Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO)

Rasheed, Walid; Ghavamzadeh, Ardeshir; Hamladji, Rose‐Marie; Othman, Tarek Ben; Al-Seraihy, Amal; Abdel-Rahman, Fawzi; Elhaddad, Alaa; Alabdulaaly, Abdulaziz; Dennison, David; Ibrahim, Ahmad; Bazarbachi, Ali; Bekadja, Mohamed Amine; Mohamed, Said; Adil, Salman Naseem; Ahmed, Parvez; Benchekroun, Saïd; Ramzi, Mani; Jarrar, Mohammad; Hussain, Fazal; Hamidieh, Amir Ali; Aljurf, Mahmoud

doi:10.1016/j.hemonc.2013.04.001

Cited by 22 publications

(12 citation statements)

References 18 publications

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“…We also found variability in the prophylaxis strategies for VOD, with some providers using ursodeoxycholic acid and others heparin. Rasheed et al [24] in their survey on stem cell transplant practice variations in Middle Eastern countries found that 88% of centers did not use VOD prophylaxis for autologous transplants, whereas 60% of the centers used it for allogeneic HSCT. Although a small number of critical care providers (n = 4) responded to the prophylaxis question, it might have skewed the results.…”

Section: Supportive Carementioning

confidence: 99%

High Variability in the Reported Management of Hepatic Veno-Occlusive Disease in Children after Hematopoietic Stem Cell Transplantation

Skeens

McArthur

Cheifetz

et al. 2016

Biology of Blood and Marrow Transplantation

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Veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Patients with VOD are often critically ill and require close collaboration between transplant physicians and intensivists. We surveyed members of a consortium of pediatric intensive care unit (PICU) and transplant physicians to assess variability in the self-reported approach to the diagnosis and management of VOD. An internet-based self-administered survey was sent to pediatric HSCT and PICU providers from September 2014 to February 2015. The survey contained questions relating to the diagnosis and treatment of VOD. The response rate was 41% of 382 providers surveyed. We found significant variability in the diagnostic and management approaches to VOD in children. Even though ultrasound is not part of the diagnostic criteria, providers reported using reversal of portal venous flow seen on abdominal ultrasound in addition to Seattle criteria (70%) or Baltimore criteria to make the diagnosis of VOD. Almost 40% of respondents did not diagnose VOD in anicteric patients (bilirubin < 2 mg/dL). Most providers (75%) initiated treatment with defibrotide at the time of diagnosis, but 14%, 7%, and 6% of the providers waited for reversal of portal venous flow, renal dysfunction, or pulmonary dysfunction, respectively, to develop before initiating therapy. Only 50% of the providers restricted fluids to 75% of the daily maintenance, whereas 21% did not restrict fluids at all. Albumin with diuretics was used by 95% of respondents. Platelets counts were maintained at 20,000 to 50,000/mm(3) and 10,000 to 20,000/mm(3) by 64% and 20% of the respondents, respectively. Paracentesis was generally initiated in the setting of oliguria or hypoxia, and nearly 50% of the providers used continuous drainage to gravity, whereas the remainder used an intermittent drainage approach. Nearly 73% of the transplant providers used VOD prophylaxis, whereas the remainder did not use any medications for VOD prophylaxis. There was also considerable variation in the management strategies among the transplant and critical care providers. We conclude that there is considerable self-reported variability in the diagnosis and management of VOD in children. The practice variations reported in this study should encourage the development of standard practice guidelines, which will be helpful in improving the outcome of this potentially fatal complication.

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Section: Supportive Carementioning

confidence: 99%

High Variability in the Reported Management of Hepatic Veno-Occlusive Disease in Children after Hematopoietic Stem Cell Transplantation

Skeens

McArthur

Cheifetz

et al. 2016

Biology of Blood and Marrow Transplantation

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“…Its success depends largely on the availability of a rapid and sensitive assay to allow early treatment while CMV levels are still low. For this purpose, the pp65 antigenemia assay is used as a cost‐effective screening tool in transplantation centers around the world . The antigenemia assay, however, has several clinical limitations including a labor‐intensive process, low sensitivity, and the need for a number of leukocytes that is not always available shortly after HSCT .…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a quantitative assay detecting cytomegalovirus transcripts for preemptive therapy in allogeneic hematopoietic stem cell transplant recipients

Onishi

Miyamura

Fukuhara

et al. 2017

Journal of Medical Virology

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Successful preemptive therapy for cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) depends on the availability of a rapid and sensitive assay to guide early treatment. Currently, the antigenemia assay and the quantitative real-time PCR (qPCR) assay are widely used for this purpose, but they have distinctive concerns. This study aimed to develop and evaluate a novel CMV diagnostic test based on transcription-reverse transcription concerted reaction (TRC), an RNA-detecting technology. The CMV-TRC assay detected CMV β2.7 transcripts within 10 min over a five-log range. Among a total of 219 samples obtained from 24 allogeneic HSCT recipients, samples detected as positive by the CMV-TRC assay showed a relatively strong correlation with those detected as positive by the qPCR assay and the antigenemia assay. The CMV-TRC assay showed higher sensitivity (77.7%) than the antigenemia assay (68.1%) and detected the first and recurrent episodes of active CMV infection in HSCT patients significantly earlier than the antigenemia assay (P < 0.001). Although the CMV-TRC assay (87.8%) showed low sensitivity compared to the qPCR assay (96.3%), the performance of the CMV-TRC assay was equivalent to that of the qPCR assay in detecting the appearance of active CMV infection episodes (P < 0.092) or rather superior in detecting the clearance of episodes (P < 0.001). The CMV-TRC assay with several advantages may be useful for guiding preemptive anti-CMV therapy in HSCT recipients.

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“…32 Further evaluation of low-microbial diets in HCT is complicated by the variety of dietary restrictions and decisions regarding timing of diet implementation across centers. 30,33 …”

Section: Discussionmentioning

confidence: 99%

Bacterial Foodborne Infections after Hematopoietic Cell Transplantation

Boyle

Podczervinski

Jordan

et al. 2014

Biology of Blood and Marrow Transplantation

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Background Diarrhea, abdominal pain and fever are common among patients undergoing hematopoietic cell transplant (HCT), but such symptoms are also typical with foodborne infections. The burden of disease caused by foodborne infections in patients undergoing HCT is unknown. We sought to describe bacterial foodborne infection incidence post-transplant within a single-center population of HCT recipients. Methods All HCT recipients transplanted from 2001 through 2011 at the Fred Hutchinson Cancer Research Center in Seattle, WA were followed for one year post-transplant. Data were collected retrospectively using center databases, which include information from transplant, on-site examinations, outside records, and collected laboratory data. Patients were considered to have a bacterial foodborne infection if Campylobacter jejuni/coli, Listeria monocytogenes, E. coli 0157:H7, Salmonella species, Shigella species, Vibrio species or Yersinia species were isolated in culture within one-year post-transplant. Non-foodborne infections with these agents and patients with preexisting bacterial foodborne infection (within 30 days of transplant) were excluded from analyses. Results A total of 12/4069 (0.3%) patients developed a bacterial foodborne infection within one year post-transplant. Patients with infections had a median age at transplant of 50.5 years (interquartile range [IQR]: 35–57), and the majority were adults ≥18 years of age (9/12 [75%]), male gender (8/12 [67%]) and post-allogeneic transplant (8/12 [67%]). Infectious episodes occurred at an incidence rate of 1.0 per 100,000 patient-days (95% CI: 0.5–1.7) and at a median of 50.5 days after transplant (IQR: 26–58.5). The most frequent pathogen detected was Campylobacter jejuni/coli (5/12 [42%]) followed by Yersinia (3/12 [25%]), while Salmonella (2/12 [17%]) and Listeria (2/12 [17%]) showed equal frequencies; no cases of Shigella, Vibrio, or E. coli 0157:H7 were detected. Most patients were diagnosed via stool (8/12 [67%]), fewer through blood (2/12 [17%]), one via both stool and blood simultaneously, and one through urine. Mortality due to bacterial foodborne infection was not observed during follow-up. Conclusions Our large single-center study indicates that common bacterial foodborne infections were a rare complication following HCT, and the few cases that did occur resolved without complications. These data provide important baseline incidence for future studies evaluating dietary interventions for HCT patients.

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Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO)

Cited by 22 publications

References 18 publications

High Variability in the Reported Management of Hepatic Veno-Occlusive Disease in Children after Hematopoietic Stem Cell Transplantation

High Variability in the Reported Management of Hepatic Veno-Occlusive Disease in Children after Hematopoietic Stem Cell Transplantation

Development and evaluation of a quantitative assay detecting cytomegalovirus transcripts for preemptive therapy in allogeneic hematopoietic stem cell transplant recipients

Bacterial Foodborne Infections after Hematopoietic Cell Transplantation

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