ISSN 1866-8836
Клеточная терапия и трансплантация

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Posttransplant care and rehabilitation: PC-01 – PC-05

PC-05. Alcohol-associated avascular bone necrosis. Case report

Vsevolod G. Potapenko1, Evgenij P. Burlachenko4, Alexej I. Berdes5, Inna M. Corablina3, Alexander I. Kazancev2, Sergey L. Vorobyev3

PC-04. Complications of central venous catheters in patients undergoing hematopoietic stem cell transplantation in Armenia

Taguhi J. Hovhannisyan1,2, Mane S. Gizhlaryan1,3, Armine H. Farmazyan2, Mira V. Saaryan2, Yervand K. Hakobyan2, Inga V. Khalatyan1,2, Lusine M. Krmoyan1,2, Mariam N. Fahradyan1,2, Vahe A. Mailyan4, Davit N. Dallaqyan4, Medea G. Anastasiadi1,2, Gevorg N. Tamamyan1,3, Samvel H. Danielyan4, Karen H. Meliksetyan2

PC-03. Role of medical nurse in observation and evaluation of the patients after CAR-T therapy

Natalya P. Gusleva, Olga O. Molostova, Olga V. Pimenova, Larisa N. Shelikhova, Michael A. Maschan

PC-02. Toxic skin lesions after chemotherapy and HSCT

Elvira A. Gasanova, Varvara N. Ovechkina, Nina N. Gurgenidze, Inga E. Zavodova, Anna A. Dotsenko, Tatyana A. Bykova

PC-01. Patient birthday celebration at the bone marrow transplant clinic during the COVID-19 pandemic

Rashida A. Bikulova, Anastasia A. Popova, Evgeniya S. Misyavichute, Svetlana I. Oleshko, Tatiana V. Kozlova, Angelica V. Pavlik, Alisa G. Volkova, Yulia A. Tarakanova, Galina N. Stolbenko

Posttransplant care and rehabilitation: PC-01 – PC-05

PC-05. Alcohol-associated avascular bone necrosis. Case report

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Vsevolod G. Potapenko1, Evgenij P. Burlachenko4, Alexej I. Berdes5, Inna M. Corablina3, Alexander I. Kazancev2, Sergey L. Vorobyev3

1 Municipal Clinical Hospital No.31, St. Petersburg, Russia
2 Municipal Polyclinic No.19, St. Petersburg, Russia
3 Natiоnal Center for Clinical Morphological Diagnostics, St. Petersburg, Russia
4 Medical center “Kardioklinika”, St. Petersburg, Russia
5 Orthopedic Clinic, Institute of Phthysiopulmonology, St. Petersburg, Russia


Correspondence:
Dr. Vsevolod G. Potapenko, phone: +7 (905) 284-51-38, e-mail: potapenko.vsevolod@mail.ru

Avascular necrosis of the bones (AN) can be induced by different factors. There are very few reports of alcohol-associated AN as a factor. We present a case report of the patient with alcohol-associated AN.

Case report

Male, 37 y.o., started regular strong drinks consumption. After two years pain in the right hip joint appeared. NSAIDs were taken daily. MRI scan revealed destruction of the right femoral bone head. After 7 months femoral spacer was implanted. The microscopic examination of the bone showed uneven osteolysis, weak osteoclastic reaction without osteoblastic proliferation, profound interbeam spaces fibrosis, and substitution of the bone marrow with fibrovascular tissue with mild local plasmocytic reaction. Plasma cells expressed CD138, but light chains restriction was not found. Alcohol consumption persisted and pain spread to knees, wrists and elbows. The pain was associated with movement. There was no local edema and swelling in affected joints. The patient was referred to a hematologist to exclude myeloma. CT scan revealed loosening and fragmentation of the right shoulder bone head and left femoral bone head with pseudoartrosis (Fig. 1, 2). The diagnosis of advanced avascular necrosis stage was suspected. Alcoholisation stopped and in a next 11 month joint pain resolved. Then alcohol consuption resumed but mainly with mild drinks (20 alcohol units per week). The pain didn`t recur during the next 30 months.

Potapenko-fig01-03.jpg

Figure 1. Pseudoarthrosis of the left hip joint. Head of the left femoral bone is fragmented

Potapenko-fig02-03.jpg

Figure 2. Avascular necrosis of right humeral bone head

Conclusion

Alcohol abuse can be the cause of bone avascular necrosis.

Keywords

Avascular necrosis, alcohol consumption, multiple myeloma.


Posttransplant care and rehabilitation: PC-01 – PC-05

PC-04. Complications of central venous catheters in patients undergoing hematopoietic stem cell transplantation in Armenia

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Taguhi J. Hovhannisyan1,2, Mane S. Gizhlaryan1,3, Armine H. Farmazyan2, Mira V. Saaryan2, Yervand K. Hakobyan2, Inga V. Khalatyan1,2, Lusine M. Krmoyan1,2, Mariam N. Fahradyan1,2, Vahe A. Mailyan4, Davit N. Dallaqyan4, Medea G. Anastasiadi1,2, Gevorg N. Tamamyan1,3, Samvel H. Danielyan4, Karen H. Meliksetyan2

1 Pediatric Cancer and Blood Disorders Center of Armenia, Prof. R. H. Yeolyan Hematology Cente, Yerevan, Armenia
2 Prof. R. H. Yeolyan Hematopoietic Stem Cell Transplant Department, Hematology Center, Yerevan, Armenia
3 Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan, Armenia
4 Hematology Center After Prof. R. H. Yeolyan, Yerevan, Armenia

Correspondence:
Taguhi J. Hovhannisyan, e-mail: taguhi.hovhannisyan.81@mail.ru

Central venous catheters (CVCs) are an important component of bone marrow transplantation (BMT) for chemotherapy, parenteral nutrition (PN), and blood infusion. Long-term CVC access is associated with an increased risk of infection and device dysfunction.

Materials and methods

Medical records of thirty-nine patients are reviewed and analyzed to track catheter-related complications in the Bone Marrow Transplantation Department of R. H. Yeolyan Hematology Center, Yerevan, Armenia. Examination of the central line was done daily. CVL dressing was replaced every day for non-tunneled catheters, and every third day for tunneled catheters. Transparent dressing (Tegaderm) was used to dress central lines. A 2% chlorhexidine-soaked cotton swab and 70% alcohol were used for at least 30 seconds to disinfect on and around the catheter. Both types of CVLs were flushed with 2.5 ml of heparinized saline (10 u/ml) twice a daily.

Results

12 children (the median age 6 years, age range [2-16] years) and 27 adults (the median age – 41 years, range [19-60] years), underwent HSCT. 2 (5.1%) pediatric patients with sickle cell anemia underwent allogeneic hematopoietic stem cell transplantation. A single-lumen Hickman tunneled catheter was placed in 2 (5.1%) patients. A double-lumen non-tunneled catheter was placed in the rest of the patients 37 (94.9%). 4 (10%) children developed complications; 2 central line-associated bloodstream infections, 1 pneumothorax, and 1 local hematoma. 5 (12%) adult patients developed a catheter-associated infection. In 37 patients, CVL was removed to a platelet count >50000/mcL, and in 2 patients a platelet count <20000/mcL. No episodes of bleeding were reported. 7 patients were febrile at the time of CVL removal, of whom 5 become afebrile within and 2 patients needed a change of antibiotics. Positive blood cultures were found in the CVLs of 7 patients, 5 of whom became afebrile within 2 days of line removal.

Conclusions

The first transplant was conducted in 2018 and here we reported CVL associated complications of our first 39 patients. CVC-associated complications are frequent during HSCT and nursing care is an ascension component of HSCT.

Keywords

CVL, CVC, bone marrow transplantation, Armenia, developing countries.

Posttransplant care and rehabilitation: PC-01 – PC-05

PC-03. Role of medical nurse in observation and evaluation of the patients after CAR-T therapy

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Natalya P. Gusleva, Olga O. Molostova, Olga V. Pimenova, Larisa N. Shelikhova, Michael A. Maschan

Dmitry Rogachev National Medical Research Center, Moscow, Russia


Correspondence:
Natalya P. Gusleva, phone: +7 (929) 594-24-62, e-mail: Natalja-leshhuk@rambler.ru

CAR-T-therapy is a novel method of acute lymphoblastic leukemia (AML) treatment in children and adults. This therapy is developed for the patients who cannot achieve remission by any of existing drug therapies. CAR-T cell therapy is associated with risks of severe and life-threatening complications, i.e., cytokine release syndrome (CRS), and neurotoxicity (NT). Therefore, to perform timely diagnostics, careful and permanent follow-up is required in these patients. Medical nurses observe the patient and contact with him during the shift, thus allowing them to be the first and very important link when detecting complications of this therapeutic mode. Our aim was to assess probable complications when performing novel treatment method, and to implement the developed diagnostic scales into systematic evaluation of somatic and neurological state of the patients receiving CAR-T cell therapy into everyday activity of medical nurses.

Materials and methods

Since February 2018, CAR-T therapy was implemented at the D. Rogachev Medical Research Center of Pediatric Hematology, Oncology and Immunology in the frames of clinical trial. A total of 57 patients received this treatment. Since January 2021, the medical nurses initiated implementation of a score for evaluation of the patient receiving CAR-T cell therapy, according to the Consensus of American Society of Transplantation and Cellular Therapy (ASTCT). The scales of neurotoxicity evaluation were implied for the children of different ages as well CRS criteria. From the day of CAR-T cell infusion and over next 28 days, the medical nurses perform daily measurements of arterial blood pressure, body temperature, and saturation levels every 6 hours, aiming for CRS diagnostics. To assess neurotoxicity, the nurses use three scales: for infants (1-2 years), for patients under 12 years old, and for children over 12 years (CAPD, ICE scales). By means of special questions, observation and cooperation with patients during the working time, appropriate scores are registered, thus assessing the grade of neurotoxicity. The results are retrieved by the daily electronic records in the patient’s medical card.

Results

Since January 2021, medical nurses at the Center perform active monitoring of the patients following CAR-T cell therapy using electronic records. Over this period, we performed monitoring of 7 patients at the age of 2 to 15 years. The observation results showed that all the patients exhibited CRS and neurotoxicity signs, with detailed information presented in Table 1.

Conclusion

Active, detailed and structured observation of the patients after CAR-T cell therapy by medical nurses allows to recognize the CRS and neurotoxicity signs at earlier terms, provides more careful control of the patient’s condition, as well as fast and clear information for attending doctors on appropriate changes, thus allowing to initiate treatment of these complications in due time.

Keywords

CAR-T cell therapy, cytokine release syndrome, neurotoxicity, evaluation scores, nurse-assisted observation.

Posttransplant care and rehabilitation: PC-01 – PC-05

PC-02. Toxic skin lesions after chemotherapy and HSCT

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Elvira A. Gasanova, Varvara N. Ovechkina, Nina N. Gurgenidze, Inga E. Zavodova, Anna A. Dotsenko, Tatyana A. Bykova

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Correspondence:
Elvira A. Gasanova, phone: +7 (931) 968-61-07, e-mail: Elviragas1@mail.ru

Skin, mucous membranes, hair and nails are often damaged during HSCT. Manifestations of skin complications arising after chemotherapy (CT) or total body irradiation (TOT) may vary and there is also damage associated with graft-versus-host disease (GVHD), which may lead to severe changes (scleroderma or lichenoid lesions). Drug allergy, drug and radiation dermatitis, contact dermatitis, engraftment syndrome, GVHD and infectious lesions are most common causes of damage to the skin and its appendages. Transplant procedure can also cause damage to nail plates. It often happens due to chemotherapy and/or radiation therapy (RT), as well as GVHD. Hair lesions include partial or complete alopecia, more often temporary than permanent. It is also often associated with chemotherapy and/or radiation therapy, as well as GVHD. Damage may result in changes in hair color and structure. Mucositis of the gastrointestinal tract is a consequence of chemotherapy and/or radiation therapy. Infectious lesions of the skin and mucous membranes often develop during post-transplant aplasia and massive immunosuppressive therapy. They are caused by bacteria, fungi and viruses. GVHD often affects mucous membranes, skin and its appendages and develops due to recipient’s tissues recognition as foreign to transplanted immunocompetent donor’s T-lymphocytes. The objective of the work was to study the symptoms involving skin, which may be seen in oncohematological patients on different stages of treatment, in order to increase the awareness level and knowledge of nurses.

Results

The epidermis and mucosal cells are often affected in HSCT recipients, because of their rapid self-renewal. Skin plays an important role in defense against microbial infections, protects against minor injuries, and prevents fluid loss. It is also involved in body temperature regulation. If its integrity is disturbed, these functions may be affected severely. Maintaining skin integrity is especially important in HSCT patients as they are prone to skin infections if the skin is damaged. Due to deep neutropenia, typical local symptoms (erythema, local hyperthermia, purulent discharge) are often absent, so a thorough examination of the skin during HSCT is very important. Also, patients undergoing long-term glucocorticosteroid therapy are more likely to be at risk of skin atrophy. Other risks for skin lesions development during HSCT include toxic complications of the conditioning regimen (because of chemotherapy and/or RT), presence of central venous catheter, surgery, GVHD, poor nutritional status, and diarrhea. Differential diagnosis of skin lesions is carried out between drug allergy, chemotherapy and/or radiotherapy toxicity, engraftment syndrome, GVHD, eczematous lesions associated with nutritional deficiency and contact dermatitis. Clinical manifestations of skin integrity disorders range from macular or papular rash to blisters and bullae. Other cutaneous manifestations include hyper- and hypopigmentation, erythema, petechiae and bruising, urticaria, nevi, cracks, ulcers, scleroderma-like and lichenoid changes, striae. The probability of acute GVHD (aGVHD) development depends on donor type and GVHD prophylaxis regimen. aGVHD develops in 20-70% of all allo-HSCTs. It often affects the skin with manifestations varying from mild erythroderma on the palms and soles to total erythroderma and bullae. One or more organs may be involved. It often presents with a skin rash during neutrophil engraftment looking like maculopapular rash on the neck, shoulders, ears, palms and feet. As the rash progresses it may transform into generalized erythroderma and become complicated by blisters (bulls). Mild cases of aGVHD with skin involvement may need only topical immunosuppressive therapy. Chronic GVHD (cGVHD) usually occurs 100 to 400 days after HSCT, although it can start as early as 45 days after HSCT. It can be a debilitating chronic condition similar in presentation to classic autoimmune diseases. cGVHD usually occurs in patients with aGVHD (called progressive cGVHD), although it can occur in the absence of aGVHD (called de novo cGVHD). It most often involves skin, but mucous membranes of the eyes, oral cavity, and other organs may also be involved. Skin manifestations include dryness, dyspigmentation, hyperkeratosis, pruritus, scleroderma, lichenification, nail dystrophy, alopecia. Xerostomia, lichen planus and ulceration of the mucosa are found in the oral cavity. Ophthalmic manifestations include dry eye syndrome, photophobia, eye irritation and pain, blurry vision. The main cause of mortality in cGVHD are infectious complications, so teamwork and careful skin and mucosal membrane care are critical. Any skin damage must be carefully assessed and monitored, especially for signs or symptoms of infection due to poor wound healing. In addition, people with chronic skin GVHD should avoid direct sunlight and use sunscreen.

Conclusion

The approach to all skin complications associated with chemotherapy and HSCT is constantly improving. It’s achieved by interdisciplinary work, which aimed to prevent more effectively, diagnose and treat these effects, thereby improving the prognosis and quality of life of patients. It is necessary to increase the level of knowledge of nurses for the prevention of development, timely detection and adequate treatment of these complications.

Keywords

HSCT, chemotherapy, dermatitis, infected wounds, graft-versus-host disease.

Posttransplant care and rehabilitation: PC-01 – PC-05

PC-01. Patient birthday celebration at the bone marrow transplant clinic during the COVID-19 pandemic

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Rashida A. Bikulova, Anastasia A. Popova, Evgeniya S. Misyavichute, Svetlana I. Oleshko, Tatiana V. Kozlova, Angelica V. Pavlik, Alisa G. Volkova, Yulia A. Tarakanova, Galina N. Stolbenko

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Correspondence:
Alisa G. Volkova, e-mail: alisa-md@inbox.ru

Volunteers play an important role in the medical and social rehabilitation of patients with oncohematological diseases and improve the quality of life of patients. During the COVID-19 pandemic, clinic staff and volunteer organizations have been faced with the necessity to invent the new forms of interaction in the context of restrictions. The objective is to develop the most effective and safe format of interaction between volunteers of the social movement “MotoDonors for Children”, patients and hospital staff during the COVID-19 pandemic. The main goal of the study was focused on the development of an algorithm for the event “Birthday at the Hospital” and the analysis of the results.

Materials and methods

The study was conducted on the basis of materials from events organized by volunteers in cooperation with the staff of the rehabilitation department from April 2020 to June 2021. The survey included the results from children and adolescents aged 0 to 18 years at different stages of treatment for hematological, oncological and hereditary diseases, including the period of cytopenia after chemotherapy and HSCT. The department staff collected up-to-date information about patients before their birthday, received parental consent for the event and accompanied their interaction with volunteers. A questionnaire for the parents of children and the patient’s medical staff was compiled as a feedback form.

Results

During the observation period, 87 events were held dedicated to the birthday of children treated at the clinic, 42 cases (48%) were in 2020 and 45 (52%) during 2021. All the patients received a gift chosen by their parent, depending on the wishes, age and interests of the child. All respondents confirmed the importance of individual approach to choosing a gift. Part of the gifts – 45 (40%) were given to the child through the medical staff, the other was received personally in an outpatient clinic. A photo session was organized in 50 (44%); motor biking, in 25 (29%), and video congratulations in 5 (6%) during the inpatient treatment. The majority of parents 80 (91%) noted an improvement in the child’s emotional background after congratulations. There were no negative reactions from children and their parents after interaction with department staff and volunteers.

Conclusions

An effective and safe algorithm of a birthday party during a long stay in the hospital has been formed in compliance with the strict quarantine rules. This way of birthday celebration has a positive effect on overcoming the hospital routine and helps to feel the moment of growing up.

Keywords

Children, oncology, hematology, hematopoietic stem cell transplantation, rehabilitation.