• Asian Oncology Nursing
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• v.8 no.1
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• pp.50-60
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• 2008

Purpose: The purpose of this study was to compare Quality of life (QOL) in type and time after Hematopoietic stem cell tansplantation (HSCT) for patients with hematologic cancer. Method: This study was cross-sectional. The autologous recipients was 120, the allogeneic recipients was 237. The obtained data were analyzed using T-test, One-way ANOVA, Scheffe's test. Results: No significant differences were total QOL between the autologous and allogeneic recipients. But the autologous recipients reported better status than the allogeneic recipients in physical domain, especially 1-3 yr after HSCT. There was poorer QOL of 1-3 yr compared to 1 yr after HSCT in physical, psychological and social domain between the two groups. QOL in time after HSCT of the autologous recipients was significance differences in psychological, social domain. And QOL in time after HSCT of the allogeneic recipients was significant differences in physical, psychological and social domain. Conclusions: QOL of recipients undergoing HSCT is recovered beyond 3 yr point. Accordingly, long term care and service is essential to recipients undergoing HSCT. And further studies with a longitudinal design are necessary.

• Journal of Hospice and Palliative Care
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• v.8 no.2
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• pp.190-199
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• 2005

Purpose: Objectives of this study was to investigate the level of anxiety and depression according to the stages of autologous and allogeneic hematopoietic stem cell transplantation (HSCT). It would be provide the basis for effective psycho-emotional nursing intervention. Methods: We report on 52 patients, including 19 with autologous HSCT, and 33 with allogeneic HSCT from August 2002 to August 2003, at a university hospital. Spielberger's State-Trait Anxiety Inventory and Jung's Depression Inventory were used to measure levels of anxiety and depression, respectively, at admission time, the day before HSCT, and discharge time. Data was analyzed using SAS program that included Chi-square test, Fisher's exact test, repeated measures ANOVA and Stepwise multiple regression analysis. Results: In all stages of HSCT, the level of anxiety of patients who underwent allogeneic HSCT was significantly higher than that of autologous HSCT (P=0.047). The depression at the day before HSCT was significantly higher than that at admission. The major variable affecting anxiety in autologous HSCT was depression. Specially depression and gender were significant predictors to explain anxiety in allogeneic HSCT at admission time (61%). Experience of relapse and gender were significant predictors to explain anxiety in allogeneic HSCT at discharge time (36%). Conclusion: We recommend that the anxiety and depression be researched during the stages of allogeneic HSCT, specifically in the day before HSCT. It is necessary to develop an effective psycho-emotional nursing intervention according to the stages of HSCT.

• Korean Journal of Psychosomatic Medicine
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• v.10 no.1
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• pp.8-17
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• 2002

Objective : Increasing in frequency and success of hematopoietic stem cell transplantation and improved survival rates have led to growing concerns regarding the psychosocial aspects of hematopoietic stem cell transplantation recipients. In this study, we have examined the stress coping strategies and related psychiatric symptom in the hematopoietic stem cell transplantation recipients. Methods : In this study, we examined the psychological stress symptoms of hematopoietic stem cell transplantation recipients and differences of psychosocial variables between active coping group and passive coping group. Twenty nine recipients of hematopoietic stem cell transplantation were recruited prospectively and assessed at 2 weeks pretranplant and at 1-2 days posttranplant. Thirty normal controls were recruited. Assessments included a psychiatric interview, a variety of standardized questionnaires (Ways of Coping Questionnaires, Perceived Stress Scale, Hospital Depression and Anxiety Scale, Short-Form 36 Health Survey). Results : Hematopoietic stem cell transplantation patients showed higher degree of depression (p<0.001) and anxiety (p=0.011) symptoms than normal control group. However, no differences of depression and anxiety symptoms between pretransplant and posttransplant status were showed. And, passive coping group showed higher degree of depression (p=0.046) and anxiety symptoms (p<0.001) than active coping group. Conclusions : Our results suggested that many hematopoietic stem cell transplantation recipients would exhibit severe to moderate symptoms of anxiety and depression. Also, it seemed likely that passive coping style might influence the development of negative affect such as anxiety and depression. The implications of these findings were discussed in terms of the need to monitor the coping strategies and apply the appropriate psychiatric intervention. And, further prospective studies about long-term survival and psychological adaptive functions of hematopoietic stem cell transplantation patients are recommended.

• Asian Oncology Nursing
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• v.12 no.1
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• pp.110-116
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• 2012

Purpose: This study was performed to identify the pre-and post-transplant nutritional assessment for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Methods: The subjects of this study were 25 patients undergoing allogeneic HSCT. The data collection was performed from January 31st to March 31st, 2011. The Patient-Generated Subjective Global Assessment (PG-SGA), anthropometrics and biochemical test were collected from the time they entered the isolation unit until they left. Results: Pre-transplant nutritional assessment status indicated moderate malnutrition which scored $7.32{\pm}1.68$ in PG-SGA. There were 22 patients (88.0%) with moderate malnutrition and 3 patients (12.0%) with severe malnutrition. Post-transplant nutritional assessment indicated severe malnutrition status which scored $11.92{\pm}3.26$ in PG-SGA. Pre-and post-transplant nutritional assessment displayed significant differences (p<.001) in PG-SGA score. Hematopoietic stem cell transplantation led to a deterioration of patients' nutritional status. Pre-transplant patients were already in malnutrition status and patients undergoing allogeneic HSCT were at risk for malnutrition. Conclusion: Pre-and post-transplant patients were categorized as having undernutritional and malnutritional status. Pre-transplant nutrition status impacted on post-transplant nutritional status. Health care personnel should pay attention to patient's nutrition status when undergoing allogeneic HSCT with appropriate nutritional assessment tools.

• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.67-72
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• 2008

Purpose : In this study, we retrospectively analyzed the clinical outcomes of patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) grafted from HLA-matched parents. Methods : Seven children with acute leukemia (4 acute lymphoblastic leukemia, 3 acute myeloid leukemia) in first complete remission received allogeneic HSCT from their respective parents at the St. Marys Hospital between April, 1999 and October, 2005. The median age of patients at transplantation was 5 years (range, 1-11 years; 2 male, 5 female) and the median age of donors was 35 years (range, 30-41 years; 5 male, 2 female). We investigated the clinical outcomes such as engraftment, acute and chronic graft-versus-host disease (GVHD), transplant-related morbidity and mortality, relapse and survival. Results : Median time from transplantation to last follow-up was 69.5 months (range, 18.8-96.5 months). All patients were successfully engrafted, with a median time of 11 days (range, 10-16 days) and 26 days (range, 13-39 days) for neutrophil and platelet recovery, respectively. Grade II acute GVHD occurred in 3, and grade III acute GVHD in 1 of 7 recipients. Extensive chronic GVHD developed in 2, and limited chronic GVHD in 1 of 7 recipients. Death from transplant-related complications occurred in 1, and relapse occurred in 1 of 7 recipients. Estimated 5-year overall survival was $83{\pm}15%$. Conclusion : The clinical outcomes of recipients who underwent HSCT from HLA-matched parents were comparable to those of patients who received HSCT grafted from HLA-matched sibling donors in childhood leukemia. HLA typing of parents, as well as siblings will increase the likelihood of finding an HLA-matched family donor for patients who need HSCT.

• Journal of Oral Medicine and Pain
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• v.37 no.3
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• pp.147-154
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• 2012

Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

• Tuberculosis and Respiratory Diseases
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• v.71 no.6
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• pp.459-463
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• 2011

Pulmonary complications occur in 40~60% of patients who receive hematopoietic stem cell transplantation (HSCT) and are a source of substantial morbidity and mortality. Acute eosinophilic pneumonia (AEP) is an uncommon, non-infectious pulmonary complication occurring in HSCT recipients. We now report the case of a 52-year-old man with AEP who was treated with allogenic HSCT due to acute myeloid leukemia. He complained of fever, cough and dyspnea 390 days after allogenic HSCT. He also had skin and hepatic graft versus host disease (GVHD). Hypoxemia, diffuse pulmonary infiltrates on a chest x-ray and eosinophilia in bronchoalveolar lavage fluid were also noted in several tests. His symptoms, pulmonary infiltrates, hepatic dysfunction and skin lesions rapidly improved after treatment with corticosteroid therapy. Our case supports the idea that AEP is a late phase non-infectious pulmonary complication and one of the manifestations of chronic GVHD.

• Journal of Korean Public Health Nursing
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• v.14 no.2
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• pp.191-202
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• 2000

This study was conducted for 39 patients who are recipients of allogeneic hemopoietic stem cell transplantation at BMT ward of St. Mary's hospital affiliated to Catholic University of Korea from April to September 1999. The subjects were devided into two groups; those who received both TEl and chemo therapy as conditioning regimen (TEl group). and those who used chemo agents as singular conditioning regimen (chemo group). The oral intake status of the two groups were compared through physical assessment and blood chemistry exam of the subjects, and factors influencing their nutritional change and oral intake were explored in each stage of the transplantation (six stages: admission, conditional stage, date of transplantation, one week after transplantation, two weeks after transplantation, and three weeks after transplantation). The prior aim of the study was to provide baseline data to minimize delayed treatment from nutritional deficiency of the subjects. The results were as follows: 1. TBI group was significantly decreased of oral calorie intake in two weeks after transplantation compared to admission and conditioning stage while that of chemo group was significantly decreased on the date of transplantation. 2. TBI group was significantly decreased of protein intake in two weeks after transplantation compared to admission and conditioning stage. In chemo group, protein intake was significantly decreased on the date of transplantation compared to admission. It was remarkable that TBI group showed lesser protein intake than chemo group. 3. Both group were significantly decreased of BMI in one week and three weeks after transplantation compared to admission. TBI group showed significantly higher BMI than chemo group. 4. Both group were significantly decreased of Triceps Skinfold Thickness (TST)on the date of transplantation compared to admission stage. 5. TBI group was significantly decreased of mid-arm muscle circumference (MAMC) in two weeks after transplantation compared to admission, conditioning, date of transplantation. 6. TBI group was significantly decreased of albumin level in two weeks after transplantation compared admission stage. In chemo group, it was significantly decreased on the date of transplantation compared to admission, three weeks after the transplantation. 7. TBI group was significantly decreased of transferrin level in two weeks after transplantation compared admission, conditioning, date of transplantation and one week after transplantation. In chemo group, it was decreased of transferrin level in 3 weeks after transplantation. 8. Oral intake of TEl group was impacted by vomiting before transplantation and gingivitis after transplantation. In chemo group, it was impacted by vomiting before transplantation and by two factors, gingivitis and nausea, after transplantation. The results showed oral calorie intake was not different between the two groups while protein intake was significantly lower in TBI group than chemo group. Oral intake was significantly impacted by vomiting before transplantation in both groups, but affected by oral gingivitis in TBI group and gingivitis and nausea in chemo group after transplantation. This findings present that standardized strategies to manage nutrition and gingivitis more effectively are desperately needed to enhance oral intake and protein intake of patients who receive TBI as conditioning regimen.

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.96-101
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• 2012

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the optimal curative treatment for acute myeloid leukemia (AML), but some patients develop bone marrow relapse due to remnant leukemia, and few patients develop extramedullary relapse without bone marrow relapse. Isolated extramedullary relapse (IMER) is defined as extramedullary relapse without bone marrow relapse. IMER has been reported in various sites, including the skin, soft tissue, and central nervous system(CNS). Isolated CNS relapse is relatively rare and is associated with poor prognosis due to the absence of an optimal treatment for it. Reported herein is a case involving an adult AML woman who suffered from isolated extramedullary relapse in the CNS after allogeneic HSCT. She was treated with intrathecal chemotherapy and whole-brain and spine radiotherapy, followed by systemic chemotherapy. She is currently well, with no evidence of leukemia recurrence for over six years.

• IMMUNE NETWORK
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• v.3 no.2
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• pp.150-155
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• 2003

Background: We investigated the effect of donor marrow T cell depletion, administration of FK506, cyclosporin A (CSA), and 3-deazaadenosine (DZA) on graft versus host disease (GVHD) after allogeneic murine hematopoietic stem cell transplantation (HSCT). Methods: We used 4 to 6 week old Balb/c ($H-2^d$, recipient), and C3H/He ($H-2^k$, donor) mice. Total body irradiated recipients received $1{\times}10^7$ bone marrow cells (BM) and $0.5{\times}10^7$ splenocytes of donor under FK506 (36 mg/kg/day), CSA (5 mg/kg/day, 20 mg/kg/day), and DZA (45 mg/kg/day), which were injected intraperitoneally from day 1 to day 14 daily and then three times a week for another 2 weeks. To prevent the GVHD, irradiated Balb/c mice were transplanted with $1{\times}10^7$ rotor-off (R/O) cells of donor BM. The severity of GVHD was assessed daily by clinical scoring method. Results: All experimental groups were well grafted after HSCT. Mice in experimental group showed higher GVHD score and more rapid progression of GVHD than the mice with R/O cells (R/O group) (p<0.01). There were relatively low GVHD scores and slow progressions in FK506 and low dose CSAgroups than high dose CSA group (p<0.01). The survival was better in FK506 group than low dose CSA group. All mice treated with CSA died within 12 days after HSCT. The GVHD score in DZA group was low and slow in comparison with control group (p<0.05), but severity and progression were similar with low dose CSA group (p=0.11). All mice without immunosuppressive treatment died within 8 days, but all survived in R/O group (p<0.01). Survival in low dose CSA group was longer than in control group (p<0.05), but in high dose CSA group, survival was similar to control group. The survival benefit in DZA group was similar with low dose CSA group. FK506 group has the best survival benefit than other groups (p<0.01), comparable with R/O group (p=0.18), although probability of survival was 60%. Conclusion: We developed lethal GVHD model after allogeneic murine HSCT. In this model, immunosuppressive agents showed survival benefits in prevention of GVHD. DZA showed similar survival benefits to low dose CSA. We propose that DZA can be used as a new immunosuppressive agent to prevent GVHD after allogeneic HSCT.