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ANKÜNDIGUNGEN

Das letzte Projekttreffen fand am 21. und 22. September 2012 in Antalya, Türkei statt, mit besonderer Beteiligung von Dr. Wolfram Ebell von der Charité in Berlin.

Pilotstudien wurden in der Türkei (Anadolu Medical Center, Hacettepe University Hospital, Oncology Nurses Association’s Hematopoietic Stem Cell Transplantation Nursing Course, Akdeniz University Hospital und Dışkapı Children’s Health and Diseases Oncology Hospital), der Tschechischen Republik (Motol University Hospital) Spanien (La Fe University Hospital) und Deutschland (Charite Universitätsklinikum) während des Monats September 2012 durchgeführt.

Oberschwester Nevin Çetin und Projektgruppen-Mitarbeiterin Ajdan Küçükçiftçi stellten das Projekt und das bmtcare-Webportal im Anadolu Medical Center in Istanbul am 17. September 2012 vor.

Oberschwester Nevin Çetin stellte das Projekt und das bmtcare-Webportal beim Oncology Nurses Association’s Hematopoietic Stem Cell Transplantation Nursing Course am 20. September 2012 vor.

Prof. Dr. Duygu Uçkan, Oberschwester Nevin Çetin und andere Projektgruppen-Mitglieder von Hemosoft stellten das Projekt und das bmtcare-Webportal im Akdeniz University Hospital, KMT-Station in Ankara am 21. September 2012 vor.

Prof. Dr. Duygu Uçkan, Oberschwester Nevin Çetin und andere Projektgruppen-Mitglieder von Hemosoft stellten das Projekt und das bmtcare-Webportal im Dışkapı Children’s Health and Diseases Oncology Hospital in Ankara am 3. September 2012 vor.

Unsere Projektgruppe nahm am Kongress “The 8th Meeting of the EBMT Pediatric Diseases WP” am 07. bis 09. Juni 2012, in Prag, Tschechische Republik teil. Projektergebnisse wurden präsentiert.

Dr. Petr Sedlacek und Dr. Duygu Uçkan besuchten die 38. Jahrestagung der European Group for Blood and Marrow Transplantation vom 1.-4. April 2012, in Genf, Schweiz.

Oberschwester Nevin Çetin und Oberschwester Guliz Karataş von der pädiatrischen Einheit des Hacettepe University Hospital stellten die Ergebnisse unseres Projekts auf dem „7th National BMT and Stem Cell Treatments Congress“ in Antalya, Türkei im Namen unserer Projektgruppe vor.

Das dritte Projekttreffen fand am 26.-27. April 2012 an der Universität Bremen mit der Beteiligung von Dr. Wolfram Ebell aus der Charité in Berlin statt.

Die 2. Wissenschaftliche Tagung des Projekts wurde am 25. November 2012 in Valencia, Spanien im Universitätsklinikum La Fe einberufen.

Die Umfrage zur Ermittlung der pädagogischen Bedürfnisse des Pflegepersonals ist jetzt in englischer Sprache abrufbar. Klicken Sie hier.

The First Prof. Dr. Duygu Uçkan, Oberschwester Nevin Çetin und andere Projektgruppen-Mitglieder von Hemosoft stellten das Projekt und das bmtcare-Webportal im Dışkapı Children’s Health and Diseases Oncology Hospital in Ankara am 3. September 2012 vor.

The project sDer Zeitplan für das Projekt-Tool inklusive Funktionen wie „Hinzufügen/Bearbeiten/Löschen“ steht nun auf dem Portal zur Verfügung. Klicken Sie hier.

Unsere Projektgruppe nahm am Kongress “The 8th Meeting of the EBMT Pediatric Diseases WP” am 07. bis 09. Juni 2012, in Prag, Tschechische Republik teil. Projektergebnisse wurden präsentiert.

Das dritte Projekttreffen fand am 26.-27. April 2012 an der Universität Bremen mit der Beteiligung von Dr. Wolfram Ebell aus der Charité in Berlin statt.

Dr. Petr Sedlacek und Dr. Duygu Uçkan besuchten die 38. Jahrestagung der European Group for Blood and Marrow Transplantation vom 1.-4. April 2012, in Genf, Schweiz.

Oberschwester Nevin Çetin und Oberschwester Guliz Karataş von der pädiatrischen Einheit des Hacettepe University Hospital stellten die Ergebnisse unseres Projekts auf dem „7th National BMT and Stem Cell Treatments Congress“ in Antalya, Türkei im Namen unserer Projektgruppe vor.

Kick Off-Meeting in Istanbul, Türkei

Das Kick-off Meeting des Projekts mit dem Titel Interaktive Unterrichtsmaterialien für das Pflegepersonal bei Pädiatrischer Knochenmarktransplantation“ wurde am 14. Dezember 2010 in Istanbul einberufen. Vertreter der Projektpartner sowie Gäste von Hemosoft (Projektleitung) nahmen an dem Treffen teil.

Das Treffen wurde von Hemosoft eröffnet. Die Mitglieder der Projektleitung stellten sich vor, Hemosoft hielt einen Vortrag über das Firmenprofil, sprach über die Erfahrung mit früheren Leonardo da Vinci-Projekten und bedankte sich bei allen Partnern für die Teilnahme an diesem sehr wichtigen Projekt. Alle Partner stellten sich dann ihrerseits vor und berichteten über ihre jeweiligen Organisationen. Es folgten weitere Präsentationen von Hemosoft, der Hacettepe Universität und den Gästen von der Exekutivagentur für Bildung, Audiovisuelles und Kultur (EACEA). Es war besonders vorteilhaft für die EACEA ihre Beobachter unter den Teilnehmern des Treffens zu haben, da sie auf diese Art wertvolle Informationen über die administrativen und finanziellen Aspekte des Projekts gewinnen konnten. Während der Vorträge der weiteren Projektteilnehmer und den daran anknüpfenden Diskussionsrunden wurden elementare inhaltliche als auch administrative Fragen geklärt.
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CONDITIONING REGIMENS FOR STEM CELL TRANSPLANTATION
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by Jaime Sanz, University Hospital La Fe, Valencia, Spain

The conditioning regimen, also so-called preparative regimen, is a critical element in the hematopoietic stem cell transplant (HSCT) procedure. This is usually a combination of chemotherapy agents, with or without radiation therapy.  The purpose of the preparative regimen is dual and varies according to the type of HSCT: i) to provide adequate immunosuppression to facilitate the patient’s body to accept the donor’s bone marrow cells and prevent rejection; and ii) to eradicate the disease for which the transplant is being performed.. The former goal is needed only in patients undergoing allogeneic stem cell transplantation, but not in those receiving autologous transplants. Fortunately, today most preparative regimens achieve high efficiency in this regard, with graft rejection being an uncommon complication.  Nevertheless, when this complication occurs it is associated with a dismal outcome. It is well known that the risk of graft rejection increases with the degree of HLA mismatch between donor and recipient. Regarding the latter objective, conditioning regimens are usually designed to kill tumor cells resistant to conventional chemotherapy by giving maximally tolerated doses of multiple chemotherapeutic agents without causing fatal nonhematologic organ toxicity. Nevertheless, several novel approaches have been designed in an attempt to minimize toxicity. As an example, RIC and nonmyeloblative conditioning regimens have been developed to treat older patients or those with concurrent comorbidities.

Types of preparative regimens

Myeloablative regimens

A myeloablative regimen usually consists of a combination of agents given at maximally tolerated doses expected to eradicate the hematopoietic cells in the bone marrow and results in profound pancytopenia within one to three weeks from the time of administration. The resulting pancytopenia is long-lasting, usually irreversible, and in most instances fatal, unless hematopoiesis is restored by infusion of hematopoietic stem cells.

Nonmyeloablative regimens

A nonmyeloablative regimen results in minimal cytopenia, significant lymphopenia, and does not require stem cell support. In this respect, fludarabine, cyclophosphamide, antithymocyte globulin and total body irradiation (TBI) ≤2 Gy are the most common agents used with this purpose.

Reduced intensity regimens

Reduced intensity regimens (RIC) are an intermediate category of regimens that do not fit the definition of myeloablative or nonmyeloablative. Such regimens cause cytopenias, which may be prolonged and result in significant morbidity and mortality, and require hematopoietic stem cell support.

Toxicity of preparative regimens

Apart from the aforementioned myelotoxicity, the most common side effects that some of them can be life-threatening include:

· Mucositis

· Nausea and vomiting

· Alopecia

· Diarrhea

· Rash

· Peripheral neuropathies

· Infertility. Sperm cryopreservation for male and oocyte cryopreservation in female patients can be attempted to overcome this complication, which is almost universal when using myeloablative regimens..

· Pulmonary toxicity: interstitial lung disease

· Hepatic toxicity: hepatic venoocclusive disease or sinusoidal obstructive syndrome.

Long-term complications following TBI used as part of a preparative regimen are relatively common:

· Asymptomatic alterations in pulmonary function (20%)

· Cataracts (15%)

· Sicca syndrome (13%)

· Hypothyroidism  (6%)

· Thyroiditis (3%)

Myeloablative preparative regimens

All myeloablative regimens are associated with a high degree of myelotoxicity. There are only a few well designed trials comparing the efficacy of different myeloablative regimens. Therefore, it is difficult to make direct statements about the suitability of a given preparative regimen in a particular disease setting. Cyclophosphamide plus TBI or busulfan are typical approaches for fully myeloablative regimens, but combining busulfan with fludarabine is being increasingly used. According to the use of radiation or not, conditioning regimens can be classified as follows

Radiation-containing regimens

TBI has been the mainstay of preparative regimens since the beginning of the activity of HSCT. Initial preparative regimens included TBI administered as a single dose using opposing Cobalt-60 sources. At present, TBI-based regimens typically fractionate the radiation and administer the total dose over several days, typically four, which helps decrease toxicity and increase tolerability. Partial lung shielding is included in an effort to reduce the potential for irreversible lung injury.

The most common radiation-containing regimen used for patients receiving allogeneic HSCT has been TBI with cyclophosphamide. The maximally tolerated dose of TBI is approximately 15 Gy. Higher doses produce excessive nonhematologic toxicity, primarily to the lungs, but also to other organs including the heart. Cyclophosphamide is usually given at a dose of 60 mg/kg of adjusted ideal body weight on each of two successive days. Etoposide (VP16) or high dose cytarabinealso have been given with TBI, with and without cyclophosphamide.

Chemotherapy-based conditioning regimens (without radiation)

A number of non-radiation-containing regimens in which TBI is replaced with additional chemotherapy have been developed. These approaches were initially developed for autologous transplantation, but they have also been used widely in the allogeneic setting. The most widely used chemotherapy-based regimen is the combination of busulfan and cyclophosphamide (BuCy) with their variants BuCy2 and BuCy4 (2 or 4 days of cyclophosphamide). A variety of other combinations that have been successful used include:

· Busulfan and etoposide (in AML)

· BCNU, cyclophosphamide, cytosine arabinoside and melphalan (BEAM)

· Cyclophosphamide, carmustine (BCNU), and etoposide (Hodgkin and non-Hodgkin lymphomas)

· Busulfan, melphalan, and thiotepa (aggressive or relapsed lymphoma).

Nonmyeloablative and reduced intensity preparative regimens

Less intense conditioning regimens are being used more frequently today to retain the desirable effects of standard high-dose conditioning regimens, but with significantly lower toxicity and, therefore, lower transplant-related mortality. The general principle in which the use of both nonmyeloablative and RIC preparative regimen is based is the so-called graft-versus-tumor (GVT) effect, which is mediated by donor immunocompetent cells in allogeneic HSCT. It is well known that the engraftment of donor type immunocompetent cells does not necessarily require a myeloablative preparative regimen, and can be achieved by using nonmyeloablative or RIC regimens.

RICy regimens are an intermediate category of regimens that do not fit the definition of myeloablative or nonmyeloablative. Such regimens cause cytopenia, which may be prolonged and result in significant morbidity and mortality, and require stem cell support. Regimens generally considered as RIC include ≤9 mg/kg of oral busulfan, or ≤140 mg/m2 of melphalan. The adoption of these less toxic conditioning regimens has expanded the number of patients eligible to receive transplants -- patients who may have previously been excluded due to older age or existing co-morbidities. It should be noted, however, that not all diseases are equally susceptible to GVT effect. It is generally accepted that chronic myeloid leukemia, chronic lymphocytic leukemia, and low-grade indolent lymphomas (follicular lymphoma and mantle cell lymphoma) appear particularly responsive to GVT effect.

RIC regimens typically use combinations of chemotherapy drugs such as fludarabine, busulfan, and melphalan, with or without low-dose radiation.