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Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies

Wahid SF

Int J Hematol, 2013 May;97(5):581-98.
PMID: 23585244 DOI: 10.1007/s12185-013-1313-0

Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.

Matched MeSH terms: Hematologic Neoplasms/complications
Fulltext Autologous mononuclear cells from different sources are seen to improve wound healing in patients with haematological malignancies

Wan Jamaludin WF, Mohamad Yusoff F, Ismail NA, Mohd Idris MR, Palaniappan S, Ng CKK, et al.

Malays J Pathol, 2018 Apr;40(1):61-67.
PMID: 29704386 MyJurnal

INTRODUCTION: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival.
BACKGROUND: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome.
METHODS: We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals.
RESULTS: All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed.
CONCLUSIONS: Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.

Matched MeSH terms: Hematologic Neoplasms/complications*
Fulltext Coping styles in patients with haematological cancer in a Malaysian hospital

Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K

East Asian Arch Psychiatry, 2011 Jun;21(2):44-51.
PMID: 21838206

Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
Results: A total of 105 haematological cancer patients ere included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality﹣of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
Conclusions: Psychological treatment along with medication and intervention should be implemented to improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer patients.
Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life

Matched MeSH terms: Hematologic Neoplasms/complications
Fulltext Quality of life among patients with hematological cancer in a Malaysian hospital

Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K

Med J Malaysia, 2011 Jun;66(2):117-20.
PMID: 22106690 MyJurnal

The aim of this study was to determine the prevalence of symptoms and problems in hospitalized hematological cancer patients. A cross-sectional design was carried out with 105 respondents in Ampang hospital in Kuala Lumpur. The European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) was used. Patients with a minimum response of "a little" were defined as having a symptom/problem while patients with a response of "quite a bit" were classified as having a "severe symptom/problem". The four most prevalent symptoms/problems identified were fatigue, financial difficulties, reduced role function and reduced social function. Multiple myeloma patients (MM) were identified as having the most symptoms/problems.

Matched MeSH terms: Hematologic Neoplasms/complications*
Fulltext Assessment of depression and anxiety in haematological cancer patients and their relationship with quality of life

Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K

East Asian Arch Psychiatry, 2011 Sep;21(3):108-14.
PMID: 21921304

Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
Results: A total of 105 haematological cancer patients were included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
Conclusions: Psychological treatment along with medication and intervention should be implemented to
improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer
patients.
Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life

Matched MeSH terms: Hematologic Neoplasms/complications
Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on diagnosis and antimicrobial utilization in patients with high-risk febrile neutropenia

Koh KC, Slavin MA, Thursky KA, Lau E, Hicks RJ, Drummond E, et al.

Leuk Lymphoma, 2012 Oct;53(10):1889-95.
PMID: 22448920 DOI: 10.3109/10428194.2012.677533

Early and targeted antimicrobial therapy improves outcomes in patients with febrile neutropenia (FN). We evaluated the impact of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) on antimicrobial utilization in the management of FN. A cohort of patients with FN and hematological malignancy was identified. Cases (in whom FDG-PET was performed, n = 37) were compared with controls (in whom conventional investigations excluding FDG-PET were performed, n = 76). An underlying cause for FN was determined in 94.6% of cases, compared to 69.7% of controls. FDG-PET had a significant impact on antimicrobial utilization compared to conventional imaging (35.1% vs. 11.8%; p = 0.003), and was associated with shorter duration of liposomal amphotericin-B therapy for systemic fungal infection (median 4.0 days cases vs. 10.0 days controls; p = 0.001). Cases had a longer length of hospitalization (p = 0.016). In the management of patients with high-risk FN, FDG-PET improves diagnostic yield and allows rationalization of antifungal therapy. The impact upon healthcare costs associated with antimicrobial therapy for FN requires further evaluation.

Matched MeSH terms: Hematologic Neoplasms/complications
Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients

Baskaran ND, Gan GG, Adeeba K

Ann Hematol, 2008 Jul;87(7):563-9.
PMID: 18437382 DOI: 10.1007/s00277-008-0487-7

The purpose of this study was to determine if the Multinational Association for Supportive Care in Cancer (MASCC) risk-index score is able to predict the outcome of febrile neutropenia in patients with underlying hematological malignancy and to look at the other possible predictors of outcome. A retrospective study of 116 episodes of febrile neutropenia in patients who were admitted to the hematology ward of a local medical center in Malaysia between January 1st 2004 and January 31st 2005. Patient characteristics and the MASCC score were compared with outcome. The MASCC score predicted the outcome of febrile neutropenic episodes with a positive predictive value of 82.9%, a sensitivity of 93%, and specificity of 67%. Other predictors of a favorable outcome were those patients who had lymphomas versus leukemias, duration of neutropenia of less than 7 days, low burden of illness characterized by the absence of an infective focus and absence of lower respiratory tract infection, a serum albumin of >25 g/l, and the absence of gram-negative bacteremia on univariate analysis but only serum albumin level, low burden of illness, and presence of respiratory infection were significantly associated with unfavorable outcome after multivariate analysis. The MASCC score is a useful predictor of outcome in patients with febrile neutropenia with underlying hematological malignancies. This scoring system may be adapted for use in local settings to guide the clinical management of patients with this condition.

Matched MeSH terms: Hematologic Neoplasms/complications*