Palestinian Children in the Hemato-Oncology Ward of an Israeli Hospital

Purpose An encounter between Palestinian parents of children with cancer and Israeli medical staff is a very special situation where “potential enemies” interact in a caring, trusting and intimate relationship for long periods of time. Our aim was to study the psychological and cultural encounter in order to understand the dynamics involved. Method The study is a qualitative one. Data was collected by way of structured in-depth interviews. Participants were physicians and nurses employed in the department, and Palestinian parents accompanying their children who were hospitalized during the research period. Results Six main themes emerged from the analysis of the interviews: (1) The decision to come to Israel for treatment. (2) The “meeting points” of the two peoples: the Israeli check points and the Palestinian Authority permits. (3) Encounter with the Israeli hospital. (4) Relationship between medical staff and parents. (5) Language and cultural barriers. (6) Emotions, thoughts and behaviors during high security tension. Conclusion The interviews depict a poignant picture of the unique encounter between Israeli Doctors and nurses and Palestinian parents. The psychological mechanism used by parents and doctors is “splitting”-having a dichotomized, simple emotional-perceptual picture of a situation with no conflicts. Nurses use another psychological mechanism in addition which enables them to contain the paradox and the conflict

Successful umbilical cord blood transplantation for Fanconi anemia using preimplantation genetic diagnosis for HLAmatched donor

Fanconi anemia is a rare autosomal recessive disease characterized by bone marrow failure, developmental anomalies, and a high incidence of myelodysplasia and acute myeloid leukemia. Stem cell transplantation is the only curative treatment. In the absence of matched-sibling donor, an alternative mismatched family or matched unrelated donor can be used, but the results are inferior to the matched-sibling transplant and carry a high risk of morbidity and mortality. Preimplantation genetic diagnosis (PGD) has been increasingly used in recent years for mutation analysis for many genetic disorders and results in the birth of healthy children, saving the need for the termination of pregnancy of an affected embryo. The use of PGD for combined analysis of mutation and HLAmatching was reported for the first time in 2001. This enables the birth of an unaffected child who can serve as a donor for an affected sibling in need for stem cell transplantation. We report successful cord blood transplantation for a Fanconi anemia patient from his HLA-matched sibling, born after PGD that included mutation analysis for Fanconi anemia and HLA typing. PGD can provide an unaffected donor for a sibling affected by genetic disease in the absence of a compatible related donor. Am

The Kinetics of Early T and B Cell Immune Recovery after Bone Marrow Transplantation in RAG-2-Deficient SCID Patients

The kinetics of T and B cell immune recovery after bone marrow transplantation (BMT) is affected by many pre- and post-transplant factors. Because of the profoundly depleted baseline T and B cell immunity in recombination activating gene 2 (RAG-2)-deficient severe combined immunodeficiency (SCID) patients, some of these factors are eliminated, and the immune recovery after BMT can then be clearly assessed. This process was followed in ten SCID patients in parallel to their associated transplant-related complications. Early peripheral presence of T and B cells was observed in 8 and 4 patients, respectively. The latter correlated with pre-transplant conditioning therapy. Cells from these patients carried mainly signal joint DNA episomes, indicative of newly derived B and T cells. They were present before the normalization of the T cell receptor (TCR) and the B cell receptor (BCR) repertoire. Early presentation of the ordered TCR gene rearrangements after BMT occurred simultaneously, but this pattern was heterogeneous over time, suggesting different and individual thymic recovery processes. Our findings early after transplant could suggest the long-term patients' clinical outcome. Early peripheral presence of newly produced B and T lymphocytes from their production and maturation sites after BMT suggests donor stem cell origin rather than peripheral expansion, and is indicative of successful outcome. Peripheral detection of TCR excision circles and kappa-deleting recombination excision circles in RAG-2-deficient SCID post-BMT are early markers of T and B cell reconstitution, and can be used to monitor outcome and tailor specific therapy for patients undergoing BMT

The clinical features of the SCID patients and their specific RAG2 genetic defect.

<p>SCID – severe combined immunodeficiency.</p

BCR rearrangement analysis and clinical outcome.

<p>Two different IgH BCR gene rearrangements (FR2 and FR3) were PCR amplified followed by Gene Scan analysis in all studied patients 2–4 months post-bone marrow transplant (BMT) and in an age-matched healthy control (a). Parallel detection of KREC levels and the FR3 IgH BCR gene rearrangement were PCR amplified, followed by RQ-PCR analysis (KREC) or by Gene Scan analysis (BCR repertoire) in patients #7 (upper panel) and #8 (lower panel) from the time of BMT and up to one year post-transplant. For KREC, both signal joint and coding joint were examined (b).</p

Early presence of KREC and transplant-related morbidity.

<p>KREC signal joint (sj) copies were detected in all studied patients (#1–#10) at either 2–4 months (a) or various time lengths (b) post-bone marrow transplant (BMT). KREC copies were determined by real-time quantitative (RQ) PCR and calculated by comapring the obtained cycle threshold (Ct) for each patient to the Ct of the same patient's KREC levels before undergoing BMT, using the ΛΛCt relative quantification analysis. The percent ratios between KREC-cj copies and KREC-sj copies were measured in patients with early presentation of KRECs (#7–#10) (c). Four age-matched healthy individuals were used as controls. Each sample was detected in triplicate in all experiments.</p

Characteristics of the BMT procedure and its related complications.

<p>MRD - match related donors, MUD - match unrelated donor, MMRD - mismatch related donor, Bu – Busulfan, Cy – cyclophosphamide, ATG – anti thymocytes globulin, Tre – Treosulfan, Flu – Fludarabine, Thi – Thiotepa, Mel – melphalan, PBSC –peripheral blood stem cells, BM – Bone marrow, UCB – Umbilical cord blood, CSA – Cyclosporin, MTX – methotrexate, MMF – mycophenolate mofetil.</p