Purpose/objectives: To describe an opioid taper algorithm for hematopoietic cell transplant (HCT) recipients and its development.
Data Sources: Nonresearch-based published guidelines, published research on opioid withdrawal symptoms, clinical experience, and multidisciplinary consultant recommendations.
Data Synthesis: Many HCT recipients receive opioid therapy for several weeks and thus become physically dependent on opioids. If opioids are discontinued abruptly or tapered too rapidly, patients may experience discomfort from withdrawal symptoms. An algorithm can guide clinicians in providing patient care.
Conclusions: No research-based opioid-taper guidelines exist in the literature; existing guidelines vary widely and are not specific to HCT recipients. Thus, the algorithm addresses a gap in the literature and also provides flexibility when dealing with patient discomfort.
Implications For Nursing Practice: Use of an algorithm may promote consistency of opioid tapering and patient comfort.
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Hematology
December 2025
Cellular Therapy & Transplantation Program, Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal, Quebec, Canada.
Umbilical cord blood (UCB) represents a valuable graft source in the absence of a human leukocyte antigen (HLA)-matched donor for hematopoietic cell transplantation (HCT). Donor-specific anti-HLA antibodies (DSAs), targeting grafts with mismatched HLA antigens, pose a significant obstacle by increasing the risk of primary graft failure, delayed engraftment, and decreased survival. Existing literature on HLA desensitization has primarily focused on haploidentical transplants, and there is a lack of experience regarding the optimal strategy in UCB transplantation.
View Article and Find Full Text PDFTransplant Cell Ther
January 2025
University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
Background: Multiple factors have been described to influence the risk of acute or chronic graft-versus-host disease (aGVHD or cGVHD) after allogeneic hematopoietic cell transplantation (HCT), including underlying chronic myeloid leukemia (CML) and high-dose total body irradiation (TBI). However, the impact of the underlying disease or low-dose TBI on the risk of GVHD in the modern era has not been determined.
Objective: To determine risk factors for GVHD in the modern era in the setting of antithymocyte globulin (ATG)-based GVHD prophylaxis.
Transplant Cell Ther
January 2025
Dana-Farber Cancer Institute, Division of Transplantation and Cellular Therapy, Boston, MA. Electronic address:
Background: Post-transplant cyclophosphamide (PTCy) is a commonly used graft-vs-host disease (GVHD) prophylaxis, particularly in the setting of haploidentical (haplo) hematopoietic cell transplantation (HCT). The rate of graft failure has been reported to be as high as 12-20% in haplo-HCT recipients using PTCy. The objective of this study was to determine if donor type influenced the risk of late graft failure following RIC HCT using PTCy-based GVHD prophylaxis.
View Article and Find Full Text PDFDrug Des Devel Ther
January 2025
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Background: Sirolimus is a commonly used immunosuppressant administered after solid organ transplantation. It is characterized by a narrow therapeutic window and highly variable exposure, necessitating the identification of the sources of variability and design of individualized drug therapies.
Aim: This study aimed to perform a population pharmacokinetic (PK) analysis of sirolimus in adult liver transplant recipients and develop dosing regimen recommendations according to patient characteristics.
Front Immunol
December 2024
German Cancer Consortium (DKTK), Partner site Frankfurt/Mainz, a partnership between DKFZ and University Medical Center Frankfurt, Frankfurt, Germany.
Introduction: Posttransplant cyclophosphamide (PTCy) has revolutionized the landscape of human leukocyte antigen (HLA)-haploidentical hematopoietic cell transplantation (haplo-HCT), providing a pivotal therapeutic option for patients with hematological malignancies who lack an HLA-matched donor.
Methods: In this retrospective analysis involving 54 adult patients undergoing PTCy-based haplo-HCT, we evaluated the impact of inhibitory killer immunoglobulin-like receptor (KIR)/HLA mismatch, alongside patient, donor, and transplant factors, on clinical outcomes within a homogeneous cohort characterized by a myeloablative conditioning regimen and bone marrow graft.
Results: With a median follow-up of 73.
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