Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 129-144).

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [58]-87).

Thesis (Ph. D.)--University of Chicago, Dept. of Neurobiology, Pharmacology and Physiology, December 1999. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 120-130).

Bibliography: leaves 152-223. Experiments were designed to identify and purify human bone marrow stromal precursor cells by positive immunoselection, based on the cell surface expression of the VCAM-1 and STRO-1 antigens. The data presented demonstrates a hierarchy of bone cell development in vitro.

Class of 2014 Abstract / Specific Aims: Busulfan is a chemotherapy used in conditioning regimens for hematopoeitic stem cell transplant (HSCT) that requires therapeutic drug monitoring (TDM) to reduce ther risk of adverse effects. Variable oral absorption and several studies demonstrating decreased toxicity with the intravenous formulation have led to IV preference despite the lower acquisition cost of oral busulfan. However, these studies failed to consider therapeutic drug monitoring and their results may therefore be flawed. The objective of this retrospective chart review was to determine the adverse effect, outcome profile, and cost-effectiveness of IV versus PO busulfan at a single medical center under TDM. Methods: This quality improvement project was a retrospective cohort analysis using patient data from a single large academic medical center from January 2007 to April 2013. Patients were included if they were 18 years or older and had undergone HSCT using either IV or PO busulfan using standard dosing regimens. This data was then used to design a cost-effectiveness model in order to determine if IV or PO busulfan is cost effective. Main Results: There were 68 subjects receiving autologous transplants and 37 subjects receiving allogeneic transplants that received busulfan as part of their pretreatment therapy and were included in this study. Allogeneic and autologous transplant populations were analyzed separately. In both populations there was no difference in occurrence of pulmonary toxicity, HVOD, or mucositis between the IV or PO groups. IV busulfan was significantly associated with an increased need for patient controlled analgesia in both autologous and allogeneic populations (p=0.038 and 0.028 respectively). Total cost of PO therapy was $30,081 and $30,047 less than IV for autologous and allogeneic transplants, respectively. PO therapy also represented a cost savings of $41 and $57 dollars for autologous and allogeneic transplants, respectively. This was confirmed through bootstrapping technique, which found PO to be dominant to IV busulfan. Conclusion: In conclusion, this study finds PO busulfan to be a therapeutically equivalent and cost saving option as part of a pretreatment regimen for both autologous and allogeneic hematopoietic stem cell transplants when therapeutic drug monitoring is performed.

Class of 2016 Abstract / Objectives: The purpose of this study was to evaluate if fluconazole 200 mg is an acceptable alternative to the fluconazole 400 mg for fungal prophylaxis in allogenic hematopoietic stem cell patients. Lower fluconazole doses will decrease cost of therapy and may reduce adverse events associated with higher doses. Methods: This study was a retrospective chart review conducted at the Arizona Cancer Center. A total of 58 patients qualified for the study. Primary endpoints were number of days on fluconazole 200 mg and type and number of fungal infections that occurred within 1 year post transplant. Results: Out of the fifty-eight patients who qualified for the study, only eight patients had a breakthrough fungal infection while on 200 mg (13.7%) after one year. Three of those eight were identified as having systemic fungal infections (5.2%). Conclusions: Fluconazole 200 mg is a reasonable low-cost and low side effect alternative to fluconazole 400 mg for antifungal prophylaxis in allogenic hematopoietic stem cell patients.

No description available.

Background: Sleep disruption is one of the most commonly reported quality of life concerns among cancer patients who have undergone hematopoietic stem cell transplantation (HSCT). Despite the high percentage of patients reporting sleep concerns, relatively little research has characterized sleep problems or explored relationships with psychological factors. In addition, no studies have used actigraph technology to characterize sleep issues among transplant recipients. Method: Autologous HSCT recipients who were 6 to 18 months post-transplant were invited to participate. Patients completed self-report measures of cancer-related distress, fear of cancer recurrence, dysfunctional cognitions about sleep, and maladaptive sleep behaviors upon enrollment, wore an actigraph and completed a sleep log at home for 7 days, and completed a self-report measure of sleep disruption on day 7 of the study. Results: 84 autologous HSCT recipients (age M = 60, 45% female) were enrolled and provided complete data. Forty-one percent of patients met criteria for sub-clinical or clinical insomnia based on patient self-report. Examination of actigraph data indicated that certain aspects of sleep were poorer than others (wake after sleep onset M = 66 minutes; total sleep time M = 6.5 hours; sleep efficiency M = 78%; sleep onset latency M = 21 minutes). Measures of cancer-related distress, fear of cancer recurrence, cognitive distortions, and maladaptive behavioral patterns were related to subjectively reported sleep disruption, p’s < .05, but were not related to objectively measured sleep disruption. Further examination revealed that the cognitive and behavioral factors accounted for the largest unique variance in subjectively reported sleep disruption. Conclusion: Results from the present study suggest that many HSCT recipients continue to experience sleep disruption during the survivorship period following transplant. Cancer-specific factors, dysfunctional cognitions about sleep, and maladaptive sleep behaviors were related to self-reported sleep disruption and are ripe targets for a cognitive behavioral intervention.

Cryopresevation is the process of cooling biological materials to low sub-zero temperatures for storage purposes. Numerous medical and technical applications, such as hematopoeitic stem cell transplantation and sperm banking, sometimes require the use of cryopreserved cells. Cryopreservation, however, can induce cell injury and reduce the yields of viable functional cells. Ice recrystallization is a mechanism of cryopreservation injury, but is rarely addressd in strategies to optimize cell cryopreservation. The results from this thesis demonstrate an association between the potency of carbohydrate-mediated ice recrystallization inhibition used in the cryopreservation of umbilical cord blood and recovery of viable non-apoptotic cells and hematopoietic progenitor function. Furthermore, increased numbers of apoptotic cells in hematopoeitic stem cell grafts were associated with reduced hematopoietic function and delayed hematopoietic recovery in patients undergoing blood stem cell transplantation. These findings provide a basis for pursuing further studies assessing ice recrystallization inhibition as a strategy for improving cell cryopreservation.