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Conference Paper: Treatment of children with Drugresistant Graft-Versus-Host-Disease by extra-corporeal photopheresis

TitleTreatment of children with Drugresistant Graft-Versus-Host-Disease by extra-corporeal photopheresis
Authors
Issue Date2013
PublisherMedcom Limited. The Journal's web site is located at http://www.hkjpaed.org/index.asp
Citation
The 2013 Joint Annual Scientific Meeting of The Hong Kong Paediatric Society and Hong Kong Paediatric Nurses Association, Hong Kong, 8 September 2013. In Hong Kong Journal of Paediatrics (New series), 2013, v. 18 n. 4, p. 262-263 How to Cite?
AbstractPURPOSE AND METHOD: We retrospectively reviewed the clinical experience of performing extracorporeal photopheresis (ECP) for the treatment of children with drugresistant graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation at Queen Mary Hospital in Hong Kong since 2011. RESULTS: We performed ECP 89 times (discontinuous flow 16 times and continuous flow 73 times) in 3 children (body weight 26 to 35 kg) who suffered from severe extensive sclerodermatous chronic GVHD with pulmonary fibrosis (patient 1, beta-thalassaemia major girl received matched unrelated stem cell transplant), steroid refractory grade 4 acute gut and liver GVHD (patient 2, AML boy received 5/6 HLA-matched unrelated cord blood transplant), and progressive bronchiolitis obliterans (patient 3, AML boy received matched sibling bone marrow transplant) respectively. Nurse is a key stakeholder in managing the technical and logistic parts of ECP program. The nurse's roles are discussed on developing the ECP program, setting operating standard, case management, problem encountered and staff training. The ECP procedures in small children are technically challenging and require special planning with attention to extracorporeal volume, inlet blood flow rate and trouble shooting. Blood priming and prior hyper-transfusions were required to minimize fluid shifts in these underweight patients. ECP was performed 1-3 times per week. The anticoagulant: blood ratio (heparin saline 20 units/ml) was adjusted according to the patients' hemostatic status between 8:1 to 12:1. Problems including machine failure possibly caused by poor inlet blood flow, blood clots or air in the circuits were encountered. Transient hypertension and cold sensation had been reported during discontinuous flow but not in continuous flow ECP. There were no adverse hemodynamic events noted. Patient 2 and 3 had significant improvement in their GVHD resulting in the reduction of immunosuppressive drugs. Patient 1 started ECP at a relatively late stage and she died of pulmonary aspergillosis and atypical mycobacterial infection, unrelated to the procedure. The nurse-led ECP program gained high satisfaction from staff and patients. CONCLUSION: ECP was well tolerated in these underweight patients by using the continuous flow photopheresis system. It seems to be an efficacious and safe alternative therapy for drugresistant severe acute or chronic GVHD. A nurse-led ECP program facilitates the success of technical and logistic parts of this new treatment modality.
DescriptionPoster Presentation (Nurse’s Session)
Persistent Identifierhttp://hdl.handle.net/10722/190109
ISSN
2015 Impact Factor: 0.194
2015 SCImago Journal Rankings: 0.123

 

DC FieldValueLanguage
dc.contributor.authorChiu, SYen_US
dc.contributor.authorChan, HYen_US
dc.contributor.authorShum, SKen_US
dc.contributor.authorCheuk, KLDen_US
dc.contributor.authorLee, PPWen_US
dc.contributor.authorChiang, AKSen_US
dc.contributor.authorHa, SYen_US
dc.contributor.authorChan, GCFen_US
dc.date.accessioned2013-09-17T15:08:30Z-
dc.date.available2013-09-17T15:08:30Z-
dc.date.issued2013en_US
dc.identifier.citationThe 2013 Joint Annual Scientific Meeting of The Hong Kong Paediatric Society and Hong Kong Paediatric Nurses Association, Hong Kong, 8 September 2013. In Hong Kong Journal of Paediatrics (New series), 2013, v. 18 n. 4, p. 262-263en_US
dc.identifier.issn1013-9923-
dc.identifier.urihttp://hdl.handle.net/10722/190109-
dc.descriptionPoster Presentation (Nurse’s Session)-
dc.description.abstractPURPOSE AND METHOD: We retrospectively reviewed the clinical experience of performing extracorporeal photopheresis (ECP) for the treatment of children with drugresistant graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation at Queen Mary Hospital in Hong Kong since 2011. RESULTS: We performed ECP 89 times (discontinuous flow 16 times and continuous flow 73 times) in 3 children (body weight 26 to 35 kg) who suffered from severe extensive sclerodermatous chronic GVHD with pulmonary fibrosis (patient 1, beta-thalassaemia major girl received matched unrelated stem cell transplant), steroid refractory grade 4 acute gut and liver GVHD (patient 2, AML boy received 5/6 HLA-matched unrelated cord blood transplant), and progressive bronchiolitis obliterans (patient 3, AML boy received matched sibling bone marrow transplant) respectively. Nurse is a key stakeholder in managing the technical and logistic parts of ECP program. The nurse's roles are discussed on developing the ECP program, setting operating standard, case management, problem encountered and staff training. The ECP procedures in small children are technically challenging and require special planning with attention to extracorporeal volume, inlet blood flow rate and trouble shooting. Blood priming and prior hyper-transfusions were required to minimize fluid shifts in these underweight patients. ECP was performed 1-3 times per week. The anticoagulant: blood ratio (heparin saline 20 units/ml) was adjusted according to the patients' hemostatic status between 8:1 to 12:1. Problems including machine failure possibly caused by poor inlet blood flow, blood clots or air in the circuits were encountered. Transient hypertension and cold sensation had been reported during discontinuous flow but not in continuous flow ECP. There were no adverse hemodynamic events noted. Patient 2 and 3 had significant improvement in their GVHD resulting in the reduction of immunosuppressive drugs. Patient 1 started ECP at a relatively late stage and she died of pulmonary aspergillosis and atypical mycobacterial infection, unrelated to the procedure. The nurse-led ECP program gained high satisfaction from staff and patients. CONCLUSION: ECP was well tolerated in these underweight patients by using the continuous flow photopheresis system. It seems to be an efficacious and safe alternative therapy for drugresistant severe acute or chronic GVHD. A nurse-led ECP program facilitates the success of technical and logistic parts of this new treatment modality.-
dc.languageengen_US
dc.publisherMedcom Limited. The Journal's web site is located at http://www.hkjpaed.org/index.asp-
dc.relation.ispartofHong Kong Journal of Paediatrics (New series)en_US
dc.titleTreatment of children with Drugresistant Graft-Versus-Host-Disease by extra-corporeal photopheresisen_US
dc.typeConference_Paperen_US
dc.identifier.emailChan, HY: hoiyanc@hku.hken_US
dc.identifier.emailCheuk, KLD: klcheuk@hkucc.hku.hken_US
dc.identifier.emailLee, PPW: ppwlee@hku.hken_US
dc.identifier.emailChiang, AKS: chiangak@hku.hken_US
dc.identifier.emailHa, SY: syha@hku.hken_US
dc.identifier.emailChan, GCF: gcfchan@hku.hken_US
dc.identifier.authorityLee, PPW=rp00462en_US
dc.identifier.authorityChiang, AKS=rp00403en_US
dc.identifier.authorityChan, GCF=rp00431en_US
dc.identifier.hkuros225086en_US
dc.identifier.volume18-
dc.identifier.issue4-
dc.identifier.spage262en_US
dc.identifier.epage263en_US
dc.publisher.placeHong Kong-

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