• Title, Summary, Keyword: Hematopoietic stem cell transplantation

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A Study of the Factors Affecting the Term of Engraftment During Hematopoietic Stem Cell Transplantation with a Focus on the Inhibitors of Oral Intake and the Period of Nutritional Support (조혈모세포이식 시 조기생착에 영향을 주는 요인 분석 - 경구섭취 저해인자 및 영양지원 시기를 중심으로 -)

  • Kim, Hye-Jin;Noh, Min-Young;Jung, Myeong-Ji;Hong, Jeong-Im;Jung, Yeon-Sun
    • Journal of the Korean Dietetic Association
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    • v.15 no.2
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    • pp.168-178
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    • 2009
  • Hematopoietic stem cell tranntation is being widely used in an attempt to treat many hematological diseases such as leukemia, anemia, and lymphoma. To evaluate the success of hematopoietic stem cell transplantation, it is very important to determine how rapidly engraftment occurs. Therefore, this retrospective study was conducted to determine which factors affected the term of engraftment during hematopoietic stem cell transplantation, while focusing on the oral intake status. To accomplish this, 416 patients who underwent transplant operations at St. Mary's hospital from May 2006 to April 2008 were evaluated. The long-term engraftment group was characterized as having longer fasting days and more frequent vomiting, diarrhea, and oral mucositis incidences than the short-term engraftment group. In addition, the inhibitors of oral intake such as vomiting, diarrhea, and oral mucositis developed frequently between the pre-transplantation and 2 weeks after transplantation. A significantly negative correlation was observed between the oral intake volume and the duration of the oral intake inhibitors. A multiple regression analysis revealed that the frequency of vomiting and oral mucositis during hematopoietic stem cell transplantation, the length of hospitalization, and the hematocrit level in the 2 weeks after hematopoietic stem cell transplantation were significant predictors of engraftment. The results of this study could be used to establish a guideline for nutritional assessment, nutritional goals, and nutritional support for patients during hematopoietic stem cell transplantation.

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Hematopoietic stem cell transplantation : overview for general pediatrician (조혈모세포이식)

  • Hwang, Tai Ju
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.613-621
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    • 2007
  • Hematopoietic stem cell transplantation (HSCT) has expanded and evolved substantially in the last decades to treat various malignant and nonmalignant diseases. However, the conditioning regimen can lead to transplantation related death by major organ dysfunction, severe infection and bleeding. In the allogeneic setting, graft versus host disease may also develop, making post-transplant management complex. To overcome these problems, new stem cell sources, stem cell mobilizing agents and new skills, nonmyeloablative stem cell transplantation including reduced intensity stem cell transplantation has been introduced in clinical practice, but problems remained so far. Recipients of stem cell transplant may be severely immunocompromised for many months after transplantation. Furthermore, long-term complications (endocrine, metabolic, relapse, second malignancies, etc) can develop. Pediatrician is open called on to participate in the evaluation and consideration of patients for possible transplant and long-term follow-up of HSCT patients. This review is intended as a basic overview of HSCT relevant to general pediatrician.

Stress and Emotional Status of Patients Undergone Hematopoietic Stem Cell Transplantation and Their Families (조혈모세포이식 환자와 가족의 스트레스와 정서 상태에 대한 연구)

  • Kang, Hye-Ryeong;Hong, Yun-Jin;Hwang, Kyung-A;Park, Mi-Ra;Chun, Sung-Sook;Lim, Nan-Young
    • The Korean Journal of Rehabilitation Nursing
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    • v.7 no.2
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    • pp.115-126
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    • 2004
  • Purpose: This study was carried out to accumulate basic data for nursing intervention development by evaluating the stress and emotional status of patients and their families after receiving hematopoietic stem cell transplantation (HSCT), illucidating and analysing related factors in order to decrease the negative effects of HSCT on their emotion. Methods: Data were collected using a questionnaire to 53 HSCT patients and 50 families, who were older than 18 at tertiary-care institutions in Seoul, from January, 2000 to August, 2003. Results: There was a significant score difference in stress (t=-2.302, P<0.05). Correlation between stress and emotional status was statistically significant (r=0.486, P<0.01; r=0, P<0.05). Economical burden of cost had significant effects on stress of patients (F=4.194, P<0.05). The series of emotional status of patients without jobs were higher (T=-2.583, P<0.05). The emotional status of families were influenced by monthly income (F=4.036, P<0.05) and patients' diagnosis (F=3.088, P<0.05). Conclusion : These results suggest that the cares for families should be considered with great concern as well as the ones for patients. In addition, such factors as economical burden by medical cost, monthly income and job status should not be excluded in transplantation nursing plans.

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Incidence and Factors Influencing Oral Mucositis in Patients with Hematopoietic Stem Cell Transplantation (조혈모세포이식 환자의 구강 점막염 발생실태와 영향요인)

  • Jo, Kwan Suk;Kim, Nam Cho
    • Journal of Korean Academy of Nursing
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    • v.44 no.5
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    • pp.542-551
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    • 2014
  • Purpose: This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity. Methods: In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test. Results: A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics. Conclusion: The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.

Physical Conditions and Social Adaptation of Children Who Have Undergone Hematopoietic Stem Cell Transplantation (급성 백혈병 아동의 동종 조혈모세포이식 후 신체적 및 사회적 적응)

  • Koo, Hyun-Young;Choi, Sun-Hee;Park, Ho-Ran
    • Child Health Nursing Research
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    • v.12 no.4
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    • pp.441-450
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    • 2006
  • Purpose: The purpose of this study was to investigate the physical conditions and social adaptation of children who have undergone hematopoietic stem cell transplantation. Methods: The participants in this descriptive survey were 37 children who had undergone hematopoietic stem cell transplantation at least one year ago. Data were collected through observation and questionnaires and processed with the SAS program. Results: Compared to the time of diagnosis, WBC, RBC and platelet counts had increased significantly. The children were taller than at the transplantation stage, but there was no change in weight and 73% of the children had physical symptoms. Boys who were between 6 to 11 years of age had lower rates of socialization and academic progress than normal Korean boys. Boys between 12 to 17 years of age had higher rates of socialization, but lower rates of academic progress. Girls between 6 to 17 years of age scored lower than normal Korean girls in both categories. Conclusion: The above findings indicate that children who have undergone hematopoietic stem cell transplantation try hard to participate in everyday activities. Therefore nursing interventions to improving normal growth and development and facilitate social adaptation should be provided for them.

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Educational Needs of Families of Children Undergoing Hematopoietic Stem Cell Transplantation (조혈모세포이식 아동 가족의 교육 요구)

  • Koo, Hyun-Young;Kim, Gwang-Sung;Park, Ho-Ran
    • Child Health Nursing Research
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    • v.15 no.2
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    • pp.190-200
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    • 2009
  • Purpose: This study was done to investigate the educational needs of families of children who underwent hematopoietic stem cell transplantation and to compare these needs with the educational importance as perceived by nurses. Methods: The participants were 44 families of children who underwent hematopoietic stem cell transplantation and 50 nurses who cared for these children. Data was collected through self-report questionnaires which included items on educational needs and the degree of educational importance. The data was analyzed using the SPSS/WIN program. Results: The educational needs of families before and after transplantation were high, with items on disease and treatment, and direct care ranked as most important, respectively. The degree of educational importance as perceived by nurses was different from that of families. Conclusion: The findings indicate that the educational needs of families before hematopoietic stem cell transplantation were different from those after the procedure. Also, the perception of educational importance was different for families compared to nurses. Therefore nursing education programs based on the educational needs of families should be provided.

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Nonmyeloablative Stem Cell Transplantation (비골수제거성 조혈모세포이식)

  • Hyun, Myung-Soo
    • Yeungnam University Journal of Medicine
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    • v.19 no.1
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    • pp.11-27
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    • 2002
  • Allogenic hematopoietic stem cell transplantation is one of the effective therapy for several hematologic malignancies. Transplantation preparative regimen is designed to eradicate the patient's underlying disease and immunosuppress the patient adequately to prevent rejection of donor's hematopoietic stem cells. So, conventional myeloablative preparative regimens with high-dose chemotherapy or radiotherapy are related to high rate of morbidity and mortality. However, It has become clear that the high-dose therapy dose not eradicate the malignancy in some patients, and that the therapeutic benefit of allogenic transplantation is largely related to graft-versus-leukemia/graft-versus-tumor (GVL/GVT) effect. An new approach is to utilize less toxic, nonmyeloablative preparative regimens to achieve engraftment and allow GVL/GVT effects to develop. This strategy reduces the risk of treatment-related mortality and allows transplantation for elderly and those with comorbidities that preclude high-dose chemoradiotherapy.

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Distributions of HLA Microsatellite Markers and the Linkage Disequilibria between HLA and Microsatellites in Koreans (한국인에서 HLA 유전자 부위 내 Microsatellite 표지자의 분포와 HLA 대립유전자의 유전적 연관성)

  • Jang, Jung-Pil;Choi, Eun-Jeong;Yoon, Ho-Yeul;Choi, Hee-Baeg;Kim, Hee-Je;Cho, Byung-Sik;Min, Woo-Sung;Lee, Jong-Wook;Kim, Chun-Choo;Kim, Tai-Gyu
    • IMMUNE NETWORK
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    • v.7 no.3
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    • pp.149-157
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    • 2007
  • Background: The microsatellites within human leukocyte antigen (HLA) region show considerable polymorphism and strong linkage disequilibrium (LD) with HLA alleles. These microsatellites have been used for genetic analysis including disease mapping to understand susceptibility to autoimmune and infectious diseases. Also, use of microsatellites has recently been proposed as an approach for identifying non-HLA markers within the HLA region that could function as transplantation determinants and for the selection of potential donors for transplantation. Methods: To analyse the frequency of five microsatellites in the Korean population, genotyping for polymorphisms at five microsatellites markers (BAT2, MIB, DQCAR, D6S105 and TNFd) within HLA region was performed on 143 healthy Korean controls. Results: The most frequent genotype shown in healthy Korean controls were BAT2 8 (153 bp, 42.7%), MIB 1 (326 bp, 40.6%), DQCAR 3 (188 bp, 38.5%), D6S105 7 (126 bp, 58.0%) and TNFd 3 (128 bp, 58.0%). And common two-loci haplotypes were found as MIB 1-HLA-B*62 (HF: 10.6%), MIB 6-HLA-B*44 (HF: 7.8%), DQCAR 3-HLA-DRB1*13 (HF: 8.5%), TNFd 5-HLA-B*62 (HF: 7.8%) and D6S105 7-HLA-A*02 (HF: 16.2%). Conclusion: These data might provide useful information on the microsatellites markers with HLA region in Korean population and be helpful in further defining the clinical impact of these microsatellites.

A Case of Nonclassifiable Interstitial Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation (동종 조혈모세포이식 후 비분류성 간질성 폐렴으로 사망한 1예)

  • Jung, Ki Hwan;Sung, Hwa Jung;Lee, Ju-Han;Han, Jungho;Shin, Chol;Park, Hyung Joo;Kim, Je Hyeong
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.2
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    • pp.122-126
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    • 2009
  • Despite the improvements in supportive care, early and late hematopoietic stem cell transplantation-related complications still remain a significant cause of morbidity and mortality. Pulmonary complications occur in 40-60% of patients who undergo allogeneic hematopoietic stem cell transplantation. Late-onset noninfectious pulmonary complications can occur months and even years after transplantation. Interstital lung disease has also been reported to be a late post-transplant complication. Exposure to cytotoxic drugs and/or irradiation has been implicated as a cause of pulmonary toxicity including pulmonary fibrosis. We report a case of an 18-year-old female with non-classifiable interstitial pneumonia that manifested eight and a half years after allogeneic hematopoietic stem cell transplantation. The condition worsened rapidly and the patient eventually died.

Population Pharmacokinetics of Cyclosporine after Hematopoietic Stem Cell Transplantation in Pediatric Patients (조혈모세포 이식을 받은 소아 환자에서 cyclosporine의 집단 약동학 분석)

  • Cho, So Yeon;Kang, Wonku;Yee, Jeong;Kim, Jae Youn;An, Sook Hee;Gwak, Hye Sun
    • Korean Journal of Clinical Pharmacy
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    • v.28 no.1
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    • pp.24-29
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    • 2018
  • Background: Cyclosporine is an immunosuppressive agent used to treat and prevent graft versus host reaction (GVHR)-a complication associated with stem cell transplantation. This study aimed to develop a population pharmacokinetic model of cyclosporine and investigate factors affecting cyclosporine clearance in pediatric hematopoietic stem cell transplant patients. Methods: A total of 650 cyclosporine concentrations recorded in 65 patients who underwent hematopoietic stem cell transplantation were used. Data including age, sex, weight, height, body surface area (BSA), type of disease, chemotherapy before stem cell transplantation, type of donor, serum creatinine levels, total bilirubin concentration, hematocrit value, and type of concomitant anti-fungal agents and methylprednisolone used were retrospectively collected. Data related to cyclosporine dosage, administration time, and blood concentration were also collected. All data were analyzed using the non-linear mixed effect model; a two-compartment model with first-order elimination was used. Results: The population pharmacokinetic model of cyclosporine using the NONMEM program was as follows: $CL(L/h)=5.9{\times}(BSA/1.2)^{0.9}$, V2 (L) = 54.5, Q (L/h) = 3.5, V3 (L) = 1080.0, $k_a(h^{-1})=0.000377$. BSA was selected as a covariate of cyclosporine clearance, which increased with an increase in BSA. Conclusion: A population pharmacokinetic model for Korean pediatric hematopoietic stem cell transplant patients was developed, and the important factor affecting cyclosporine clearance was found to be BSA. The model might contribute to the development of the most appropriate dosing regimen for cyclosporine. Further studies on population pharmacokinetics should be carried out, prospectively targeting pediatric patients.