Background. The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Patients and Methods. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category (,400 m vs. $400 m) and the change in 6MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. Results. Compared with ,400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96)
Objective: To analyze the relationship between platelet counts, the intensities of physical therapies (PT) and occupational therapies (OT) services received, and the frequency of bleeding complications in children undergoing hematopoietic stem cell transplants (HSCT) during a period of severe thrombocytopenia. Design: Retrospective review study Setting: Tertiary care hospital Participants: Children (age <18) hospitalized for HSCT in 2010 and 2011 who received PT and OT services while markedly thrombocytopenic (platelets≤50K/mcL). Interventions: None Main Outcome Measures: Intensities of PT and OT interventions, the patients’ platelet counts on specific therapy days and any bleeding events (minor or major) that occurred during or briefly following rehabilitation interventions. Results: Sixty-two patients (accounting for sixty-three HSCTs) met the criteria for analysis. Fifty-six of these patients (fifty-seven HSCTs) underwent PT and/or OT while markedly thrombocytopenic. There was no correlation between the platelet count and the intensity of rehabilitation interventions. There were no major bleeding events. There was no association between minor bleeding and intensities of PT or OT interventions and no association between minor bleeding events and platelet counts. Only 5 minor bleeding events occurred during or following moderate or intensive therapy out of 346 PT and OT sessions (1.5%). Conclusion: The results of our study suggest that bleeding complications during or following mobilization and supervised exercise during PT and OT in children with severe thrombocytopenia undergoing HSCT are minor and relatively rare. These are encouraging results for both patients and rehabilitation specialists treating this population who is at high risk for developing immobility related complications.
These high risk class 3 also received hydroxyurea 20 mg/kg/ d for at least 3 months prior to HSCT. All pts received 2 courses of pre-transplant immunosuppression (PTIS) consisting of fludarabine (Flu) 40 mg/m 2 /d together with dexamethasone (dex) 25 mg/m 2 /d for 5 days. After 2 courses of PTIS, all pts received a reduced-toxicity conditioning regimen consisting of thymoglobulin 1.5 mg/kg/d (d-11 to d-9), Flu 35 mg/m 2 /d i.v. (-7 to -2) each dose immediately followed by busulfan (Bu) 130 mg/m 2 once daily i.v. (d-7 to d-4) for pts > 10 years and 0.95-1.2 mg/kg every 6 hr (d-7 to d-4) for pts < 10 yrs. GVHD prophylaxis consisted of cyclophosphamide (Cy) 50 mg/kg/d (d+3 to d+4). Tacrolimus was given for 6 months to 1 yr started together with mycophenolate mofetil on d+5, the latter was quickly tapered after 2 months. T-cell repleted peripheral blood stem cells were given to all pts targeting a CD34+ dose of 7-10 x 10 6 cells/kg. Results: Fourteen of 15 were engrafted with full donor chimerism (100%) while one pt suffered graft failure. However, this pt received second transplant on day +30 with minimal conditioning regimen and additional PBSC, after which she achieved full donor chimerism. The median time to neutrophil engraftment was 18 days (range; 14 -22). Six pts had acute GVHD gr I, 3 grade II and1 gr III. Only one had limited chronic GVHD. At this time, all 15 pts survive thalassemia-free and have sustained full donor chimerism (100%). The thalassemia free survival and overall survival rates are 100%. The median follow up time was 12 months (range 4-22). Conclusion: Haplo-SCT for high risk thalassemia pts with our novel approach is safe, and should be considered as a modality to secure thalassemia-free survival with a low risk of graft rejection and treatment-related mortality. With this result, our Haplo-SCT in thalassemia pts has favorable outcome as related and unrelated HSCT (thalassemia free survival rate > 90%). In view of our results, we suggest that all thalassemia pts even those with high risk class 3 features should be offered the chance for cure with HSCT.Background: Identification of patients at high risk of hematopoietic cell transplantation (HCT)-related complications
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