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The article presents a study, which describes the risk magnitude in individuals, who survived a year or more following a hematopoietic cell transplantation (HCT). Result shows that the avascular necrosis (AVN) is considered a debilitating condition reported following a chronic steroid use. It is concluded that AVN is expected to develop targeted interventions in such a way that chronic debilitating condition can be prevented.

Background: The authors investigated the risk of delayed chronic kidney disease (CKD) in 1190 adult hematopoietic cell transplantation (HCT) survivors who underwent HCT for hematologic malignancies or aplastic anemia between 1976 and 1997 and survived for at least 1 year.Methods: CKD was defined as a sustained elevation of serum creatinine that indicated a glomerular filtration rate of <60 mL per minute per 1.73 m2 for > or =3 months. The median age at HCT was 35 years (range, 18.1-68.6 years), and the median length of follow-up was 7.1 years after HCT (range, 1-24.3 years).Results: Sixty patients with CKD were identified, resulting in a cumulative incidence of 4.4% at 5 years (autologous HCT, 3.8%; matched-sibling HCT, 4.5%; unrelated donor HCT, 10%; P = .09 compared with autologous HCT). Older age at HCT (relative risk [RR] per 5-year increment, 1.33; 95% confidence interval [CI], 1.2-1.5), exposure to cyclosporine without tacrolimus (RR, 1.90; 95% CI, 1.1-3.4) or with tacrolimus (RR, 4.59; 95% CI, 1.8-11.5), and a primary diagnosis of multiple myeloma (RR, 2.51; 95% CI, 1.1-5.6) were associated with an increased risk of delayed CKD.Conclusions: In this study, the authors identified a subpopulation of patients who underwent HCT and remained at increased risk for CKD. The current findings set the stage for appropriate long-term follow-up of vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of the current study was to determine whether the use of hematopoietic stem cell transplantation (HCT) to treat leukemia, lymphoma, or multiple myeloma (MM) differs by race and sex.Methods: The annual incidence of leukemia, lymphoma, and MM was estimated in the United States in people aged <70 years by race and sex using the Surveillance, Epidemiology, and End Results (SEER) cancer registry between 1997 and 2002 and US census reports for the year 2000. The annual incidence of autologous, human leukocyte antigen (HLA) identical sibling, and unrelated HCT performed in these groups was estimated using Center for International Blood and Marrow Transplant Research data from 1997 through 2002. Logistic regression analysis was used to calculate the age-adjusted odds ratio (OR) of receiving HCT for Caucasians versus African Americans and for men versus women.Results: The likelihood of undergoing HCT was found to be higher for Caucasians than for African Americans (OR, 1.40; 95% confidence interval [95% CI], 1.34-1.46). This difference existed for each type of HCT: autologous (OR, 1.24; 95% CI, 1.19-1.30), HLA identical sibling (OR, 1.59; 95% CI, 1.46-1.74), and unrelated donor (OR, 2.02; 95% CI, 1.75-2.33). Overall, men were more likely than women to receive HCT (OR, 1.07; 95% CI, 1.05-1.1 [P<.0001]); however, this difference was found to be significant only for autologous HCT (OR, 1.10; 95% CI, 1.07-1.13 [P<.0001]).Conclusions: HCT is more frequently used to treat leukemia, lymphoma, and MM in Caucasians than in African American individuals. African Americans have lower rates of both autologous and allogeneic HCT, indicating that donor availability cannot fully explain the differences. Women are less likely than men to receive autologous HCT for reasons unexplained by age or disease status. [ABSTRACT FROM AUTHOR]

The article offers information on a study which examined whether the employment of hematopoietic stem cell transplantation (HCT) to treat leukemia, lymphoma or multiple myeloma (MM) differs by race and sex. Data analyzed were from the Surveillance, Epidemiology and End Results (SEER) cancer registry between 1997 and 2002 and U.S. census reports for 2000. A discussion on the research findings is detailed. It concludes that Caucasians more often receive HCT and that African Americans have lower incidences of both autologous and allogeneic HCT.

Abstract: Outcome disparity associated with race or ethnicity in the United States has been observed in hematopoietic cell transplantation (HCT). The underlying reasons for such disparity are not known. In the United States, an optimal study of health care disparity by race or ethnicity involves consideration of both biologic and psychosocial determinants, which requires an adequately powered, prospective cohort study design. To better characterize the nature and quantify the magnitude of the many impediments relevant to conducting a successful prospective study involving racial or ethnic minorities in HCT, we conducted a feasibility study to help guide planning of a larger scale outcome and disparity study in HCT. The primary questions to be addressed in the study were: (1) can we establish a racially or ethnically diverse patient sample that will respond to a survey focused on sociodemographic, economic, health insurance, cultural, spiritual, and religious well-being, and social support information? (2) What is the retention rate in the study over time? (3) What is the quality of the data collected from the patients over time? The challenges we faced in conducting this multicenter feasibility study are summarized in this report. Despite the difficulty in conducting disparity studies in racial and ethnic minorities, such studies are essential to ensure that people of all ethnic and racial backgrounds have the best chance possible of benefiting from HCT. [Copyright &y& Elsevier]

Abstract: We have reported a lower incidence of acute graft-versus-host disease (aGVHD) with a novel conditioning regimen using low-dose rabbit antithymocyte globulin (ATG; Thymoglobulin [TG]) with fludarabine and intravenous busulfan (FluBuTG). To assess further this single-center experience, we performed a retrospective matched-pair analysis comparing outcomes of adult patients transplanted using the FluBuTG conditioning regimen with matched controls from patients reported to the CIBMTR receiving a first allogeneic hematopoietic stem cell transplant (HCT) after standard oral busulfan and cyclophosphamide (BuCy). One hundred twenty cases and 215 matched controls were available for comparison. Patients receiving FluBuTG had significantly less treatment related mortality (TRM; 12% versus 34%, P < .001) and grades II-IV aGVHD (15% versus 34%, P < .001) compared to BuCy patients. The risk of relapse was higher in the FluBuTG patients (42% versus 20%, P < .001). The risks of chronic GVHD (cGVHD) and disease free survival (DFS) were similar in the cases and controls. These results suggest that the novel regimen FluBuTG decreases the risk of aGVHD and TRM after HLA-identical sibling HSCT, but is associated with an increased risk of relapse, resulting in similar DFS. Whether these conditioning regimens may be more suitable for specific patient populations based on relapse risk requires testing in prospective randomized trials. [Copyright &y& Elsevier]

Most childhood cancer survivors are at risk for late effects related to their cancer treatment, many of which can be serious or life-threatening. Therefore, a vital aspect of nursing care for this vulnerable population includes patient education regarding the importance of targeted health screening, protective health care interventions, and/ or modification of health behaviors in order to allow for early detection or prevention of late complications. A wealth of patient education materials for childhood cancer survivors is now available from the Children's Oncology Group. These materials provide comprehensive information regarding health risks and health protective behaviors and are specifically designed to accompany the Children's Oncology Group Long-Term Follow-Up Guidelines (available at www.survivorshipguidelines.org). Although we have found that these materials significantly enhance care provided in our long-term follow-up program, we have also found that their length and depth may present challenges to clinical application, particularly for patients with limited reading abilities or language barriers. To address this need, the City of Hope Childhood Cancer Survivorship Program has developed an innovative template that summarizes key information from these educational materials. Our template is arranged by system (e.g., ocular, auditory, cardiac) in modular format and includes visual cues (icons) and simple text to assist patients with retention of key content. By using information from our clinic's Microsoft Access© database, the nurse is able to use the template to easily generate a customized teaching tool for each survivor based on their treatment history. In order to meet the needs of our patient population, this teaching tool can be generated in both English and Spanish. The effectiveness of this innovative tool will be evaluated by determining patient adherence to recommended health screening and their understanding of recommended health practices. Childhood cancer survivors are heterogeneous in terms of age, diagnoses and treatment history. The nurse must therefore provide health education that is comprehensive yet individualized, memorable enough to impact patient recall and influence health behaviors, and streamlined enough to address major health risks in a reasonable timeframe. Use of this innovative teaching tool can assist in accomplishing these goals. [ABSTRACT FROM AUTHOR]