstrate ovarian tissue cryopreservation (OTC) as an emerging fertility preservation technique DESIGN: Video presentation. University hospital. A 6 year-old female patient diagnosed with aplastic anemia with plan for bone marrow transplantation underwent laparoscopic unilateral oophorectomy in conjunction with surgical procedure for port placement by the pediatric surgeon, followed by cryopreservation of ovarian tissue. Laparoscopic unilateral oophorectomy followed by ovarian decortication in the operating room, and ovarian tissue freezing prior to undergoing bone marrow transplantation. To present principle surgical techniques of ovarian tissue harvesting prior to OTC in pediatric patients, and different surgical techniques for ovarian auto-transplantation of cryobanked ovarian tissue after completion of gonadotoxic treatment and when the patient is ready to conceive. This video demonstrates the detailed surgical technique for ovarian tissue harvesting. This harvesting can be performed laparoscopically or via mini-laparotomy and can involve a complete oophorectomy versus removing a portion of the ovary (a procedure also known as ovarian decortication). In the prepubertal child, due to the small size of the ovaries, we recommend oophorectomy rather than decortication owing to the small size of prepubertal gonadal tissue. Many young cancer patients can be offered the option of ovarian tissue freezing. This tissue contains immature primordial follicles that can be stored. OTC requires surgical ovarian harvesting followed by cryopreservation of strips of ovarian tissue. The increased number of eggs in prepubertal children underscores the fact that smaller ovarian size in this population does not preclude OTC. At this time, ovarian auto-transplantation is the only option to utilize this stored tissue for fertility preservation. OTC is a relatively new procedure within the area of ART. The overall data from OTC is reassuring and further suggests that cryopreservation of ovarian tissue has the potential to become an established fertility preservation method in the near future.

PIN30 - The Economic Burden of Varicella in Mexico

To assess the clinical and economic burden of varicella in Mexico, where the varicella vaccine is not publicly available, except in children undergoing bone marrow transplantation. Annual societal costs were estimated for a base scenario by multiplying per-patient costs with varicella incidence from the Mexican epidemiological surveillance system (SUIVE), adjusted for the estimated proportion of public healthcare centers who do not regularly report. In a sensitivity analysis where cost calculations remained stable, epidemiological estimates ranged between raw SUIVE varicella rates (lower bound), and a 25% additive increment to reflect the estimated proportion of public sector patients who utilize private services (upper bound). Outcome Measures Clinical complications; health care resource utilization (HCRU)(frequency and type) including outpatient visits, allied healthcare contacts, doctor’s visits, tests/procedures performed, prescription and over-the-counter (OTC) medications, hospitalizations, and Emergency Room (ER) and Intensive Care Unit(ICU) visits/stays. Charts of 152 varicella patients were included, of which 75 and 77 were outpatients and inpatients [mean (SD) age=3.0 (3.2) and 2.6 (3.5) years, respectively]. Inpatients reported higher complication rates (inpatients vs. outpatients: 84.4% vs. 6.7%), prescription medication use (94.8% vs. 80.0%), over-the-counter medications use (71.4% vs. 80.0%), tests/procedures (87.0% vs. 5.3%), and allied health professional consultations (61.0% vs. 12.0%). Direct/indirect costs per case were $198/$42 (outpatients), and $5,633/$175 (inpatients). Estimated societal costs related to varicella ranged from $77-$218 million. Substantial clinical and associated public health and economic burden were observed among children with primary varicella infection in Mexico. These results highlight the need for implementation of a childhood varicella vaccination program.

Hematopoietic Stem Cell Transplantation: History and Perioperative Care of Patients Undergoing HSCT

Hematopoietic stem cell transplantation is used to treat a variety of hematologic, oncologic, immunologic, and metabolic disorders in both children and adults. Patients who undergo bone marrow transplantation can have numerous complications such as infection, engraftment failure, mucositis, and graft versus host disease. As a result, they require numerous diagnostic and therapeutic interventions. Anesthesiologists can aid these patients by providing anesthesia and/or heavy sedation for these often uncomfortable procedures. Both the underlying disease process and the complications of HSCT such as graft versus host disease must be taken into consideration when managing these patients.

Ovarian Tissue Cryopreservation and Rates of Primary Ovarian Insufficiency in Adolescent Patients Undergoing Bone Marrow Transplant

Ovarian Tissue Cryopreservation and Rates of Primary Ovarian Insufficiency in Adolescent Patients Undergoing Bone Marrow Transplant