• 성인간호학회지
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• 제20권2호
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• pp.341-352
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• 2008

Purpose: The purpose of this study was to identify relatively important predictors of quality of life (QOL) of HSCT recipients among client's characteristics(age, gender, family income, religiosity), HSCT-related characteristics(time since HSCT, type of HSCT, decision maker of HSCT) and social support. Methods: Eighty two participants who had a HSCT were recruited for the study. Data were analyzed by descriptive analysis, pearson's correlation, ANOVA and stepwise multiple regression using SPSS for Window(version 12.0) program to answer the research questions. Results: Family income, time since HSCT and religiosity explained 23.8% of the variance in the QOL of HSCT recipients. HSCT recipients who had higher family income, longer time past since HSCT, and more religious tend to have higher quality of life. Conclusion: Based on the findings of this study, we could know that the HSCT recipients need certain amount of time to recover their QOL after HSCT. Opportunities of reemployment and religious support should be considered when we develop intervention program for HSCT recipients.

• 생물치료정신의학
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• 제24권3호
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• pp.142-155
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• 2018

Insomnia in patients with hematopoietic stem cell transplantation(HSCT) has been underdiagnosed and undertreated. This study reviewed the frequency, characteristics, physical and psychological effects, and treatments of insomnia in HSCT patients to highlight clinical importance in this specialized population. Furthermore, the authors intended to suggest a model that would conceptualize insomnia in the context of HSCT. In the pre-transplant period, about half of patients with HSCT suffered from sleep disturbance. A substantial number of patients experienced distressing insomnia during the HSCT procedure and recovered to the level of the pre-transplant period. However, sleep disruption could be a chronic symptom in HSCT survivors and could negatively impact quality of control, cancer-related fatigue(CRF), immune function, and psychological distress. The 3P's model(Predisposing, Precipitating, Perpetuating) explains insomnia in cancer population and could be also relevant to HSCT patients with specific consideration of CRF, graft-versus-host diseases, specific properties of hematological disease, and protective isolated milieu. Effective treatment of insomnia in HSCT includes non-pharmacological(e.g., cognitive behavioral therapy, environmental modification) and pharmacological interventions. The decision of pharmacological treatment should be based on the issue of safety due to high risk of potential drug-drug interactions. Screening, treatment, and further research of insomnia in HSCT patients using validated subjective and/or objective measures are warranted.

• Clinical and Experimental Pediatrics
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• 제56권7호
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• pp.298-303
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• 2013

Purpose: The purpose of this study was to evaluate short-term thyroid dysfunction and related risk factors in pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) during childhood. Methods: We studied 166 patients (100 boys and 66 girls) who underwent HSCT at the Catholic HSCT Center from January 2004 through December 2009. The mean age at HSCT was $10.0{\pm}4.8$ years. Thyroid function of the patients was tested before and during 3 months of HSCT. Results: Out of 166 patients, 165 (99.4%) underwent allotransplantation. Acute graft-versus-host disease (GVHD, grades II to IV) developed in 76 patients. Conditioning regimens before HSCT include total body irradiation (n=57), busulfan (n=80), and reduced intensity (n=29). Forty-five (27.1%) had thyroid dysfunction during 3 months after HSCT (29 euthyroid sick syndrome [ESS], 6 subclinical hyperthyroidism, 4 subclinical hypothyroidism, 3 hypothyroxinemia, 2 overt hyperthyroidism, and 1 high $T_4$ syndrome). In a univariate logistic regression analysis, age at HSCT (P=0.002) and acute GVHD (P=0.009) had statistically significant relationships with thyroid dysfunction during 3 months after HSCT. Also, in a univariate logistic regression analysis, ESS (P=0.014) showed a strong statistically significant association with mortality. Conclusion: In our study 27.1% patients experienced thyroid dysfunction during 3 months after HSCT. Increase in age and acute GVHD may be risk factors for thyroid dysfunction during 3 months after HSCT. There was a significant association between ESS and mortality.

• Clinical and Experimental Pediatrics
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• 제54권3호
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• pp.111-116
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• 2011

Childhood chronic myelogenous leukemia (CML) is a rare hematologic disease, with limited literature on the methods of treatment. Previously, allogeneic hematopoietic stem cell transplantation (HSCT) was considered the only curative treatment for this disease. Treatment with imatinib, a selective inhibitor of the BCR-ABL tyrosine kinase (TKI), has resulted in prolonged molecular response with limited drug toxicity. Imatinib is now implemented in the primary treatment regimen for children, but the paucity of evidence on its ability to result in permanent cure and the potential complications that may arise from long-term treatment with TKIs have prevented imatinib from superseding HSCT as the primary means of curative treatment in children. The results of allogeneic HSCT in children with CML are similar to those observed in adults; HSCT-related complications such as transplant-related mortality and graft-versus-host disease remain significant challenges. An overall consensus has been formed with regards to the need for HSCT in patients with imatinib resistance or those with advanced-phase disease. However, issues such as when to undertake HSCT in chronic-phase CML patients or how best to treat patients who have relapsed after HSCT are still controversial. The imatinib era calls for a reevaluation of the role of HSCT in the treatment of CML. Specific guidelines for the treatment of pediatric CML have not yet been formulated, underscoring the importance of prospective studies on issues such as duration of imatinib treatment, optimal timing of HSCT and the type of conditioning utilized, possible treatment pre-and post-HSCT, and the role of second-generation TKIs.

• 한국융합학회논문지
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• 제8권4호
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• pp.49-57
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• 2017

본 연구는 소아암 환아의 조혈모세포이식 후 성장을 확인하고, 이에 영향을 미치는 요인들을 조사하고자 진행된 융합연구이다. 2009년 2월부터 3월까지 조혈모세포이식을 받은 소아암 환아 112명의 의무기록으로부터 키와 몸무게를 조사하였으며 자료 분석을 위해 혼합효과 모델을 사용하였다. 연구 결과 조혈모세포이식 후 대상자의 신장과 체중의 표준과의 평균표준편차값이 음의 값이었으며 동종이식 보다 자가이식의 경우 신장(p=0.0008)과 체중(p=0.0012)의 평균이 낮았다. 이식 후 신장에 영향을 주는 것으로 대상자의 이식 시 연령(p=0.0251)과 이식 형태(p=0.0020)가 확인되었으며. 동종이식 환아에서는 성장에 영향을 주는 것으로 스테로이드의 사용량이 확인되었다(p=0.0403). 대상자의 이식 후 체중은 이식 시 연령(p=0.0042), 이식형태(p=0.0035) 그리고 총정맥영양의 주입기간(p=0.0159)에 영향을 받는 것으로 나타났다. 본 연구 결과를 바탕으로 소아암 환아의 조혈모세포이식 후 성장이 잘 이루어질 수 있도록 성장저하의 고위험군을 식별할 수 있도록 하여야하며, 이러한 환아에게 적절한 간호중재가 수행되어야 할 것이다.

• 종양간호연구
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• 제8권1호
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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.

• Radiation Oncology Journal
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• 제30권4호
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• pp.165-172
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• 2012

Purpose: To retrospectively evaluate the outcome and toxicity of total lymphoid irradiation (TLI) based conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) patients who experienced an engraftment failure from prior HSCT or were heavily transfused. Materials and Methods: Between 1995 and 2006, 20 SAA patients received TLI for conditioning of HSCT. All patients were multi-transfused or had long duration of disease. Fifteen (75%) patients had graft failure from prior HSCT. In 18 (90%) patients, the donors were human leukocyte antigen identical siblings. The stem cell source was the peripheral blood stem cell in 15 (75%) patients. The conditioning regimen was composed of antithymocyte globulin plus TLI with a median dose of 750 cGy in 1 fraction. The graft-versus-host disease (GVHD) prophylaxis used cyclosporine with methotrexate. Results: With a median follow-up of 10.8 years, graft failures developed in 6 patients. Among them, 3 patients received their third HSCT to be engrafted finally. The Kaplan-Meier overall survival rate was 85.0% and 83.1% at 5 and 10 years, respectively. The incidence of acute and chronic GVHD was 20% and 20%, respectively. None of the patients have developed a malignancy after HSCT. Conclusion: In our study, TLI based conditioning in allogeneic HSCT was feasible with acceptable rates of GVHD in SAA patients who experienced graft failure from prior HSCT or was at a high risk of graft rejection. We achieved relatively better results of engraftment and survival with a long term follow-up.

• 대한간호학회지
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• 제45권5호
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• pp.694-703
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• 2015

Purpose: This study was a prospective longitudinal study to identify changes in quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). It was based on Roy's adaptation model. Methods: The questionnaires were administered before HSCT, 30 and 100 days after HSCT. Of the 48 potentially eligible patients, 44 (91.7%) participated in the study and 40 (90.9%) completed the questionnaires at 100 days after HSCT. Multilevel analysis was applied to analyze changes in quality of life. Results: Overall, quality of life showed a decreasing tendency from pre-HSCT to 100 days after HSCT. The adaptation level of participants was compensatory. Type of conditioning was the significant factor influencing quality of life before HSCT (${\beta}_{00}$=79.92, p <.001; ${\beta}_{01}$= - 12.64, p <.001) and the change rate of quality of life (${\beta}_{10}$= - 1.66, p =.020; ${\beta}_{11}$=2.88, p =.014). Symptom severity (${\beta}_{20}$= - 1.81, p =.004), depression (${\beta}_{30}$= - 0.58, p =.001), social dependency (${\beta}_{40}$= - 0.35, p =.165), and loneliness (${\beta}_{50}$= - 0.23, p =.065) had a negative effect on changes in quality of life. Symptom severity and depression were statistically significant factors influencing changes in quality of life. Conclusion: According to the results of this study, the development of nursing intervention is needed to improve quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation in the early immune reconstruction period. The interventions should include programs to enhance coping capacity and programs to help control symptom severity and depression. Also these interventions need to be started from the beginning of HSCT and a multidisciplinary approach would be helpful.

• 종양간호연구
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• 제5권2호
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• pp.126-135
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• 2005

Purpose: The present study was to investigate sleep disturbance and related variables in patients undergoing hemopoietic stem cell transplantation(HSCT) on the day of admission, before HSCT, and of discharge, respectively. Method: A total of 52 HSCT patients were recruited from an university hospital from August 2002 to August 2003. The patients were asked to complete a set of sleep disturbance questionnaires. Result: The scores of sleep disturbance-related physical and emotional subscales on the day before HSCT and on the day of discharge were significantly higher than that on the day of admission. However, the score of a emotional subscale was not significantly different during the hospitalization for HSCT. About 10% of the variance of sleep disturbance was explained by the length after diagnosis on the day of admission, and 59.4% was by the type of disease, religion, gender, educational level on the day before HSCT. About 40.7% was by family income, gender, and the frequency of administration on the day of discharge. Conclusion: Nursing staffs should care for HSCT patients with more interest to reduce variables disturbing sleep. Especially, more careful nursing interventions have to be considered at the time of the day before HSCT and the time of discharge.

• 종양간호연구
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• 제8권1호
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• pp.40-49
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• 2008

Purpose: This descriptive study was to investigate the quality of life in patients with hematopoietic stem cell transplantation (HSCT) from June 1 to October 13, 2007. Method: The survey was conducted in 6 different university hospitals which located in Seoul and Jeollanam-do province using the Functional Assessment of Cancer Therapy-BMT Scale (FACT-BMT) version 4. We collected a total of 155 questionnaires and analyzed 149 among them. Results: The average score of quality of life was 2.53 out of 5. Physical well being score was highest among sub-domains, followed by emotional well-being, additional concerns, social/family well-being, and functional well-being. Study subjects worried that their conditions would get worse. However study subjects didn't regret having been received HSCT. Age, duration from HSCT, age at diagnosis, income, readmission, HSCT type, educational background, marital status, and the level of activities of daily living were related to quality of life. Conclusions: The findings of this study indicates that the HSCT survivor's quality of life issue is still important and have to be investigated repeatedly in the future. That is necessary for generalizing QOL outcomes for clinical use. We also suggest to develop interventions to improve QOL.