Patterns of Signs, Symptoms, and Cytokines During the Engraftment Phase of Autologous Stem Cell Transplantation

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Publication Type dissertation
School or College College of Pharmacy
Department Pharmacology & Toxicology
Author Rice, Robert David
Title Patterns of Signs, Symptoms, and Cytokines During the Engraftment Phase of Autologous Stem Cell Transplantation
Date 2010-02-03
Description Autologous stem cell transplant is a potentially curative treatment for certain cancers, yet there is significant risk of complications. Among these is engraftment syndrome, a constellation of physical signs and symptoms that occurs during the stem cell engraftment phase of treatment. Given the high volume of transplants performed worldwide, the cost of illness, loss of life and healthcare resource utilization, the complication of engraftment syndrome is an important clinical problem. The purpose of this study was to evaluate the patterns of physical signs and symptoms and proinflammatory serum cytokines associated with the engraftment phase in a population of 66 patients with hematologic malignancies who underwent high-dose therapy and autologous stem cell transplantation. Secondary data analysis was performed utilizing patients' medical records. Using Two-step Cluster Analysis, the physical signs and symptoms were evaluated to determine naturally forming clusters. Two distinct subgroups were identified based on five input variables (white blood count recovery, hypoxia, renal function, liver function, and fluid balance). The subgroup Autologous stem cell transplant is a potentially curative treatment for certain cancers, yet there is significant risk of complications. Among these is engraftment syndrome, a constellation of physical signs and symptoms that occurs during the stem cell engraftment phase of treatment. Given the high volume of transplants performed worldwide, the cost of illness, loss of life and healthcare resource utilization, the complication of engraftment syndrome is an important clinical problem. The purpose of this study was to evaluate the patterns of physical signs and symptoms and proinflammatory serum cytokines associated with the engraftment phase in a population of 66 patients with hematologic malignancies who underwent high-dose therapy and autologous stem cell transplantation. Secondary data analysis was performed utilizing patients' medical records. Using Two-step Cluster Analysis, the physical signs and symptoms were evaluated to determine naturally forming clusters. Two distinct subgroups were identified based on five input variables (white blood count recovery, hypoxia, renal function, liver function, and fluid balance). The subgroup with more dysfunction had significantly worse treatment related outcomes, reflected by more transfers to intensive care, infections and positive radiographic findings, blood component transfusions, antibiotic therapy, antifungal therapy, and longer hospital stays. Interestingly, classic signs such as rash and fever were not significant. In a subset of 31 patients, an analysis of proinflammatory cytokines was also conducted using Two-step Cluster Analysis. Based on the Interleukin 12 to Interleukin 6 ratio, two distinct subgroups formed where the group with suppressed ratio recovery had worse outcomes, reflected by greater blood component transfusions, antibiotic therapy, antifungal therapy, and longer hospital stays. Patterns of physical signs and symptoms, as well as cytokine biomarkers, may suggest patients who are at higher risk of treatment related morbidity and worse outcomes. It is therefore important that clinical and advanced practice nurses carefully assess patients so as to identify patterns of clinical deterioration and intervene to prevent organ damage associated with engraftment syndrome. Future studies should prospectively test a risk model to update the critical components of engraftment syndrome that predict worse outcomes.
Type Text
Publisher University of Utah
Subject Autotransplantation; Stem Cells
Subject MESH Stem Cell Transplantation; Transplantation, Autologous; Cytokines
Dissertation Institution University of Utah
Dissertation Name PhD
Language eng
Relation is Version of Digital reproduction of "Patterns of signs, symptoms, and cytokines during the engraftment phase of autologous stem cell transplantation." Spencer S. Eccles Health Sciences Library." Print version of "Patterns of signs, symptoms, and cytokines during the engraftment phase of autologous stem cell transplantation." available at J. Willard Marriott Library Special Collection. RC39.5 2009.R52.
Rights Management © Robert David Rice
Format Medium application/pdf
Format Extent 1,266,255 bytes
Source Original: University of Utah Spencer S. Eccles Health Sciences Library
Conversion Specifications Original scanned on Fujitsi fi-5220G as 400 dpi to pdf using ABBYY FineReader 10
ARK ark:/87278/s6c82qtw
Setname ir_etd
Date Created 2012-04-23
Date Modified 2012-04-23
ID 192855
Reference URL https://collections.lib.utah.edu/ark:/87278/s6c82qtw