Publications by authors named "Rachel Phelan"

Article Synopsis
  • * A retrospective study analyzed data from 5,790 young patients who underwent HCT to evaluate the incidence of late effects and their associated risk factors, focusing on various health complications like avascular necrosis and diabetes.
  • * The study included patients from diverse backgrounds, revealing that 60.5% were male and most were white, with major findings regarding the timing and prevalence of complications occurring within five to seven years post-transplant.
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Article Synopsis
  • Diffuse alveolar hemorrhage (DAH) is a serious lung complication that can occur after hematopoietic cell transplantation (HCT) in patients under 21, with a low incidence rate of about 1% in this population.
  • A study analyzed data from nearly 7,000 patients to identify risk factors for developing DAH, finding that nonmalignant hematologic disease, specific transplant medication regimens, and severe acute graft-versus-host disease significantly increased the risk.
  • Critical care patients with DAH also showed higher instances of various health issues, including systemic and pulmonary hypertension, and other serious conditions like renal failure.
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Dexamethasone use during hematopoietic cell transplant (HCT) conditioning varies between pediatric centers. This study aimed to estimate the difference in 1-year treatment-related mortality (TRM) between patients who did or did not receive dexamethasone during HCT conditioning. Secondary objectives were to estimate the difference between dexamethasone-exposed and dexamethasone-unexposed groups in 1-year event-free survival (EFS), time to neutrophil engraftment, acute graft-versus-host disease (aGVHD), and invasive fungal disease (IFD) at day + 100.

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Purpose: Treatment strategies for osteosarcoma evolving between 1970 and 1999 improved 5-year survival and continue as standard of care today. This report evaluates the impact of these evolving therapies on long-term health outcomes.

Methods: Five-year survivors of childhood osteosarcoma in CCSS treated from 1970 to 1999 were evaluated for late (>5 years from diagnosis) mortality, chronic health conditions (CHCs), and health status using piecewise-exponential and logistical models.

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Article Synopsis
  • The CIBMTR's 2023 summary slides now include data on CAR-T therapy and patient-reported outcomes (PROs), enhancing the understanding of transplantation trends.
  • The CIBMTR launched a PRO data collection protocol in August 2020 to gather insights from adult hematopoietic cell transplantation (HCT) and CAR-T recipients at participating centers.
  • As of September 2023, PRO data from 993 patients across 25 centers have been collected and integrated with clinical data to improve patient care and support comprehensive research.
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Purpose: Medical errors may be occasionally explained by inattentional blindness (IB), i.e., failing to notice an event/object that is in plain sight.

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The EBMT (European Blood and Marrow Transplantation Society) aims to connect patients, the scientific community, and other stakeholders to improve hematopoietic stem cell transplantation and cellular therapy outcomes. We performed a cross-sectional online survey to understand the perceptions regarding Patient Reported Outcomes (PROs) and Patient Active Involvement in Research (PAIR) in over 800 stakeholders (n = 813). Patients (n = 278) and health care professionals (HCPs) (n = 351) were compared.

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Article Synopsis
  • Hematopoietic cell transplantation (HCT) has seen significant advancements over time, influenced by research data from the Center for International Blood and Marrow Transplant Research (CIBMTR).
  • The CIBMTR Biorepository maintains a diverse inventory of biospecimens, which can be utilized for further analyses to enhance understanding and practices in HCT.
  • Ongoing collaboration and utilization of these resources are aimed at improving patient outcomes and expanding research opportunities in the field of HCT.
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  • A study examined the incidence, risk factors, and outcomes of pulmonary hypertension (PH) in pediatric patients after hematopoietic stem cell transplants (HCT) conducted in a PICU setting from 2008 to 2014.
  • Out of nearly 7,000 HCT patients, 29 developed PH, revealing a low overall incidence of 0.42%, but a higher prevalence of 2.72% among patients needing intensive care post-transplant.
  • Key risk factors for developing PH included being Black/African American, having metabolic disorders, and a lower functional status prior to transplant, with patients experiencing significant complications and a 6-month survival rate of only 51.7% after PH diagnosis.
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Compared with the general population, hematopoietic cell transplantation (HCT) survivors are at elevated risk for developing solid subsequent neoplasms (SNs). The Center for International Blood and Marrow Transplant Research (CIBMTR) is a key resource for quantifying solid SN incidence following HCT, but the completeness of SN ascertainment is uncertain. Within a cohort of 18 450 CIBMTR patients linked to the California Cancer Registry (CCR), we evaluated the completeness of solid SN data reported to the CIBMTR from 1991 to 2018 to understand the implications of using CIBMTR data alone or combined with CCR data to quantify the burden of solid SNs after HCT.

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Hematopoietic cell transplantation (HCT) uses cytotoxic chemotherapy and/or radiation followed by intravenous infusion of stem cells to cure malignancies, bone marrow failure and inborn errors of immunity, hemoglobin and metabolism. Lung injury is a known complication of the process, due in part to disruption in the pulmonary microenvironment by insults such as infection, alloreactive inflammation and cellular toxicity. How microorganisms, immunity and the respiratory epithelium interact to contribute to lung injury is uncertain, limiting the development of prevention and treatment strategies.

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As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the volume of HCT performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long-term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and other underlying risk-factors.

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As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the number of HCTs performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pretransplantation, peritransplantation, and post-transplantation exposures and other underlying risk factors.

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Purpose Of Review: To summarize the mechanism of action, clinical outcomes, and perioperative implications of glucagon-like peptide-1 receptor agonists (GLP-1-RAs). Specifically, this review focuses on the available literature surrounding complications (primarily, bronchoaspiration) and current recommendations, as well as knowledge gaps and future research directions on the perioperative management of GLP-1-RAs.

Recent Findings: GLP-1-RAs are known to delay gastric emptying.

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To understand transplant center recommendations on return-to-school timing and related support for hematopoietic cell transplant (HCT) survivors, we conducted a two-phase, cross-sectional, web-based survey: In Phase I, medical directors of pediatric HCT centers from the National Marrow Donor Program/ Be The Match Registry were asked regarding the availability of a return to school standardized operating procedure (SOP). In Phase II, HCT physician members of the Pediatric Transplantation and Cellular Therapy Consortium were approached to study inter-physician practice variability regarding return to school post-HCT, factors affecting their decision-making, and support provided by HCT centers for return to school. Out of 46 respondents in Phase I (55% response rate), 28 (61%) reported having a SOP.

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Article Synopsis
  • The study investigates the effects of reduced-intensity conditioning (RIC) regimens on fertility and gonadal function in adolescent and young adult survivors of hematopoietic stem cell transplantation (HCT).
  • Researchers analyzed data from 326 patients aged 10 to 40 who underwent their first allogeneic HCT, focusing on hormonal levels as indicators of fertility potential and gonadal failure.
  • Findings revealed that a significant majority of female HCT recipients had very low levels of AMH, indicating poor fertility potential, and that RIC might have a lower incidence of detectable AMH compared to myeloablative conditioning (MAC), although impairment was still common.
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Background: The Center for International Blood and Marrow Transplant Research (CIBMTR) provides a 1-year overall survival calculator to estimate outcomes for individual patients before they undergo allogeneic hematopoietic cell transplantation (HCT) to inform risk. The calculator considers pre-HCT clinical and demographic characteristics, but not patient-reported outcomes (PROs). Because pre-HCT PRO scores have been associated with post-HCT outcomes, the authors hypothesized that adding PRO scores to the calculator would enhance its predictive power.

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Article Synopsis
  • Allogeneic hematopoietic cell transplantation (HCT) in pediatric patients can lead to serious complications, requiring intensive care for a notable percentage of patients post-transplant.
  • A study analyzing data from multiple centers found that about 15.3% of patients needed ICU care within 5 years, with factors like patient demographics and pre-existing conditions influencing this need.
  • Although survival to discharge from the ICU is high (85.7%), many patients face ongoing health issues, resulting in a significant drop in long-term survival rates, especially among those with malignancies and poor organ function.
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  • Lung injury is really important for kids' survival after getting special treatments for blood diseases, and scientists want to learn more about how germs and the body work together in the lungs.
  • In a big study, researchers looked at lung samples from 229 kids at 32 hospitals over 8 years and found 4 different groups of patients based on their lung microbe makeup.
  • Each group had different health outcomes: one group had low infection rates and low death rates, while others had high infection and death rates, showing that the type of lung microbes can greatly affect survival.
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Objectives: Approximately 30% of patients develop chronic poststernotomy pain (CPSP) following cardiac surgery with sternal retraction. Risk factors have been described but no causal determinants identified. Investigators hypothesized that opening the sternum slowly would impart less force (and thereby less nerve/tissue damage) and translate to a reduced incidence of CPSP.

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Background: Breast reconstruction is an integral part of breast cancer care. There are 2 main types of breast reconstruction: alloplastic (using implants) and autologous (using the patient's own tissue). The latter creates a more natural breast mound and avoids the long-term need for surgical revision-more often associated with implant-based surgery.

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Patient-reported outcomes (PROs) capture subjective social determinants of health (SDOHs), which can affect health outcomes through the stress response pathway. The conserved transcriptional response to adversity (CTRA) is a stress-mediated proinflammatory transcriptomic pattern that has been linked to adverse hematopoietic cell transplant (HCT) outcomes. This study examined the association of pretransplant CTRA with patient-reported SDOHs in allogeneic HCT recipients.

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The COVID-19 pandemic paved the way for the widespread use of virtual care for childhood cancer survivors (CCSs). CCSs were virtual recipients of diverse care, including long-term follow-up (LTFU), primary care, mental health care, and several others. Virtual care comes with well-documented benefits and challenges.

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