Pediatric Bone Marrow Transplantation: Psychopathologic Features in Recipients a Long with Siblings

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Evaluation of Drug-Related Problems in a Pediatric Bone Marrow Transplantation Unit Identified by a Clinical Pharmacist in-training in a 7-Month Period

Objective: This cross sectional study was performed to demonstrate the importance of clinical pharmacists’ participation in pediatric hematopoietic stem cell transplantation patient management with regards to the detection, prevention, and management of drug-related problems.Methods: The study was carried out from 1st October 2015 to 1st May 2016 in a pediatric bone marrow transplantation unit of a tertiary care hospital. The inpatients and outpatients between 0 to 18 years of age were included and the patients were monitored and evaluated for drug-related problems (interactions, side effects, preparation, and administration). A clinical pharmacist-in-training made recommendations to the physicians and the nurses on the problems that were identified.Results: Twenty inpatients and twenty-two outpatients were monitored during the study. In total, 245 problems were identified in the inpatients, 37.14 % of which were drug-related; 33 % of the drug-related problems were the side effects of cyclosporine. Eleven recommendations on drug-related problems were made to the physicians and six of them were for the problems identified in the inpatient services with regards to drug dosing and administration. Five recommendations regarding total parenteral nutrition, drug incompatibility, drug administration from the feeding tube, and drug side effects were made to the nurses. Twenty-nine information on the dosing, side effects, incompatibilities, administration, and preparation of the drugs, were given by the pharmacist to the physicians and the nurses.Conclusion: Clinical pharmacists’ participation will improve the detection and the management of drug-related problems in pediatric hematopoietic stem cell transplantation units in TurkeyDiğe

Vancomycin-Resistant Enterococcus Bacteremia in A Child With Acute Myeloid Leukemia: Successful Treatment With Daptomycin

Multiple-drug-resistant enterococcal infections canbe a serious problem in pediatric patients particularly concomitance with severe underlying diseases and lead to significant morbidity and mortality. The treatment options in children are limited compared with adults. We report a 3-year old-boy with acute myeloid leukemia (AML)-M7 and vancomycin-resistant enterococcus bacteremia successfully treated with daptomycin. Daptomycin may be an alternative therapy for VRE infections in children; more studies are needed for extended usage

Successful Outcome With Second Hematopoietic Stem Cell Transplantation in A Patient With IL-10R Deficiency

nterleukin-10 (IL-10) and IL-10 receptor (IL-10R) deficiencies, which are caused by loss of function mutations in the related genes, are primary immunodeficiencies that result in severe dysregulation of the immune system.1, 2 Patients usually present early in life with an inflammatory bowel disease-like phenotype accompanied with severe perianal disease. Other clinical features of the disease are chronic folliculitis, recurrent respiratory diseases and arthritisWo

A Phase II, Multicenter, Single-Arm Study to Evaluate the Safety and Efficacy of Deferasirox after Hematopoietic Stem Cell Transplantation in Children with Beta-Thalassemia Major

We conducted a prospective, phase II, multicenter, single-arm study to evaluate the efficacy and safety of deferasirox in patients age >2 to 1000 mu g/L; cardiac MRI T2* = 5 mg/g). Patients received deferasirox at an initial dose of 10 mg/kg/day, with up-titration to a maximum of 20 mg/kg/day. The study continued for 52 weeks and included a total of 27 patients (mean age, 9.1 +/- 3.8 years; 70.4% male). One patient (3.7%) was lost to follow-up. The majority of patients (n = 20; 74.1%) were able to achieve the intended dose of 20 mg/kg/day. No deaths occurred. A total of 134 adverse events (AEs) were reported in 25 patients (92.6%) during the study. The majority of patients had grade 1 or 2 AEs, with only 8 patients (29.6%) experiencing grade 3 AEs. Only 10 AEs occurring in 4 patients (14.8%) were suspected to be related to deferasirox (ALT/AST increase, n = 4; urinary tract infection, n = 1). The deferasirox dose had to be adjusted or interrupted for 6 AEs occurring in 4 patients (14.8%). A total of 6 serious AEs occurred in 3 patients (11.1%), none of which were suspected to be related to deferasirox. From baseline to week 52, there were decreases in median concentrations of alanine aminotransferase (ALT), from 30.0 to 17.0 IU/L, and aspartate aminotransferase (AST), from 35.5 to 26.0 IU/L. Median serum creatinine and cystatin C concentrations were similar at baseline and week 52. There was a continuous and significant decrease in median serum ferritin level from 1718.0 mu g/L at baseline to 845.3 mu g/L following 52 weeks of therapy (P<.001); 9 patients (33.3%) achieved a level of <500 mu g/L. There was also a significant decrease in median LIC (from 8.6 to 4.1 mg/g; P<.001) and an increase in median cardiac T2* (from 26.0 to 28.0 ms; P=.520) from baseline to week 52. Our findings indicate that deferasirox treatment at doses up to 20 mg/kg/day reduces the iron burden in children with TM post-HSCT, with a manageable safety profile. (C) 2017 American Society for Blood and Marrow Transplantation.WoSScopu

Course of IL-2-inducible T-cell kinase deficiency in a family: lymphomatoid granulomatosis, lymphoma and allogeneic bone marrow transplantation in one sibling; and death in the other

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Human Bone Marrow Mesenchymal Stem Cells Secrete Endocannabinoids That Stimulate in Vitro Hematopoietic Stem Cell Migration Effectively Comparable To Beta-Adrenergic Stimulation

Granulocyte colony-stimulating factor (G-CSF) is a well-known hematopoietic stem cell (HSC)-mobilizing agent used in both allogeneic and autologous transplantation. However, a proportion of patients or healthy donors fail to mobilize a sufficient number of cells. New mobilization agents are therefore needed. Endocannabinoids (eCBs) are endogenous lipid mediators generated in the brain and peripheral tissues and activate the cannabinoid receptors CB1 and CB2. We suggest that eCBs may act as mobilizers of HSCs from the bone marrow (BM) under stress conditions as beta-adrenergic receptors (Adrβ). This study demonstrates that BM mesenchymal stem cells (MSCs) secrete anandamide (AEA) and 2-arachidonylglycerol (2-AG) and the peripheral blood (PB) and BM microenvironment contain AEA and 2-AG. 2-AG levels are significantly higher in PB of the G-CSF-treated group compared with BM plasma. BM mononuclear cells (MNCs) and CD34+ HSCs express CB1, CB2, and Adrβ subtypes. CD34+ HSCs had higher CB1 and CB2 receptor expression in G-CSF-untreated and G-CSF-treated groups compared with MSCs. MNCs but not MSCs expressed CB1 and CB2 receptors based on qRT-PCR and flow cytometry. AEA- and 2-AG-stimulated HSC migration was blocked by eCB receptor antagonists in an in vitro migration assay. In conclusion, components of the eCB system and their interaction with Adrβ subtypes were demonstrated on HSCs and MSCs of G-CSF-treated and G-CSF-untreated healthy donors in vitro, revealing that eCBs might be potential candidates to enhance or facilitate G-CSF-mediated HSC migration under stress conditions in a clinical setting.Wo

Effects of Multimodal Exercise on Clinical Status and Patient-Reported Outcomes in Children Undergoing Hematopoietic Stem Cell Transplantation.

There are limited data available regarding effectiveness of exercise training in children undergoing hematopoietic stem cell transplantation (HSCT). We aimed to investigate effects of multimodal exercise program on clinical status and patient-reported outcomes including pain, fatigue, depression, and quality of life (QOL) level of children and their parents' QOL level. Twenty-six children undergoing HSCT participated in this study. Clinical status, pain, fatigue, depression, and QOL level of children were assessed three times: before HSCT, at discharge, and one month later. For intervention group (IG, n = 15), multimodal exercise program was performed five days a week, throughout hospitalization and children were advised to continue exercise program at home. For control group (CG, n = 11), being active as much as possible was advised. The number of painful day and pain intensity was significantly lower in IG than in CG during hospitalization (p < .05). Depression level decreased in IG at the time points (p ˂ .05); however, there was no significantly difference between groups. The QOL level was higher in IG than CG only at control measurements (p ˂ .05). In addition, QOL level of the parents decreased in both groups (p ˂ .05). There was no statistically difference between groups in terms of other clinical variables. The multimodal supervised exercise program has positive effects on children's pain and QOL level. Exercise program was also well tolerated by children during hospitalization. In addition, QOL levels of the parents were also negatively affected during hospitalization, and interventions aiming to increase QOL level of the parents should be considered.Wo