Blood and Marrow Transplant Handbook PDF
Preview Blood and Marrow Transplant Handbook
Blood and Marrow Transplant Handbook Blood and Marrow Transplant Handbook Comprehensive Guide for Patient Care Richard T. Maziarz, MD Portland,Oregon,USA Susan Slater, MN, FNP-BC Portland,Oregon,USA 1 3 Editors RichardT.Maziarz,MD SusanSlater,MN,FNP-BC CenterforHematologic CenterforHematologic Malignancies Malignancies AdultBloodandMarrowStem AdultBloodandMarrowStem CellTransplantProgram CellTransplantProgram KnightCancerInstitute KnightCancerInstitute OregonHealth&Science OregonHealth&Science University University Portland,OR97239,USA Portland,OR97239,USA ISBN978-1-4419-7505-8 e-ISBN978-1-4419-7506-5 DOI10.1007/978-1-4419-7506-5 SpringerNewYorkDordrechtHeidelbergLondon ©SpringerScience+BusinessMedia,LLC2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,and similarterms,eveniftheyarenotidentifiedassuch,isnottobetakenasan expressionofopinionastowhetherornottheyaresubjecttoproprietary rights. Whiletheadviceandinformationinthisbookarebelievedtobetrueand accurateatthedateofgoingtopress,neithertheauthorsnortheeditors nor the publisher can accept any legal responsibility for any errors or omissionsthatmaybemade.Thepublishermakesnowarranty,expressor implied,withrespecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface and Acknowledgments Hematopoieticstemcelltransplantationhasexperiencedadra- maticincreaseofactivityoverthepastdecadewithacontinued markedescalationofproceduresprojectedoverthenexttento fifteenyears.Thisexpansionisnotonlyareflectionofanever changing field with increasing demand but also the pursuit of innovation that contributes to continued improved outcomes withlessriskofadverseeventsordeleteriouslong-termconse- quences for the transplant patient population. Cell therapy is a dynamic field. It requires multi-specialty input for the man- agementofthesecomplexpatients.Inthepast,transplantation wasthesoleresponsibilityofafewacademiccenters,andinfor- mationresidedwithinthehandsofafewindividuals.However, with the dissemination of technology and the ongoing prolif- erationoftheseprocedures,therehasbeenanobligatoryneed forthedevelopmentoftoolstoprovidestandardguidelinesand algorithmsforthemanagementofpatients. Most institutions have established their own set of guide- lines and recommendations designed for consensus manage- ment as patients are in constant need of shared care. As new workforcedemandshaveemerged,therehavebeenchangesin theworkplacewithrecentpredictionsofamarkedshortageof transplant physicians. As an alternative, more non-physician providers are being recruited to this field to provide day-to- daycareofthetransplantpatient.Inlightofthesechanges,it becomes imperative to provide detailed and shared consensus guidelinestoensurethebestandmostpredictableoutcomesof ourpatientscanbeachieved. Thisguidetopatientmanagementistheproductoffifteen years of evolution of patient care at our institution. Wherever possible, the information herein has been altered to reflect the multiple options that exist for treatment of various condi- tions.However,itisnotmeanttodefinetheexactcarepathway for all patients. Rather, we have provided a practical set of guidelines that can be shared across institutions. This effort is our contribution to the workforce shortage for transplant physicians.Byprovidinganeasy-to-usemanualthatcoversthe basics of care of the stem cell transplant patient which can beutilizedtoeducatephysicianassistants,nursepractitioners, v vi PREFACEANDACKNOWLEDGMENTS residents,post-doctoralfellows,andotherhospitaliststhatmay be recruited to the day-to-day care of the patient, we have achieved our goal. We recognize that this pocket guide is a work in progress, and we anticipate that as time passes, even potentiallyquitequickly,anewsetofguidelineswillneedtobe generated. We recognize that this manual is incomplete. We do not discuss graft engineering to any great degree. We are not addressing the nuances of cord blood transplantation. We are notconsideringhaplo-identicaltransplantationorotherthera- piesthatremaininclinicaltrialdevelopmentandmayemerge soon into the clinical arena. Nor are we talking about regen- eration medicine, its futures, and its overlap with hematopoi- etic stem cell transplantation. Rather, we provide information aboutstandardsofcareandassimilateknowledgegainedfrom others. The work presented within this volume represents not the workofafew,buttheworkofmany.Anumberofourauthors were members of the team that helped create our institution- specific consensus guidelines. We have also recruited new memberstoassistingeneratingtheseeverchangingsetofstan- dards. We wish to thank the many contributors, as well as our mentors and colleagues who have inspired us to pursue this field and who have provided us with the energy to make thiscontribution.WewouldliketothankThomasThomasfor his assistance in the preparation of this manual. We specifi- cally acknowledge the work of Florence Seelig, Peter Curtin, Mark Brunvand, Kamar Godder, Gerald Segal, and the late Keith Hansen among many of our former team members. Theircontributionstoourprogramcannotbeunderestimated. In addition, we thank our team of dedicated nurses, social workers, CMAs, CNAs, physical therapists, nutrition special- ists,andallprovidersthatarepresentatthepatients’bedside. We also thank our collaborating community partners: refer- ring physicians, mid-level providers, and nurse coordinators. Through collaboration and shared information, we hope to assurethebestoutcomeofourpatientsastheyreturntotheir communitiesacrossthecountry. Editors,2011 RichardT.Maziarz,MD SusanSlater,MN,FNP-BC Contents PartI The Nuts and Bolts of Stem Cell Transplant 1 Overview of Hematopoietic Stem Cell Transplantation . . . . . . . . . . . . . . . . . . . . 3 RichardT.Maziarz 2 The Business of Cellular Therapy and HematopoieticStemCellTransplantation . . . 9 PeggyAppelandRichardT.Maziarz 3 StemCellSources . . . . . . . . . . . . . . . . . . 21 JoseLeis 4 Pre-transplantEvaluation . . . . . . . . . . . . . 27 AndyChen 5 ConditioningRegimens . . . . . . . . . . . . . . . 39 JosephBubalo 6 SupportiveCare . . . . . . . . . . . . . . . . . . . . 51 BryonAllen 7 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . 63 StaceyEvert 8 InfectionProphylaxis . . . . . . . . . . . . . . . . 71 LynneStrasfeld 9 Graft-Versus-HostDiseaseProphylaxis . . . . . 83 ErinCorella 10 TransfusionMedicine . . . . . . . . . . . . . . . . 101 JamesGajewskiandSusanSlater 11 AntithromboticGuidelines . . . . . . . . . . . . . 111 ThomasDeLoughery 12 Engraftment . . . . . . . . . . . . . . . . . . . . . . 119 SaraMurray 13 Follow-UpCare . . . . . . . . . . . . . . . . . . . . 125 CarolJacoby vii viii CONTENTS PartII TransplantComplications 14 InfectiousComplications . . . . . . . . . . . . . . 143 LynneStrasfeld 15 AcuteGraft-Versus-HostDisease . . . . . . . . . 167 SusanSlater 16 ChronicGraft-Versus-HostDisease . . . . . . . . 189 RichardT.MaziarzandFarnoushAbar 17 OralComplications . . . . . . . . . . . . . . . . . . 213 KimberlyBrennanTyler 18 GastrointestinalComplications . . . . . . . . . . 223 EneidaNemecek 19 PulmonaryComplications . . . . . . . . . . . . . 233 TarekEidandAlanF.Barker 20 CardiovascularComplications . . . . . . . . . . . 245 ChristopherGreenman 21 AcuteKidneyInjury . . . . . . . . . . . . . . . . . 253 AnujaMittalhenkle 22 ThromboticMicroangiopathies . . . . . . . . . . 261 ThomasDeLoughery 23 GraftFailure . . . . . . . . . . . . . . . . . . . . . . 265 GabrielleMeyers 24 Post-transplantRelapse . . . . . . . . . . . . . . . 271 RichardT.MaziarzandSusanSlater 25 PalliativeCare . . . . . . . . . . . . . . . . . . . . . 277 MaryDeniseSmithandAmyGuthrie 26 Survivorship . . . . . . . . . . . . . . . . . . . . . . 281 LisaHansenandBrandonHayes-Lattin Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Contributors FarnoushAbar,MD CenterforHematologicMalignancies,AdultBloodand MarrowStemCellTransplantProgram,OregonHealthand ScienceUniversity,Portland,OR,USA BryonAllen,MSN,FNP-BC CenterforHematologicMalignancies,AdultBloodand MarrowStemCellTransplantProgram,OregonHealthand ScienceUniversity,Portland,OR,USA PeggyAppel,MHA NorthwestMarrowTransplantProgram,OregonHealthand ScienceUniversity,Portland,OR,USA AlanF.Barker,MD PulmonaryandCriticalCareMedicine,OregonHealthand ScienceUniversity,Portland,OR,USA JosephBubalo,PharmD,BCPS,BCOP ClinicalOperationsManagerandOncologyClinical Pharmacist,PharmacyServices,OregonHealthandScience University,Portland,OR,USA AndyChen,MD,PhD CenterforHematologicMalignancies,AdultBloodand MarrowStemCellTransplantProgram,OregonHealthand ScienceUniversity,Portland,OR,USA ErinCorella,PharmD,BCPS,BCOP PharmacyServices,OregonHealthandScienceUniversity, Portland,OR,USA ThomasDeLoughery,MD DivisionsofHematology/OncologyandLaboratoryMedicine, OregonHealthandScienceUniversity,Portland,OR,USA TarekEid,MD PulmonaryandCriticalCareMedicine,OregonHealthand ScienceUniversity,Portland,OR,USA ix
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