Supportive care during pediatric hematopoietic stem cell transplantation: beyond infectious diseases. A report from workshops on supportive care of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Nava, Tiago; Ansari, Marc; Dalle, Jean Hugues; Heredia, Cristina Diaz de; Güngör, Tayfun; Trigoso, Eugenia; Falkenberg, Ulrike; Bertaina, Alice; Gibson, Brenda; Jarisch, Andrea; Balduzzi, Adriana; Boenig, Halvard; Kriván, Gergely; Vettenranta, Kim; Matić, Toni; Buechner, Jochen; Kałwak, Krzysztof; Lawitschka, Anita; Yeşilipek, Akif; Lucchini, Giovanna; Peters, Christina; Turkiewicz, Dominik; Niinimäki, Riitta; Diesch, Tamara; Lehrnbecher, Thomas; Sedláček, Petr; Hutt, Daphna; Dalissier, Arnaud; Wachowiak, Jacek; Yaniv, Isaac; Stein, Jerry; Yalçın, Koray; Sisinni, Luisa; Deiana, Marco; Ifversen, Marianne; Kuhlen, Michaela; Meisel, Roland; Bakhtiar, Shahrzad; Cesaro, Simone; Willasch, André; Corbacioglu, Selim; Bader, Peter

doi:10.1038/s41409-020-0818-4

Cited by 24 publications

(28 citation statements)

References 57 publications

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“…They may also interfere with a patient’s ability to enjoy life and perform general activities, two of the most common symptom-related interferences experienced by patients following transplantation in this study. Overall, the observations presented above and combined with the increase in the number of AYA patients experiencing most of the symptoms after transplantation agrees with the literature that HSCT is associated with a high symptom burden that spans physical and psychological manifestations [ 1 , 2 , 3 ]. The importance of early recognition of symptoms is underlined by the potentially negative impact on quality of life, especially in the early stages of recovery [ 1 ].…”

Section: Discussionsupporting

confidence: 89%

“…Patients receive chemotherapy as well as numerous other medications and can experience complications that affect their ability to perform activities of daily living [ 1 ]. In the period surrounding HSCT, patients often have symptoms such as painful mucositis, infection, fatigue, nausea/vomiting, decreased appetite, and psychological stress [ 2 , 3 ]. This symptom burden can lead to significant distress and reduce patients’ quality of life [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients

et al. 2021

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Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period surrounding transplant as well as during long-term recovery. The MD Anderson Symptom Inventory (MDASI) is a symptom-reporting survey that has been successfully used in adult patients with cancer and may have utility in the adolescent and young adult (AYA) population. At the Children’s Cancer Hospital at MD Anderson Cancer Center, we adopted a modified version of the MDASI, the MDASI-adolescent (MDASI-Adol), as a standard of care for clinical practice in assessing the symptom burden of patients in the peri-transplant period. We then conducted a retrospective chart review to describe the clinical utility of implementing this symptom-screening tool in AYA patients admitted to our pediatric stem cell transplant service. Here, we report our findings on the symptom burden experienced by pediatric and AYA patients undergoing stem cell transplantation as reported on the MDASI-Adol. Our study confirmed that the MDASI-Adol was able to identify a high symptom burden related to HSCT in the AYA population and that it can be used to guide symptom-specific interventions prior to transplant and during recovery. Implementing a standard symptom-screening survey proved informative to our clinical practice and could mitigate treatment complications and alleviate symptom burden.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients

et al. 2021

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“…Enteral nutrition is generally encouraged in order to preserve the natural microbiota, thus reducing the risk of graft vs. host disease (GvHD) and possibly the speed of platelet recovery ( 20 ). Conditioning-associated nausea and mucositis generally leads to a reduction in the appetite and oral food intake during HSCT, especially during the neutropenic phase ( 4 ). Traditionally, certain dietary items have been widely restricted to reduce the risk of introducing harmful food-borne microorganisms to the HSCT patient (“neutropenic diet”), which is increasingly questioned.…”

Section: Dietary Restriction During Admissionmentioning

confidence: 99%

“…The work was based on repeated focused meetings of the board of PDWP and experts within the fields of pediatric HSCT: Different topics on supportive care were each prepared and finalized by a sub-committee within a total of three meetings held between October 2017 and November 2018 as detailed in the initial paper by Nava et al ( 4 ). Briefly, prior to the initial meeting experts from each sub-committee reviewed the literature and presented during the first meeting a list of issues to be addressed and a draft proposal for the structure and major content of a consensus statement.…”

Section: Introductionmentioning

confidence: 99%

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

et al. 2021

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Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

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“…Definitions of CMV infection and disease were initially developed and published as part of the proceedings of the 4th International CMV Conference in Paris in 1993 and have been progressively updated, most recently in 2020 (42)(43)(44)(45).…”

Section: Definitions Regarding CMV Infectionmentioning

confidence: 99%

Cytomegalovirus in Haematological Tumours

et al. 2021

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The exquisite coupling between herpesvirus and human beings is the result of millions of years of relationship, coexistence, adaptation, and divergence. It is probably based on the ability to generate a latency that keeps viral activity at a very low level, thereby apparently minimising harm to its host. However, this evolutionary success disappears in immunosuppressed patients, especially in haematological patients. The relevance of infection and reactivation in haematological patients has been a matter of interest, although one fundamentally focused on reactivation in the post-allogeneic stem cell transplant (SCT) patient cohort. Newer transplant modalities have been progressively introduced in clinical settings, with successively more drugs being used to manipulate graft composition and functionality. In addition, new antiviral drugs are available to treat CMV infection. We review the immunological architecture that is key to a favourable outcome in this subset of patients. Less is known about the effects of herpesvirus in terms of mortality or disease progression in patients with other malignant haematological diseases who are treated with immuno-chemotherapy or new molecules, or in patients who receive autologous SCT. The absence of serious consequences in these groups has probably limited the motivation to deepen our knowledge of this aspect. However, the introduction of new therapeutic agents for haematological malignancies has led to a better understanding of how natural killer (NK) cells, CD4+ and CD8+ T lymphocytes, and B lymphocytes interact, and of the role of CMV infection in the context of recently introduced drugs such as Bruton tyrosine kinase (BTK) inhibitors, phosphoinosytol-3-kinase inhibitors, anti-BCL2 drugs, and even CAR-T cells. We analyse the immunological basis and recommendations regarding these scenarios.

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Supportive care during pediatric hematopoietic stem cell transplantation: beyond infectious diseases. A report from workshops on supportive care of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Cited by 24 publications

References 57 publications

Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients

Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Cytomegalovirus in Haematological Tumours

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