Purpose/Objectives: To determine if children undergoing reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC-AlloHSCT) have lower incidence of acute toxicities and, subsequently, require less supportive care than is required with myeloablative conditioning (MAC)-AlloHSCT. An additional purpose is to examine later outcomes by comparing 100-day transplantation-related mortality (TRM).
Design: Retrospective chart and electronic medical records review.
Setting: A pediatric care center in the northeastern United States.
Sample: 86 patients who underwent AlloHSCT from January 2004 through March 2008.
Methods: Charts were retrospectively reviewed. The comparison between groups was done by t test (continuous variables) and chi-square test (categorical variables). The logistic regressions, Kaplan-Meier product-limit estimator, log rank test, and Cox proportional hazards model were used.
Main Research Variables: Days requiring total parenteral nutrition (TPN), patient-controlled analgesia (PCA), incidence of mucositis, days with fevers, number of infections, transfers to pediatric intensive care unit (PICU), blood product infusions, and 100-day TRM, all for 30 days post-transplantation.
Findings: When comparing pediatric patients undergoing RIC-AlloHSCT (n = 43) versus MAC-AlloHSCT (n = 43) in the first 30 days post-transplantation, a statistically significant decreased incidence was noted for mucositis, infections, transfers to PICU, days on TPN and PCA, and days with fever, as well as 100-day TRM.
Conclusions: For pediatric patients, RIC-AlloHSCT is associated with significantly lower acute post-transplantation toxicities and TRM than MAC-AlloHSCT.
Implications for Nursing: For nurses to correctly educate their patients and family members, and to aid nurses in anticipating patient's needs, an understanding of the potential different acute toxicities and supportive care between pediatric patients undergoing RIC- versus MAC-AlloHSCT is vital.
References
American Nurses Association. (2010). Guidelines for data collection on the American Nurses Association's National Quality Forum Endorsed Measures. Washington, DC: Author.
Avritscher, E., Cooksley, C., & Elting, L. (2004). Scope and epidemiology of cancer therapy-induced oral and gastrointestinal mucositis. Seminars in Oncology Nursing, 204, 3-10.
Barker, J. N., Weisdorf, D. J., DeFor, T. E., Blazar, B. R., Miller, J. S., & Wagner, J. E. (2003). Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning. Blood, 102, 1915-1919. doi:10.1182./blood-2002-11-3337
Bhatia, M., Militano, O., Jin, Z., Figurski, M., Shaw, L., Moore, V., … Cairo, M. S. (2010). An age-dependent pharmacokinetic study of intravenous and oral mycophenolate mofetil in combination with tacrolimus for GVHD prophylaxis in pediatric allogeneic stem cell transplantation recipients. Biology of Blood and Marrow Transplantation, 16, 333-343. doi:101.1016/j.bbmt.2009.10.2007
Bradley, M. B., Satwani, P., Baldinger, L., Morris, E., van de Ven, C., Del Toro, G., … Cairo, M. S. (2007). Reduced intensity allogeneic umbilical cord blood transplantation in children and adolescent recipients with malignant and non-malignant diseases. Bone Marrow Transplantation, 40, 621-631. doi:10.1038/sj.bmt.1705785
Centers for Disease Control and Prevention. (2011). Vital signs: Central line-associated blood stream infections—United States, 2001, 2008, and 2009. Morbidity and Mortality Weekly Report, 60, 243-248.
Champlin, R., Khouri, I., Shimoni, A., Gajewski, J., Kornblau, S., Molldrem, J., … Anderlini, P. (2000). Harnessing graft-versus-malignancy: Non-myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy. British Journal of Haematology, 111, 18-29. doi:10.1111/j.1365-2141.2000.02196
DeLeve, L. D., Shulman, H. M., & McDonald, G. B. (2002). Toxic injury to hepatic sinusoids sinusoidal obstruction syndrome (veno-occlusive disease). Seminars in Liver Disease, 2(22), 27-41. doi:10.1055/s-2002-23204
Del Toro, G., Satwani, P., Harrison, L., Cheung, Y. K., Bradley, B., George, D., … Cairo, M. S. (2004). A pilot study of reduced intensity conditioning and allogeneic stem cell transplantation from unrelated cord blood and matched family donors in children and adolescent recipients. Bone Marrow Transplantation, 33, 613-622. doi:101.1038/sj.bmt.1704399
Diaconescu, R., Flowers, C. R., Storer, B., Sorror, M. L., Maris, M. B., Maloney, D. G., … Storb, R. (2004). Morbidity and mortality with nonmyeloblative compared with myeloablative conditioning before hematopoetic stem cell transplantation from HLA-matched related donors. Blood, 104, 1550-1558. doi:10.1182/blood-2004-03-0804
Pulsipher, M. A., Boucher, K. M., Wall, D., Frangoul, H., Duval, M., Goyal, R. K., … Katoda, R. (2009). Reduced-intensity allogeneic transplantation in pediatric patients ineligible for myeloablative therapy: Results of the Pediatric Blood and Marrow Transplant Consortium Study ONCO313. Blood, 114, 1429-1436. doi:10.1182/blood-209-01-196303
Roman, E., Osunkwo, I., Militano, O., Cooney, E., van de Ven, C., & Cairo, M. S. (2008). Liposomal amphotericin B prophylaxis of invasive mold infections in children post allogeneic stem cell transplantation. Pediatric Blood Cancer, 50, 325-330. doi:10.1002/pbc.21239
Saito, A. M., Zahrieh, D., Cutler, C., Ho, V. T., Antin, J. H., Soiffer, R. J., … Lee, S. J. (2007). Lower costs associated with hematopoietic cell transplantation using reduced intensity vs. high-dose regimens for hematologic malignancy. Bone Marrow Transplantation, 40, 209-217.
Satwani, P., Morris, E., Bradley, B., Bhatia, M., van de Ven, C., & Cairo, MS. (2008). Reduced intensity and non-myeloblative allogeneic stem cell transplant in children and adolescents with non-malignant and malignant diseases. Pediatric Blood Cancer, 50, 1-8. doi:10.1002/pbc.21303
Shelburne, N., & Bevans, M. (2009). Non-myeloblative allogeneic hematopoietic stem cell transplantation. Seminars in Oncology Nursing, 25, 120-128. doi:10.1016/j.soncn.2009.03.006
Shereck, E. B., Cooney, E., van de Ven, C., Della-Lotta, P., & Cairo, M. S. (2007). A pilot phase II study of alternate day ganciclovir and foscarnet in preventing cytomegalovirus (CMV) infections in at-risk pediatric and adolescent allogeneic stem cell transplant recipients. Pediatric Blood Cancer, 49, 306-312. doi:10.1002/pbc.21043
Socie, G., Stone, J. V., Wingard, J. R., Wesidorf, G., Henslee-Downey, P. J., Bredesen, C., … Klein, J. (1999). Long-term survival and late deaths after allogeneic bone marrow transplantation. New England Journal of Medicine, 341, 14-21. doi:10.1056/NEJM199907013410103
Thomas, E. D. (1983). Karnofsky Memorial Lecture: Marrow transplantation for malignant disease. Journal of Clinical Oncology, 1, 517-531.
