Underwent Bone Marrow Aspiration Research Articles

The effect of music on comfort, pain, and anxiety in patients with bone marrow aspiration and biopsy in Turkey: a mixed-methods study

AimThis study was conducted to determine the effect of music on the pain, anxiety, and comfort levels of patients who underwent bone marrow aspiration and biopsy.MethodsThis study was conducted on patients with hematological malignancies. Music was used with the intervention group. Patients’ pain, anxiety, and comfort levels were measured. In addition, qualitative data were obtained through in-depth interviews with patients.ResultsA significant difference (p < 0.05) was found between the experimental and control groups regarding pain, comfort and anxiety levels following the application of music. It was found that there was a negative correlation between comfort and pain (r=-0.442 p < 0.001) and between comfort and anxiety (r=-0.544 p < 0.001). As a result of qualitative interviews, patients mentioned the relaxing effect of music and the reduction of anxiety and pain levels. They also stated that music can be utilized as an alternative method.ConclusionAccording to the results of the present study, music reduced the pain and anxiety levels of the patients in bone marrow aspiration and biopsy and increased their comfort levels. We can say that music can be used in the clinic as a non-pharmacological method for pain, anxiety and comfort.Clinical Trials NumberNCT05895357 (Date:08/06/2023).

The effectiveness of non-pharmacological interventions on reducing pain in patients undergoing bone marrow aspiration and biopsy: A systematic review and meta-analysis of randomized controlled trials.

Patients often consider bone marrow aspiration and biopsy to be one of the most painful medical procedures. The effectiveness of non-pharmacological interventions to reduce pain during bone marrow aspiration and biopsy remains unclear. To synthesize existing evidence regarding the effectiveness of non-pharmacological interventions in mitigating procedural pain among patients undergoing bone marrow aspiration and biopsy. A systematic review and meta-analysis of randomized controlled trials. Six electronic databases, including PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library and Web of Science were searched from inception to July 15, 2023. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 2.0. Meta-analysis was conducted using STATA 16. The certainty of the evidence was assessed by the GRADE approach. This meta-analysis included 18 studies derived from 17 articles involving a total of 1017 participants. The pooled results revealed statistically significant pain reduction effects using distraction (SMD: -.845, 95% CI: -1.344 to -.346, p < .001), powered bone marrow biopsy system (SMD: -.266, 95% CI: -.529 to -.003, p = .048), and acupoint stimulation (SMD: -1.016, 95% CI: -1.995 to -.037, p = .042) among patients undergoing bone marrow aspiration and biopsy. However, the pooled results on hypnosis (SMD: -1.228, 95% CI: -4.091 to 1.515, p = .368) showed no significant impact on pain reduction. Additionally, the pooled results for distraction did not demonstrate a significant effect on operative anxiety (MD: -2.942, 95% CI: -7.650 to 1.767, p = .221). Distraction, powered bone marrow biopsy system and acupoint stimulation are effective in reducing pain among patients undergoing bone marrow aspiration and biopsy. Not applicable. This meta-analysis highlights the effectiveness of distraction, powered bone marrow biopsy system and acupoint stimulation for reducing pain in patients undergoing bone marrow biopsy. Healthcare professionals should consider integrating these interventions into pain management practices for these patients. (PROSPERO): CRD42023422854.

Thrombocytopenia in Klebsiella pneumoniae liver abscess: a retrospective study on its correlation with disease severity and potential causes.

Thrombocytopenia is commonly associated with infectious diseases and serves as an indicator of disease severity. However, reports on its manifestation in conjunction with Klebsiella pneumoniae liver abscess (KPLA) are scarce. The present study sought to elucidate the correlation between thrombocytopenia and KPLA severity and delve into the etiological factors contributing to the incidence of thrombocytopenia. A retrospective analysis of the clinical data from patients with KPLA admitted between June 2012 and June 2023 was performed. Baseline characteristics, biochemical assessments, therapeutic interventions, complications, and clinical outcomes were compared between patients with and without thrombocytopenia. To investigate the potential etiologies underlying thrombocytopenia, the association between platelet count reduction and thrombophlebitis was examined, with a particular focus on platelet consumption. Furthermore, bone marrow aspiration results were evaluated to assess platelet production anomalies. A total of 361 KPLA patients were included in the study, among whom 60 (17%) had concurrent thrombocytopenia. Those in the thrombocytopenia group exhibited significantly higher rates of thrombophlebitis (p = 0.042), extrahepatic metastatic infection (p = 0.01), septic shock (p = 0.024), admissions to the intensive care unit (p = 0.002), and in-hospital mortality (p = 0.045). Multivariate analysis revealed that thrombocytopenia (odds ratio, 2.125; 95% confidence interval, 1.114-4.056; p = 0.022) was independently associated with thrombophlebitis. Among the thrombocytopenic patients, eight underwent bone marrow aspiration, and six (75%) had impaired medullar platelet production. After treatment, 88.6% of thrombocytopenic patients (n = 47) demonstrated recovery in their platelet counts with a median recovery time of five days (interquartile range, 3-6 days). Thrombocytopenia in patients with KPLA is indicative of increased disease severity. The underlying etiologies for thrombocytopenia may include impaired platelet production within the bone marrow and augmented peripheral platelet consumption as evidenced by the presence of thrombophlebitis.

The Incidence of Postoperative Complications Following Lumbar and Bone Marrow Punctures in Pediatric Anesthesia: Insights From APRICOT.

Bone marrow aspiration and lumbar puncture are procedures frequently performed in pediatric oncology. We aimed at assessing the incidence and risk factors of perioperative complications in children undergoing these procedures under sedation or general anesthesia. Based on the APRICOT study, we performed a secondary analysis, including 893 children undergoing bone marrow aspiration and lumbar puncture. The primary outcome was the incidence of perioperative complications. Secondary outcomes were their risk factors. We analyzed data of 893 children who underwent 915 procedures. The incidence of severe adverse events was 1.7% and of respiratory complications was 1.1%. Prematurity (RR 4.976; 95% CI 1.097-22.568; P = 0.038), intubation (RR: 6.80, 95% CI 1.66-27.7; P =0.008), and emergency situations (RR 3.99; 95% CI 1.14-13.96; P = 0.030) increased the risk for respiratory complications. The incidence of cardiovascular instability was 0.4%, with premedication as risk factor (RR 6.678; 95% CI 1.325-33.644; P =0.021). A low incidence of perioperative adverse events was observed in children undergoing bone marrow aspiration or lumbar puncture under sedation and/or general anesthesia, with respiratory complications being the most frequent. Careful preoperative assessment should be undertaken to identify risk factors associated with an increased risk, allowing for appropriate adjustment of anesthesia management.

Safety and Biodistribution of an Autologous Bone Marrow-Derived Mononuclear Cell Infusion into Renal Arteries in Patients with Focal Segmental Glomerulosclerosis: A Phase 1 Study.

Patients with focal segmental glomerulosclerosis (FSGS) who are refractory to drug treatment may present progressive loss of kidney function, leading to chronic kidney disease stage 5 under dialysis treatment. The safety of systemic administration of bone marrow-derived mononuclear cells (BMDMCs) has been shown in different preclinical models of kidney diseases. However, to date, no study has evaluated the safety and biodistribution of BMDMCs after infusion in renal arteries in patients with FSGS. We used a prospective, non-randomized, single-center longitudinal design to investigate this approach. Five patients with refractory FSGS and an estimated glomerular filtration rate (eGFR) between 20 and 40 ml/min/1.73 m2 underwent bone marrow aspiration and received an arterial infusion of autologous BMDMCs (5 × 107) for each kidney. In addition, BMDMCs labeled with technetium-99m (99mTc-BMDMCs) were used to assess the biodistribution by scintigraphy. All patients completed the 270-day follow-up protocol with no serious adverse events. A transient increase in creatinine was observed after the cell therapy, with improvement on day 30. 99mTc-BMDMCs were detected in both kidneys and counts were higher after 2 hr compared with 24 hr. The arterial infusion of BMDMCs in both kidneys of patients with FSGS was considered safe with stable eGFR at the end of follow-up. This trial is registered with NCT02693366.

Designed Nursing Guidelines regarding Care of Children Undergoing Bone Marrow Aspiration

Designed Nursing Guidelines regarding Care of Children Undergoing Bone Marrow Aspiration

Clinico-pathological profile of patients with plasma cell neoplasms with special reference to bone marrow fibrosis and amyloid deposition.

To clarify the significance of bone marrow fibrosis and amyloid deposition in plasma cell neoplasm, a retrospective cross-sectional study for a period of 3 years was conducted. Patients who underwent bone marrow aspiration and biopsy with suspicion of plasma cell neoplasms were included in the study. The bone marrow findings were correlated with clinical profile of the patient along with biochemical parameters, cytogenetics, Fluorescent in situ hybridization (FISH) wherever available. A total of 273 bone marrow aspirates and biopsies of patients with suspected plasma cell neoplasms were analyzed. There were 181 male patients and 92 female patients (Male: Female = 1.96: 1). There were 245 cases of multiple myeloma (89.7%), 8 cases of primary amyloidosis (2.9%) and 6 monoclonal gammopathy of undetermined significance (MGUS) (2.1%), 5 cases of plasmacytoma (1.8%) and 4 cases of smouldering myeloma (1.4%), 5 cases of POEMS syndrome (1.8%). Bone marrow fibrosis was noted in 12 patients at diagnosis (4.3%). Among the parameters studied, only the mean Hemoglobin was significantly low in patients with marrow fibrosis. Amyloid deposition in various organs including bone marrow, kidney, liver etc., were noted in 17 patients overall (6.2%). In conclusion, the incidence of fibrosis (4.3%) and amyloidosis (6.2%) associated with plasma cell neoplasms were much lower in our study as compared to published studies.

Genomic Characterization of Newly Diagnosed Acute Myeloid Leukemia in Patients Age 60 Years and Older; A Report from the Beat AML Master Trial

Background. Acute myeloid leukemia (AML) is a heterogenous disease that occurs primarily in older adults with a median age of 69 years at diagnosis. Most studies that characterize the genomic landscape of AML include younger adults with the majority of patients being younger than 60 years of age. We aimed to study the mutational landscape of newly diagnosed AML patients aged 60 years or older. Methods.Samples were collected from the multi-center Beat AML Master Trial (Burd, Nat Med 2020). Patients were enrolled between 2016 and 2023. Informed consent was obtained according to the Declaration of Helsinki. Patients diagnosed with non-APL AML and who were aged ≥ 60 years old were included. Patients underwent bone marrow aspiration and biopsy, cytogenetic analysis, FLT3-ITD ratio assessment (LeukoStrat CDx FLT3 Mutation Assay, Invivoscribe) and next generation sequencing (NGS) using FoundationOne®Heme(Foundation Medicine) to interrogate the entire coding region of 406 genes and select introns of 31 genes involved in rearrangements, as well as RNA sequencing to interrogate 265 genes known to be somatically altered in human hematological malignancies. The presence of multiple hotspot mutations within one gene in an individual patient was counted as one gene mutation. Patterns of co-occurrence between gene mutations were calculated using the Phi correlation coefficient. Statistical analyses were performed using R statistical software. P&amp;lt;0.01 was considered statistically significant. Results. A total of 1088 newly diagnosed AML patients were identified, of whom 1032 were 60 years or older. Patients had a median age of 72 years at time of diagnosis (range 60-92 years). Forty-two percent of the patients were female, most patients were non-Hispanic and 79% were Caucasian. NGS data were available for 1024 patients and mutations were identified in 461 different genes. Patients had a median number of 11.0 mutations (range 3.0 to 28.0). The most frequently mutated genes were DNMT3A (n=257; 25.1%), TP53(n=255; 24.9%), TET2 (n=243; 23.7%), RUNX1 (n=225; 22.0%), SRSF2 (n=221; 21.6%), ASXL1 (n=216; 21.1%), NPM1 (n=206; 20.1%), FLT3 (n=205; 20.0%), IDH2 (n=190; 18.6%), NRAS (n=208; 16.9%), PTPN11(n=104; 10.2%), STAG2 (n=101, 9.9% and IDH1 (n=99; 9.7%) (Figure 1A). FLT3-ITD was present in 98 (12.1%) of the 810 patients who were tested. Strongest significant co-occurrence was found between FLT3and NPM1 (n=103), STAG2 and ASXL1 (n=63), ASXL1 and RUNX1 (n=92), ASXL1 and SRSF2 (n=88), RUNX1 and SRSF2 (n=94), STAG2 and SRSF2 (n=51) and DNMT3A and NPM1 (n=92) (p&amp;lt;0.01). Pairwise negative correlations were observed between TP53 and NPM1 (n=6), TP53 and SRSF2 (n=17), and between NPM1 and RUNX1 (n=6) (p&amp;lt;0.01) (Figure 1B). The cytogenetic profiles and the full genomic landscape will be presented during the ASH meeting. Discussion. This is the largest study investigating the mutational profile in older adults with AML aged 60 years and older. Due to the 7-day screening period of the Beat AML study, patient selection was biased towards less-rapidly proliferative AML. We showed that the pattern of gene mutations was markedly different from other studies in AML that mainly included younger AML patients (Papaemmanuil, NEJM 2016; TCGA, NEJM 2013 ). The frequency of mutated TP53 was substantially higher in older AML patients, as was the occurrence of myelodysplasia-related gene mutations (e.g., SRSF2, RUNX1, ASXL1, STAG2, U2AF1, and SF3B1) and gene mutations in IDH1, IDH2 and TET2. In contrast, NPM1 mutation was less frequently mutated in older AML patients. Furthermore, we demonstrated that a large proportion (46%) of the AML patients older than 60 years of age do have a mutation that is potentially targetable for treatment ( FLT3 IDH1 IDH2 and NPM1). The high incidence of mutated TP53 and MDS-related gene mutations underscores the increased incidence of high-risk AML and the need for innovative personalized therapies in this older age group. Figure 1. A. Co-occurrence of the 15 most frequently mutated genes, and B. co-correlation between the 15 most frequently mutated genes. Blue indicates positive correlation, red indicated negative correlation. Only significant correlations (p&amp;lt;0.01) are shown.

Biomarker MSC-C5b-9-Guided Master Therapies for Resistant/Recurrent ITP: A Prospective, Randomized, Open-Label, Multicenter Trial

Introduction: Immune thrombocytopenia (ITP) is an acquired organ-specific autoimmune disorder and a common bleeding disorder that poses a considerable risk to human health. Steroids, as the first-line treatment, do not provide long-term relief. Our previous clinical trials have confirmed the efficacy and safety of all-trans retinoic acid (ATRA) in the treatment of ITP and identified that the biomarker MSC-C5b-9 may be a stratification marker for evaluating the efficacy of ATRA (Haematologica, 2019; Lancet Haematol. 2017; 2021). This research aims to develop a new treatment approach for steroid-resistant/recurrent ITP based on the marker MSC-C5b-9. Method: We conducted a prospective, randomized, open-label, multicenter trial to evaluate the efficacy and safety of ATRA combined with eltrombopag based on MSC-C5b-9 as a novel treatment for steroid-resistant/recurrent ITP. Following enrollment, all patients underwent bone marrow aspiration to assess MSC-C5b-9 levels. Subsequently, patients were randomly assigned in a 1:1 ratio to either the eltrombopag group or the eltrombopag + ATRA group. In both treatment groups, the initial dose of eltrombopag was 50 mg daily, with dose adjustments based on platelet levels. For patients assigned to the ATRA group, ATRA was given at a dose of 10 mg twice daily. Peripheral blood cell counts and adverse drug reactions were regularly monitored. The primary endpoint was the sustained response rate at 18 months after randomization, and secondary endpoints include Complete Remission, Partial Remission, Relapse rate, Early Response, Initial Response, Adverse Events, and Adverse Events graded using the National Cancer Institute Common Terminology Criteria (NCI CTCAE) v5.0 criteria. The study has been registered at clinicaltrials.gov. NCT05438875. Result: From March 2023 to July 2023, a total of 30 patients with steroid-resistant/recurrent ITP were enrolled in the study and randomized 1:1 to receive eltrombopag combined with ATRA (ATRA group, n=15, MSC-C5b-9 +6, -9) or eltrombopag alone (control group, n=15, MSC-C5b-9 +6, -9) in 5 centers, and all enrolled patients were included in the intention-to-treat (ITT) analysis. In the ATRA group, the median age was 38 years (range, 29-64), consisting of 8 male patients. In the control group, the median age was 44 years (range, 23-75), consisting of 9 male patients. There were no statistically significant differences observed in the baseline clinical characteristics between the two groups. There was no difference in the bleeding score and ECOG score between the two groups (P=0.717; P=1.000). The median platelet count was comparable between the ATRA group and the control group (17 (1-28) vs. 16 (2-26), P=0.850). Comorbidities at random, such as hypertension, were comparable between the two groups (26.7% (4/15) vs. 33.3% (5/15), P=1.000). Combined autoantibody abnormalities were compared between the two groups (6.7% (1/15) vs. 6.7% (1/15), P=1.000). The rate of Early Response in the ATRA group was higher than that in the control group, but the difference was not significant (73.3% (11/15) vs. 53.5% (8/15), P=0.256). As of July 29, 2023, a total of 24 patients had been enrolled for a duration exceeding 4 weeks. Similarly, the Initial Response rate was higher in the ATRA group, but no significant difference was observed between the two groups (84.6% (11/13) vs. 63.6% (7/11), P=0.357). Nevertheless, it is noteworthy that the 4-week CR rate in the ATRA group was higher than that in the control group (76.9% (10/13) vs. 36.4% (4/11), P=0.045). What's more, the overall efficacy of the ATRA group was better than that of the control group. The mean platelet count at weeks 1, 2, 3, and 4 posttreatment, along with the mean maximum platelet count posttreatment, exhibited higher values in the ATRA group than in the control group; however, these disparities did not reach statistical significance (P=0.310; P=0.568; P=0.779; P=0.618; P=0.355). ATRA was well tolerated, and only one patient developed grade I dry mouth and headache, which improved after dose reduction. There was no difference between the ATRA and control groups in terms of medication adverse effects (13.3% (2/15) vs. 13.3% (2/15), P=1.000). Conclusions: Eltrombopag plus ATRA is an effective and well-tolerated approach for treating steroid-resistant/recurrent ITP. Eltrombopag plus ATRA can enhance patients' complete remission and is well tolerated.

A Pilot, First in Human Study of Autologous IFN-Gamma Stimulated Mesenchymal Stromal Cells for Treatment of Radiation-Induced Xerostomia

There are no existing effective treatments for radiation-induced xerostomia (RIX), a common side effect of head and neck radiation. Mesenchymal stromal cells (MSCs) exhibit regenerative effects in multiple tissues and may represent an effective cell therapy for the treatment of RIX. Here we present the primary safety and secondary efficacy endpoints of a first-in-human pilot study of IFNγ-stimulated autologous bone marrow- derived MSCs [MSC(M)] for the treatment of RIX. We conducted a single-center clinical trial investigating the safety and tolerability of autologous IFNγ-stimulated MSC(M). The study was conducted under an FDA-IND and approved by the local IRB. Patients underwent bone marrow aspiration, MSC(M) were then culture-expanded, stimulated with IFNγ, and cryopreserved. Banked IFNγ-stimulated MSC(M) were thawed, allowed to recover, and then 10 × 106 MSC(M) were injected transcutaneously via ultrasound guidance into one submandibular gland. The primary objective was safety and tolerability determined by dose-limiting toxicity (DLT) defined as submandibular pain > 5 on a standard 10-point pain scale or any serious adverse event (SAE) within one month after injection. Secondary objectives included analysis of efficacy as measured by salivary quantification and using 3 validated quality of life instruments. Quantitative results are reported as mean and standard deviation (SD). Six radiation-induced xerostomia patients with head and neck cancer who had completed radiation at least 2 years earlier were enrolled. The median age was 71 (61-74) and 5 (83%) patients were male. Five patients (83%) were treated with chemoradiation and one patient (17%) with radiation alone. The average dose of radiation to the injected submandibular gland was 59.9 Gy. Three patients (50%) reported a pain score of 1 after submandibular gland injection, all pain resolved within 4 days. No patients reported pain 1 month after injection, with no SAEs or other DLTs reported 1 month after injection. The analysis of secondary endpoints demonstrated a trend of increased salivary production. The mean unstimulated saliva was 0.13 mL/min (SD 0.17) at baseline and increased to 0.14 mL/min (SD 0.12) at 1 month after injection and 0.19 mL/min (SD 0.21) at 3-months. Quality of life surveys also showed a trend towards improvement. Injection of autologous IFNγ-stimulated MSC(M) into the submandibular gland of patients with RIX is safe and well tolerated. A trend towards an improvement in secondary endpoints of salivary quantity and quality of life was observed. This first-in-human pilot study provides support for further investigation into IFNγ-stimulated MSC(M) as an innovative, potentially curative, remedy to treat RIX. A phase I dose-escalation study injecting into bilateral submandibular glands is scheduled to begin accrual in the spring of 2023.

WBC Count and WBC to Hb Ratio Could Predict Short-Term Recurrence Rate in Multiple Myeloma Patients Underwent Autologous Stem Cell Transplantation

Multiple myeloma (MM) is a hematologic malignancy with a variable clinical course. We investigated the prognostic role of routine laboratory factors including CBC indices and serum vitamin D levels to predict MM recurrence after receiving an autologous stem cell transplant (ASCT). 29 patients were enrolled. Before ASCT, demographic data and CBC, serum Cr, and Vit D levels were obtained. Patients underwent bone marrow aspiration (BMA) and biopsy (BMB) before ASCT and pretransplant plasma cell counts were also evaluated. Patients were followed for 6 months and BMA and biopsy were done in the 3rd and 6th month of the follow-up to detect recurrence. Overall, 9 patients were reported to have recurrence. The patient's WBC count mean was 13.3±11.6. WBC count was lower in patients with overall recurrence (P=0.005). Patients were divided into 2 groups according to WBC count (&lt;5.5 109/L and ≥5.5 109/L) and we found that WBC count &lt;5.5 109/L was associated with increased risk of recurrence by 15.2 times (Odds ratio: 15.2, 95%CI: 1.4-168, P=0.005). We also evaluated Wbc to Hb ratio (Wbc/Hb) and found that Wbc/Hb &lt;1 had a significant statistical relationship with overall recurrence (P=0.026) as patients with WBC/Hb &lt;1 were in 9.8 times increased risk of recurrence (Odds ratio:9.8, 95% CI: 2-93.5, P=0.026). pretransplant WBC &lt;5.5 109/L and WBC/Hb &lt;1 were associated with 9.8 and 15.2 times increased risk of myeloma recurrence and could be useful predictive factors for a patient's short-term recurrence.

Outcomes and Complications After Bone Marrow Aspirate Harvest From the Calcaneus.

Bone marrow aspirate (BMA) is used with the putative goal of enhancing healing of injured tissue. The most common sites to harvest BMA are the iliac crest, the tibia, and the calcaneus. Investigators have found that the tibia and calcaneus have fewer progenitor cells than the iliac crest. This retrospective review evaluates the efficacy and safety profile of harvesting BMA from the calcaneus bone. We hypothesized that harvesting BMA from the calcaneus will have high efficacy and safety profile with low complication rates. A retrospective chart review of patients undergoing bone marrow aspiration from the calcaneus bone from January 2019 to October 2022 was performed. The main data points evaluated were patient satisfaction and pain level, follow-up times, quantity of BMA harvested, fusion rates, and complications including nerve damage, infections, and nonunions. There were 45 (34 female and 11 male) patients who underwent 45 procedures. The average age, BMI, and amount of BMA were 45.1 years (range 23-79), 33.1 (range 19.2-61.3), and 10.3 mL (range 2-40), respectively. There was no pain reported at the final follow-up in 32 patients (71.1%), and there was minimal to no pain in the area of surgery in the remaining 13 patients (28.9%). The 10 cases of fusion successfully healed with combined use of allograft and BMA. The average follow-up time was 12.3 months (range 2.4-33.7). There were no infections, wound complications, or nerve injuries. Harvesting BMA from the calcaneus bone is a safe procedure. In this heterogenous series where BMA augmented other surgical strategies, patients had little to no pain and there were no cases of wound complication or iatrogenic neuropraxia after undergoing bone marrow harvest from the calcaneus. Level IV, case series.

Comparison between total intravenous anesthesia using propofol or dexmedetomidine versus sevoflurane during anesthesia of children undergoing bone marrow aspiration

Background Although bone marrow aspiration (BMA) in children is a familiar short duration procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to chronic postoperative behavioral changes. Consequently, the objectives of any related anesthetic technique is to afford smooth nontraumatic induction with safe maintenance and rapid recovery. The rational of the current study is to assess the outcomes of total intravenous anesthesia (TIVA) using propofol or dexmedetomidine versus sevoflurane for maintenance of anesthesia in children scheduled for BMA. Patients and methods A total of 60 children aged 3–12 years of American Society of Anesthesiologists physical status I and II, who planned to undergo elective BMA and biopsy were enrolled randomly to one of three groups (20 child each) receiving either sevoflurane inhalational anesthesia for induction, then sevoflurane and fentanyl infusion for maintenance (group S), propofol infusion for induction afterward propofol and fentanyl infusions for maintenance of anesthesia (group P) or dexmedetomidine infusion for induction after that dexmedetomidine and fentanyl infusions for maintenance (group D). The primary endpoint was postoperative sedation score on arriving the postanesthetic care unit after the procedure. Secondary outcomes included procedure duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any adverse events. Results Hemodynamics revealed statistically comparable significant decrease in the three studied groups relative to the preoperative baseline levels. Values of oxygen saturation in group D showed significant increase relative to those of group P. Time for spontaneous eye open were significantly shorter in group P comparable to the other two groups (P&lt;0.001). Members of group D were more sedated relative to the other two groups. Satisfaction of both parents and surgeons were significantly higher in the group D relative to the other two studied groups (P&lt;0.05). Conclusion TIVA with dexmedetomidine can be a superior alternative to TIVA with propofol or sevoflurane for maintenance of anesthesia in children scheduled for BMA in consequence of favorable hemodynamic stability and smooth recovery profile.

Cytomorphology of Human Bone Marrow Subjected to Prolonged Standing That Mimic Features of Myelodysplasia

Examination of bone marrow (BM) aspirate smears plays an important role in the diagnosis of patients with various hematological disorders particularly patients with myelodysplastic syndromes (MDS). In current practice, bone marrow samples are often collected by the clinical staff and sent to the laboratory after a variable period of delay. As a result bone marrow aspirate smears prepared from such samples are prone to show morphological changes which may mimic changes observed in MDS. To ascertain the type and extent of morphological changes that may occur due to prolonged standing we have studied BM aspirate specimens from patients diagnosed with various hematological disorders which have been left standing for 30 minutes to 24 hours. Bone marrow aspirate samples were obtained from the right or left posterior iliac crest from ten patients (seven men and three women, age range 50-70 years) presenting with various hematological disorders who underwent BM aspiration and BM trephine biopsy procedures as part of their diagnostic work-up. Clinical indications included pancytopenia (n=3), leukopenia (n=2), thrombocytopenia (n=2), thrombocytosis (n=1), lymphocytosis (n=2). The first draw of 2.0 ml of BM aspirate sample was obtained using a conventional BM aspiration needle and placed in a tube containing appropriate concentrations of dipotassium ethylenediamine tetraacetic acid (EDTA). A drop of marrow was then placed on each of the three glass slides and smears were made. The subsequent smears (three slides from each patient) were made from the collected samples at intervals of 30 minutes, one hour, two hours, four hours, eight hours, 12 hours, 18 hours, and 24 hours. The slides were stained with Romanowsky stain and examined under a light microscope. Five hundred consecutive cells in each slide were assessed and the number of cells exhibiting dysplastic changes was recorded. Striking morphological changes were observed between the smears made of fresh marrow as compared to marrows left standing for a "lengthy" period. No noticeable changes in the morphology of hematopoietic cells were observed in the films made from the marrow which was left standing for not more than an hour at room temperature and were not easily distinguishable from the films made immediately after its collection (fresh marrow). By two hours changes were discernible and by 18-24 hours they became striking, affecting the morphology of all the hematopoietic cells. Myeloid cells were affected uniformly; their nuclei stained more homogeneously than in the fresh marrow, the nuclear lobes became separated and the cytoplasmic margins appeared ragged or less well defined. Small vacuoles appeared in the cytoplasm and they became more prominent and more numerous and the quantity of cytoplasmic granules decreased the longer the samples stood. Nuclear hypolobulation (pseudo-Pelger-Huet anomaly) and bizarre nuclear shapes were also observed. Erythroid precursors were also affected by prolonged standing which led to progressive degenerative changes such as nuclear lobulation and budding, nuclear-cytoplasmic asynchrony, karyorrhexis, cytoplasmic vacuolation, and cytoplasmic blebs. Megakaryocytes were also adversely affected and showed morphological changes in the form of multi-nuclearity and less granulation. Some of the lymphocytes also showed similar changes, including cytoplasmic vacuolation. Some of the nuclei showed major budding giving the appearance of a nucleus with two or three lobes (clover leaf shape). Examination of a BM aspirate smear is a highly informative hematological tool at the hematologist's disposal. However, the preparation of a good quality BM aspirate smear and the aberrations in the morphology of hematopoietic cells caused by a delay in smear preparation have not been reported. Our findings demonstrate that the morphology of hematopoietic cells in the BM aspirate deteriorates considerably during prolonged standing. Some of the changes that were noted were akin to the alterations seen in patients with MDS. We recommend that whenever possible the smears should be made immediately after the sample is withdrawn from the patient. This approach helps ensure the ideal morphology of hematopoietic cells and their accurate analysis for hematological diagnosis and may even prevent misdiagnosis of conditions such as myelodysplastic syndromes.

HIV Infection Induces Aberrant Myeloid Lineage Differentiation

AbstractIntroduction: Numerous studies on hematopoietic changes caused by HIV infection have focused on immune cell depletion, while research on other hematopoietic lineages development have been sparse and inconclusive. In this study, we used precise markers to detect changes in the distribution of bone marrow hematopoietic stem/progenitor cells in HIV-infected patients and analyzed the dynamic changes of mature cells of each lineages in 782 patients with disease progression. Furthermore, we sought to explore the potential relationship between abnormal development of these lineage cells and survival of HIV patients. Our study provides evidence for a more comprehensive understanding of the effects of HIV on hematopoiesis. Methods: We included 782 HIV-infected patients who underwent bone marrow aspiration from January 2016 to October 2020 in Zhongnan Hospital, and were followed up until January 2022. Examination including flow cytometry and bone marrow aspiration were performed to detect the development of hematopoietic cells. 509 cases were tested for lymphocyte subsets. According to CD3+CD4+ cell count, 325 patients (63.9%) were in the very low group, 61 patients (12.0%) in the low group, 55 patients (10.8%) in the medium group, and 68 patients (13.4%) in the high group. By January 2022, 84 patients had been lost to follow-up and 425 patients had accurate and complete follow-up data. We analyzed the risk factors for HIV death in 425 patients and established a predictive model. Results: Flow cytometry analysis showed an increased proportion of granulocytemonocyte progenitors (GMP) but a decreased proportion of common lymphoid progenitors (CLP) in HIV patients. In myelogram, the percentage of granulocytes and granulocytes/erythroid cells (G/E) increased with the decrease of CD3+CD4+ count (both P<0.001). In addition to the increase in cell proportion, we also observed that the morphologic abnormalities in granulocyte increased with the progression of the disease, including toxic granulation, cytoplasmic vacuolization, Intracellular and extracellular plasma (P<0.001), Döhle bodies (P=0.033) and increased lobulation in megakaryocyte (P=0.048). Subsequent LASSO binary logistic regression also confirmed that the increased granulocyte ratio was an important factor in patients' disease. Conclusion: HIV infection directly or indirectly induces bias on myeloid lineage differentiation. Increased granulocyte ratio is an important risk factor for disease aggravation and death in HIV patients. Our research provide a new perspective for evaluating the status and prognosis of HIV patients by focusing on the changes of myeloid granulocytes. Disclosures No relevant conflicts of interest to declare.

AML-078 Pain and Anxiety Associated With Bone Marrow Aspiration in Hematologic Patients

Bone marrow aspiration is an essential procedure used to diagnose hematologic malignancies, monitor treatment, and evaluate the response. It is painful and feared by patients but has to be done frequently during the course of the disease. The objective of this study was to assess the degree of pain and anxiety in patients undergoing bone marrow aspiration in order to make it easier and more tolerable. We observed 54 patients admitted for bone marrow aspiration in the outpatient hospital unit of the Department of Hematology in Gustave Roussy Institute in Paris during the month of February 2022. The patients were adults already diagnosed with hematologic malignancies who were undergoing treatment or under surveillance. Each patient filled out a questionnaire before and after the procedure, and another was filled out by the doctor performing the procedure. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety in patients during this period of their lives. Pain was assessed using the Wong-Baker FACES® pain scale with numbers ranging from zero to 10 and was compared to the patient's expectations. On the other hand, the doctor noted the analgesics used and graded the anxiety and the pain he observed in the patient on a scale of one to 10. The average HADS score was 7.85/21, suggesting a basal anxious state in patients, and anxiety assessed by doctors was 4.7/10. Pain during the procedure averaged 3.25/10 and exceeded expectations in only 2 patients. We can see that anxiety is the main problem in patients undergoing bone marrow aspiration, whereas objective pain is well controlled by analgesics. These results encourage the use of anxiolytics before the procedure to make it more comfortable for patients and doctors.

Effect of Classical Turkish Music on Pain and Anxiety of Patients undergoing Bone Marrow Aspiration and Biopsy: A Randomized Controlled Clinical Trial

Introduction: Bone Marrow Aspiration and Biopsy (BMAB) is a painful procedure that can causes anxiety in patients. Music can help reduce pain and anxiety levels in patients by directing their attention from negative stimuli towards pleasant and encouraging thoughts. Objective: This study aims to determine the effect of classical Turkish music on pain and anxiety of patients undergoing BMAB. Materials and Methods: This is a randomized, controlled trial conducted on 68 patients undergoing BMAB who were selected from the hematology outpatient clinics in a hospital in İzmir, western Turkey. They were randomly divided into two groups of control (n=34) who received the general procedure only and the music group (n=34) who listened to classical Turkish music for 15 minutes before the procedure. Data were collected using a demographic form, Visual Analogue Scale (VAS), and State Anxiety subscale of Spielberger’s State-Trait Anxiety Inventory. Chi-square was used for comparing categorical variables, and t-test and ANOVA ​​were used for comparing numerical variables. Bonferroni test was used for post hoc comparisons. A P&lt;0.05 statistically significant. In case of a significant difference between the groups, Cohen’s d effect size was calculated. Results: In the music group (Mean±SD age=63.73±14.81 years), 62% were male, 71% were married, 76% had a secondary education or lower, and 49.1% reported that biopsy was for diagnostic purposes. In the control group (Mean±SD age=51.76±19.45 years), 50% were female, 53% were married, 62% had a secondary education or lower, and 50.9% reported that biopsy was for diagnostic purposes. A statistically significant difference was found in the mean VAS scores of both groups before and after the treatment (P=0.001). A significant difference was found in the state anxiety level only in the music group before and after the treatment (P=0.003). Conclusion: Classical Turkish music prior to BMAB can reduce the pain and anxiety of patients. It is recommended for nurses to use music therapy to reduce the pain and anxiety of patients undergoing BMAB.

Clinical Value of Serum miRNA in Patients with Acute Promyelocytic Leukemia.

Objective To explore the clinical value of specific miRNA in patients with acute promyelocytic leukemia. Methods 129 patients with acute promyelocytic leukemia diagnosed in our hospital from January 2015 to January 2020 were selected as the observation group. At the same time, 74 patients with nonacute promyelocytic leukemia who underwent bone marrow aspiration were included as the control group. The expression levels of miR-126-5p and miR-13, different characteristic parameters, and prognosis were compared between the two groups, and the clinical significance of miR-126-5p and miR-13 in acute promyelocytic leukemia was analyzed. Results The expression of miR-126-5p (12.31 ± 2.25 versus 17.30 ± 3.28) and miR-13 (16.05 ± 3.47 versus 21.66 ± 2.18) in the observation group was significantly lower than that in the control group (P < 0.05). The expression level of miR-126-5p was significantly correlated with lactate dehydrogenase level, HGB level, NPM1 mutant type, and complete remission (P < 0.05). The expression level of miR-13 was significantly correlated with HGB level, NPM1 mutant type, and complete remission (P < 0.05). Both expression levels of miR-126-5p and miR-13 were not correlated with sex, age, WBC, PLT, proportion of bone marrow primordial cells, hepatomegaly, splenomegaly, lymph node enlargement, and FLT3-ITD (P > 0.05). Cox multivariate regression analysis showed that peripheral blood WBC, bone marrow blast cell count, and miR-126-5p and miR-13 were prognostic factors in patients with acute promyelocytic leukemia (P < 0.05). The sensitivity, specificity, accuracy, and AUC of serum miR-126-5p prediction were 75.83%, 84.56%, 82.17%, and 0.729, respectively. The sensitivity, specificity, accuracy, and AUC of serum miR-13 prediction were 78.64%, 88.49%, 86.20% and 0.882, respectively. Conclusion Serum miR-126-5p and miR-13 are closely related to the prognosis of patients with acute promyelocytic leukemia. Serum miR-126-5p and miR-13 can be used as reliable indexes to predict the prognosis of patients.

PANCYTOPENIA AS INITIAL PRESENTATION OF ACUTE LYMPHOBLASTIC LEUKEMIA AND ITS ASSOCIATIONWITH BONE MARROWRESPONSE

Objective:The objective of this study is to determine the frequency of pancytopenia and bone marrow response to treatment of acute lymphoblastic leukemia. Materials And Methods:This is a cross sectional study carried out at Medical Oncology Department, Hayatabad Medical Complex, Peshawar. A total of 120 patients were included in the study. Venous blood sample was obtained from patients and sent to the laboratory of the hospital for assessment of red blood cells, white blood cells, and platelets. Reports were assessed and levels were noted. If levels were lower than normal, then patients were labeled as having pancytopenia was labeled.Patients were advised treatment i.e drug regimen including weekly intravenous vincristine, daunorubicin, weekly intrathecal methotrexate and daily dexamethosone for 4 weeks). After 4 weeks they underwent bone marrow aspiration. All samples were sent to the laboratory of the hospital for assessment of bone marrow response i.e M1 (less than 5% lymphoblasts), M2 (5% to 25% Lymphoblasts)&amp; M3 (more than 25% Lymphoblasts). Results:Pancytopenia was recorded in 35 (29.16%) patients presenting with acute lymphoblastic leukemia. Out of these thirty-five patients, 21 (60%) were male and 14(40%) were female. Out the 21 males, 20 (95.24%)hadM1 responsewhile01(4.76%)patienthadM2response. Out of the14female patients,12(85.71 %)hadM1 response, 1(7.14 %) had M2 and 1(7.14%) had M3 response. Out of the 85 patients who did not have pancytopenia, 50 (58.8%) were male and 35 (41.2%) were female. Out of the 50 males withoutpancytopenia,36(72%) hadM1,10(20%)hadM2and4(8%) hadM3response.Among the 35 female patients, 31(88.57%) had M1, 2(5.71%) had M2 and 2(5.71%) had M3 response. Conclusion:The study concluded that although pancytopenia is a fairly common presentation of acute lymphoblastic leukemia but there is no significant difference in the outcome of patients receiving treatment for acute lymphoblastic leukemia in association with presence or absence of pancytopenia as initial presentation or with respect to duration of the disease.

Longitudinal minimal residual disease assessment in multiple myeloma patients in complete remission \u2013 results from the NMSG flow-MRD substudy within the EMN02/HO95 MM trial

BackgroundMultiple myeloma remains an incurable disease with multiple relapses due to residual myeloma cells in the bone marrow of patients after therapy. Presence of small number of cancer cells in the body after cancer treatment, called minimal residual disease, has been shown to be prognostic for progression-free and overall survival. However, for multiple myeloma, it is unclear whether patients attaining minimal residual disease negativity may be candidates for treatment discontinuation. We investigated, if longitudinal flow cytometry-based monitoring of minimal residual disease (flow-MRD) may predict disease progression earlier and with higher sensitivity compared to biochemical assessments.MethodsPatients from the Nordic countries with newly diagnosed multiple myeloma enrolled in the European-Myeloma-Network-02/Hovon-95 (EMN02/HO95) trial and undergoing bone marrow aspiration confirmation of complete response, were eligible for this Nordic Myeloma Study Group (NMSG) substudy. Longitdudinal flow-MRD assessment of bone marrow samples was performed to identify and enumerate residual malignant plasma cells until observed clinical progression.ResultsMinimal residual disease dynamics were compared to biochemically assessed changes in serum free light chain and M-component. Among 20 patients, reaching complete response or stringent complete response during the observation period, and with ≥3 sequential flow-MRD assessments analysed over time, increasing levels of minimal residual disease in the bone marrow were observed in six cases, preceding biochemically assessed disease and clinical progression by 5.5 months and 12.6 months (mean values), respectively. Mean malignant plasma cells doubling time for the six patients was 1.8 months (95% CI, 1.4–2.3 months). Minimal malignant plasma cells detection limit was 4 × 10–5.ConclusionsFlow-MRD is a sensitive method for longitudinal monitoring of minimal residual disease dynamics in multiple myeloma patients in complete response. Increasing minimal residual disease levels precedes biochemically assessed changes and is an early indicator of subsequent clinical progression.Trial registrationNCT01208766