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Introduction Caregivers of patients undergoing hematopoietic stem cell transplantation need encouragement to maintain their own wellbeing. This feasibility study explored a six-session wellness intervention for caregivers entitled Ready to CARE (Connect, Actively Relax, and Exercise). Method This study used a single-arm pre–post design to explore the feasibility and acceptability of the intervention and study procedures. The individual, participant-directed intervention was initiated at hospitalization for stem cell reinfusion. Caregivers completed telephone surveys on four occasions and engaged in one semi-structured interview to share their perceptions of the intervention. Results Twenty participants enrolled and completed the baseline survey, with 50%, 90%, and 80% completing the subsequent three surveys, respectively. Seventy-four percent completed all six sessions of the intervention. Caregivers most often used the sessions to set goals related to physical activity (36%), stress management (14%), sleep (13%), and caregiving tasks (11%). Caregivers reported appreciation of the intervention’s focus on supporting caregivers, taking action with goal-setting, and allowing caregivers to determine the focus of the goals. Scheduling the sessions was the most problematic aspect of the intervention. Conclusion While caregivers were open to a wellness intervention, a high degree of flexibility and tailoring is needed to engage and support busy caregivers. Clinical Trial Registration: NCT03210727

Date Presented 03/28/20 HSCT is a lengthy and debilitating cancer treatment. Caregivers of HSCT recipients report distress and reductions in their own self-care. A caregiver wellness intervention based on behavioral activation was developed and implemented in order to assess its feasibility and acceptability. Future research will explore the efficacy of the intervention, which is well-suited for delivery by OTs working in cancer rehabilitation. Primary Author and Speaker: Jamme Morency Additional Authors and Speakers: Kathleen Lyons Contributing Authors: Lynn Root, Kate Caldon, Christi Hayes, Susan Brighton

Donor cell leukemia (DCL) represents a rare complication of allogeneic transplantation. The precise incidence remains unclear, though it may be higher following umbilical cord blood transplants. Here, we present an unusual case of a patient with B-ALL who presented with a donor derived myeloid sarcoma of the heart following a double cord blood transplant. To our knowledge, it is the first case of sarcomatous or chloromatous presentation of DCL following a UCBT.

Extracorporeal photopheresis (ECP) is an established therapy for the treatment of graft-versus-host-disease (GVHD) following an allogeneic stem cell transplant. We performed a prospective analysis of patients receiving ECP treatment for GVHD to identify a clinical pathway and resource utilization of this process. The cohort included consecutive allogeneic stem cell recipients with GVHD. ECP was performed using the CELLEX Photopheresis System or the UVAR XTS Photopheresis System (Therakos, Inc, Exton, PA). A clinical pathway was developed and a time and motion study was conducted to define the resource utilization and costs associated with ECP. Patients were treated with either CELLEX (n = 18 procedures) or UVAR (n = 4 procedures). Total time commitment for each procedure for the 2 machines differed. The time for ECP was 117 min (median, range: 91-164 min) using CELLEX and 161 min (median; range: 140-210) using the UVAR-XTS machine. Total costs of each ECP procedure were $3420.50. There is a considerable time commitment of the patient and the clinical staff when employing ECP to treat GVHD. ECP costs are significant considering this is a prolonged therapy continued for several months. With this finalized pathway and costs, we have a standardized clinical pathway for the treatment of GVHD. We are addressing minimizing resource utilization while emphasizing quality care for these patients.

Background Patient-reported outcomes (PROs), including symptoms and quality of life (QOL) measures capture the patient-centered experience of hematopoietic stem cell transplantation (HSCT). They enhance patient-provider communication and allow for symptom intervention. PROMIS-29 is one of the NIH developed and validated tools for collecting PROs. It examines 7 domains: physical function, anxiety, depression, fatigue, sleep disturbance, social participation, and pain interference. We have piloted its use in the HSCT patients. Methods Twenty five patients both pre- and post- hematopoietic stem cell transplantation (allogeneic, n = 14; autologous, n = 11) were surveyed using the PROMIS 29 scale. Patients ranged from 4.6 months pre-transplant to 5.8 years post-transplant. The patients completed the PROMIS-29 survey in the waiting room prior to their scheduled appointments. Results The top three reported concerns were decreased physical function (38.5%), fatigue (30.8%) and pain (20%). Fatigue remained a prominent complain with patients commonly reporting moderate to severe fatigue post-transplant. Strikingly, patients reported fatigue commonly whether they were within a year of their transplant or several years out from their transplant. Conclusions PROs, such as PROMIS-29, provide valuable insight into the HSCT patient experience and QOL. Our pilot data, demonstrates that these symptoms can persist long after the patient has been cured of their hematologic malignancy. We are broadening the implementation of this survey to capture all HSCT recipients. We plan to use the results to enhance communication at our outpatient visits. We also plan to use the aggregated data to define areas for future intervention to help our patients cope following transplantation.