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Younger, healthier patients contemplating high-risk (but potentially curative) hematopoietic cell transplants (HCT) may not consider advance care planning (ACP). We investigated the effect of pre transplant ACP in surviving HCT patients and bereaved caregivers using retrospective, audiotaped telephone surveys. Subjects were identified between 2001 and 2003 via databases at two high-volume HCT centers. Transcripts were coded by two investigators, with differences resolved by consensus. HCT survivors (n=18) were interviewed a median of 13 months after HCT for acute leukemia (7), lymphoma (5) or other (6); 50% had living wills, 72% had a formal proxy. Twelve (67%) had discussed mortality risk pre HCT with the medical team. Of those, 92% felt their hope and perception of the medical team's truthfulness was increased or unchanged (I/U) by the conversation, whereas all felt clinician commitment to transplant was I/U. Bereaved caregivers (n=11) were interviewed a median of 10 months post death (median 31 days post HCT, range 13-152). Nine (82%) had discussed mortality risk pre-HCT with the medical team; 7 (78%) felt hope was I/U, all felt clinician commitment to transplant and truthfulness was I/U, and most felt ACP reduced burden (67%). ACP discussions with patients and caregivers pre-HCT did not affect hope and supported confidence in medical teams. [ABSTRACT FROM AUTHOR]

Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management. [ABSTRACT FROM AUTHOR]

There have been no recommendations for revaccination with the Japanese encephalitis (JE) vaccine in post-hematopoietic stem cell transplantation (HSCT) patients. This study aimed to measure the immunogenic response to a live-attenuated JE vaccine (SA 14-14-2) in post-HSCT patients. JE-specific neutralizing Ab titers were measured before and after the JE vaccination. The patients with Ab titers <10 at the 3-month time point received a second injection at 6 months. A total of 28 patients (male:female=11:17) with a median age of 13 years (4-21 years) were included. The underlying diseases were thalassemia (50%) and hematologic malignancies (50%). Ten patients (35.7%) had Ab titers above the preventive level before vaccination. Nine of 18 patients (50%) seroconverted at 3 months after a single JE vaccination, but only three of these patients had sustained protective Ab levels. Seven of nine patients (78%) seroconverted at 3 months after a second JE vaccine injection, and all of these patients sustained protective Ab levels at 12 months. In conclusion, post-HSCT patients had low seroconversion rates after a single dose of the live-attenuated JE vaccine. These patients may require at least two doses of the JE vaccine to ensure protective Ab levels. [ABSTRACT FROM AUTHOR]

The article discusses the risk of total body irradiation (TBI)-based myeloablative allogeneic hematopoietic cell transplantation (alloHCT) for patients with high risk hematologic diseases such as acute lymphoblastic leukemia (ALL). The usefulness of technology risk management (TRM) to determine which patients could benefit more from lower-intensity conditioning approaches is stated. The contribution of physical fitness to TRM is also cited.