Syftet med den här undersökningen var att beskriva hur anhöriga upplever och hanterar sin livssituation, med fokus på familjen och deras egen hälsa, under den akuta fasen vid allogen stamcellstransplantation. Undersökningen ägde rum på Centrum för Allogen Stamcellstransplantation vid Karolinska Universitetssjukhuset Huddinge. Sju anhöriga till patienter som genomgick en allogen stamcellstransplantation deltog. Metoden som användes var att genom semistrukturerade intervjuer låta anhöriga själva berätta om sin livssituation. Dessa intervjuer analyserades sedan med hjälp av kvalitativ innehållsanalys vilket resulterade i att temat den nuvarande situationen formulerades. Temat bestod av tre kategorier livspussel, familj och hälsa och hade tio underkategorier totalt. Resultatet blev att när anhöriga får berätta om hur de upplever sin livssituation berättar de om hur de mobiliserar och fokuserar all sin kraft och alla sina resurser till den nuvarande situationen som de befinner sig i. Slutsatsen blev att vidare forskning för att utveckla interventioner för dessa anhöriga behövs, där sårbarhet upptäcks och inre och yttre resurser uppmärksammas och stärks. Att fokusera på anhöriga och den sjuka familjemedlemmen samtidigt, som en enhet, främjar hela familjens hälsa och medför därför en vinst, inte bara för de anhöriga utan även för patienten och dess tillfrisknande. / The aim of this study was to describe family members’ experience of life during the acute phase of allogenic stem cell transplantation. Seven family members of patients at, “Centrum for Allogenic Stem cell transplantation” Karolinska University Hospital in Huddinge participated. The method used was semistruktured interviews that allowed the respondents to tell about their living situation. These interviews were then analyzed through qualitative content analysis. The findings were a theme named; this present time consisting of three categories: living-pieces, family and health. There were also ten subcategories all together. The result was that when family members gives the opportunity to, with their own words, describe and tell about their living situation they tell about the present time and how they focus and mobilise all their strength and energy on their sick family member to get well. The conclusion of this study was that further research and development of interventions, for family members, are necessary and to focus on the family as a unite is an absolute condition in order to maintain health and prevent physical- and mental illness for the whole family. This ought to be beneficial not only for the family but also for the patients’ recovery.

Clinical trials investigating autologous stem cell transplantation (ASCT) have historically excluded elderly patients due to the risk of treatment-related morbidity related to the administration of high dose chemotherapy. While the availability of this procedure continues to expand, the elderly still represent a population for which the role of ASCT needs to be fully defined. 201 patients who underwent autologous stem cell transplantation (ASCT) for Non Hodgkins lymphoma (NHL) at a single institution following BEAM conditioning between January 1, 2000 and December 31, 2007 were retrospectively identified from the Yale University School of Medicine Bone Marrow Transplant Database. 67 patients were older than 60 years at the time of transplantation (median age 65, range 60 75) and were compared to a matched group of 134 patients transplanted during the same time period. These groups were extremely well-matched for all demographics such as gender, NHL histology, performance status, and comorbidities. Most patients had advanced stage disease at diagnosis and were transplanted at first or second remission. Diffuse large B-cell and mantle cell lymphoma were the most common subtypes but other subtypes were represented. The elderly group experienced significantly more serious toxicities within the first 100 days (63%) when compared to the control group (42%). However, there were no statistical differences (p<0.0001) between the groups regarding specific organ system toxicities. The 1-year non-relapse mortality (3%) was not significantly different when compared to the younger cohort (1%). At a median follow-up of 31 months the median overall survival is 85 months in the elderly group and at a median follow up of 33 months in the younger group the median overall survival has not yet been reached. The overall survival at 3 years is 74% and 75% respectively (p=0.91). The disease-free survival at 3 years is 48% in the elderly group compared to 58% in the control group (p=0.66). By univariate analysis, age >60 years (RR 3.1, 95% CI 1.7 5.7, p=0.004) was the only factor predictive of developing a serious toxicity from ASCT within the first 100 days. HCT-CI score (RR 2, 95% CI 1 4, p=0.043) was the only factor associated with significantly worse overall survival. Autologous stem cell transplantation can be safely performed in selected patients older than 60 years with chemosensitive NHL. Although elderly patients appear more likely to develop acute toxicities, the outcomes are similar to that of younger patients with respect to non-relapse mortality, disease-free survival, and overall survival.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 85-105).

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 101-113).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 5 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2008. / Includes vita. Includes bibliographical references. Also available online.

Dissertation (Ph.D.)--University of South Florida, 2008. / Includes vita. Includes bibliographical references. Also available online.

A possible treatment for patients with lymphoma and myeloma is stem cell transplantation (SCT). SCT is preceded with cytostatic treatment. There are several side effects related to this treatment, for example fatigue, nausea, constipation/diarrhoea, pain, mucositis and loss of appetite. Aim: Investigate which side effects related to the treatment where most troubling after SCT and if nurse assessment and patient assessment differ. Methods: A quantitative empirical study with repeated measuring. The two groups of nurses and patients answered a form independently. Results: Loss of appetite and fatigue are the most troubling side effects according to both nurse and patient. Older patients tended to be more affected by fatigue. The nurses estimated the side effects such as loss of appetite, fatigue, diarrhoea and nausea lower than the patients did. Conclusion: No definitive conclusion could be made because of the small patient/nurse sample. However, there is a tendency showing difficulty for nurses to estimate correctly the side effects suffered by the patients. The nurses tend to estimate the side effects lower than the patients do.

Moklsiniame darbe tirtas chimerizmas vaikams po alogeninės kraujodaros kamieninių ląstelių transplantacijos. Tyrimas pradėtas Charité klinikose (Humboldto universitetas, Berlynas), kur chimerizmo tyrinėjimams pasirinkti recipientai, sergantys ūmia limfoblastine leukemija (ŪLL), Fanconi anemija (FA) ir adrenoleukodistrofija (ALD). Sergant šiomis ligomis nuoseklus chimerizmo stebėjimas ALP atliktas pirmą kartą. Darbas tęstas Vilniaus universitete, kuomet pirmą kartą buvo atlikti chimerizmo tyrinėjimai Lietuvoje transplantuotiems vaikams. Donoro ir recipiento ląstelėms atskirti naudoti polimorfiniai DNR žymenys, kurie tirti periferinio kraujo leukocituose (PKL) ir atskirose ląstelių populiacijose (ALP): CD3, CD19 ir CD34. Ląstelių frakcijoms atskirti naudotos imunomagnetinės dalelės. Atlikus chimerizmo analizę nutatyta, kad esant visiškam donoro chimerimui PKL, 74,4% ŪLL ir 66,7% ALD recipientų po mieloabliacinio kondicionavimo ląstelių populiacijose išlieka autologinė, aptinkama iki kelerių metų po transplantacijos. Po sumažinto intensyvumo kondicionavimo 45,5% FA recipientų autologinės kraujodaros pėdsakų nerandama nei PKL, nei ALP. FA ligoniams vystosi stabilus ilgalaikis mišrus chimerizmas, kuris susijęs su su ilgesniu išgyvenamumu po transplantacijos. Nustatėme, kad sergantiems FA galimybė išsivystyti mišriam chimerizmui yra 20 kartų didesnė perpylus kaulų čiulpus, nei periferinio kraujo kamienines ląsteles. / The doctoral thesis aimed to evaluate in a comparative way the benefit chimerism assessment in isolated cell populations (ICP) versus conventional monitoring in whole blood cells (WBC). The study was initiated in Pediatric Bone Marrow Transplant Service of Charité Children’s Hospital (Humboldt University, Berlin). Children suffered from: acute lymphoblastic leukemia (ALL), Fanconi anemia (FA) and adrenoleukodystrophy (ALD) were included into the study. Thereafter the doctoral thesis was accomplished at the Vilnius University where evaluation of the own experience of chimerism analysis in pediatric patients was performed. Chimerism was prospectively monitored in WBC and three cell subsets: CD3, CD19 and CD34. Cell populations were extracted from peripheral blood using immunomagnetic beads. Following polymorphisms of short tandem repeats between donor and recipient were compared. The analysis reveled that following myeloablative conditioning in patients with ALL and ALD analysis of ICP revealed persistent autologous hemopoiesis despite stable donor chimerism in WBC. In contrast after reduced intensity conditioning 45.5% of FA recipients had no evidence of autologous signals either in WBC, or in ICP. FA were found to develop stable long-lasting mixed chimerism associated with better overall survival. development of MC was related to the infusion of bone marrow but not to peripheral blood stem cells. Chimerism in ICP did no affected transplant outcome in any disease group.

The doctoral thesis aimed to evaluate in a comparative way the benefit chimerism assessment in isolated cell populations (ICP) versus conventional monitoring in whole blood cells (WBC). The study was initiated in Pediatric Bone Marrow Transplant Service of Charité Children’s Hospital (Humboldt University, Berlin). Children suffered from: acute lymphoblastic leukemia (ALL), Fanconi anemia (FA) and adrenoleukodystrophy (ALD) were included into the study. Thereafter the doctoral thesis was accomplished at the Vilnius University where evaluation of the own experience of chimerism analysis in pediatric patients was performed. Chimerism was prospectively monitored in WBC and three cell subsets: CD3, CD19 and CD34. Cell populations were extracted from peripheral blood using immunomagnetic beads. Following polymorphisms of short tandem repeats between donor and recipient were compared. The analysis reveled that following myeloablative conditioning in patients with ALL and ALD analysis of ICP revealed persistent autologous hemopoiesis despite stable donor chimerism in WBC. In contrast after reduced intensity conditioning 45.5% of FA recipients had no evidence of autologous signals either in WBC, or in ICP. FA were found to develop stable long-lasting mixed chimerism associated with better overall survival. development of MC was related to the infusion of bone marrow but not to peripheral blood stem cells. Chimerism in ICP did no affected transplant outcome in any disease group. / Moklsiniame darbe tirtas chimerizmas vaikams po alogeninės kraujodaros kamieninių ląstelių transplantacijos. Tyrimas pradėtas Charité klinikose (Humboldto universitetas, Berlynas), kur chimerizmo tyrinėjimams pasirinkti recipientai, sergantys ūmia limfoblastine leukemija (ŪLL), Fanconi anemija (FA) ir adrenoleukodistrofija (ALD). Sergant šiomis ligomis nuoseklus chimerizmo stebėjimas ALP atliktas pirmą kartą. Darbas tęstas Vilniaus universitete, kuomet pirmą kartą buvo atlikti chimerizmo tyrinėjimai Lietuvoje transplantuotiems vaikams. Donoro ir recipiento ląstelėms atskirti naudoti polimorfiniai DNR žymenys, kurie tirti periferinio kraujo leukocituose (PKL) ir atskirose ląstelių populiacijose (ALP): CD3, CD19 ir CD34. Ląstelių frakcijoms atskirti naudotos imunomagnetinės dalelės. Atlikus chimerizmo analizę nutatyta, kad esant visiškam donoro chimerimui PKL, 74,4% ŪLL ir 66,7% ALD recipientų po mieloabliacinio kondicionavimo ląstelių populiacijose išlieka autologinė, aptinkama iki kelerių metų po transplantacijos. Po sumažinto intensyvumo kondicionavimo 45,5% FA recipientų autologinės kraujodaros pėdsakų nerandama nei PKL, nei ALP. FA ligoniams vystosi stabilus ilgalaikis mišrus chimerizmas, kuris susijęs su su ilgesniu išgyvenamumu po transplantacijos. Nustatėme, kad sergantiems FA galimybė išsivystyti mišriam chimerizmui yra 20 kartų didesnė perpylus kaulų čiulpus, nei periferinio kraujo kamienines ląsteles.