| 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. |
