The number of CD56dim NK cells in the graft has a major impact on risk of disease relapse following allo-HSCT.

The graft-versus-leukemia (GVL) effect of allogeneic hemopoietic stem cell transplantation (allo-HSCT) is mediated by the donor immune system and acts to decrease the rate of disease relapse. Although studies of posttransplant immune reconstitution have identified correlates of clinical outcome, the number and profile of mature immune cells infused with the stem cell graft is also likely to be an important determinant and has been relatively poorly studied. We characterized immune cells within the stem cell graft of 107 patients who underwent T-cell-depleted allo-HSCT and related this to clinical outcome. The number of natural killer (NK) cells and T cells that were infused varied markedly between patients, but T-cell dose was not an important factor in subsequent outcome. In contrast, the number of NK cells was a powerful determinant of the risk of disease relapse. Patients who received an NK cell dose below the median level of 6.3 × 106 cells per kg had a relapse rate of 40% at 2 years posttransplant compared with only 6% for those whose stem cell graft contained a dose above this value. Analysis of NK subsets showed that this effect was mediated primarily by the CD56dim population of mature effector cells and that high-level expression of the activatory protein DNAM on donor NK cells was also strongly protective. These observations offer important insights into the mechanism of GVL and suggest that optimization studies of the number of NK cells within the stem cell graft should be considered as a means to reduce disease relapse.

Coping with melanoma-related worry: a qualitative study of the experiences and support needs of patients with malignant melanoma.

AIMS AND OBJECTIVES: To explore the patients' experience of having malignant melanoma, their related support needs and the processes that lead to these needs being met. BACKGROUND: The number of patients attending surveillance clinics after a diagnosis of malignant melanoma is increasing. In the UK specialist nurses provide support to patients, but little evidence exists about the nature of patients' support needs or their experience of having melanoma. Melanoma has often been researched within general cancer studies, yet the support needs of melanoma patients may be different from those of patients with other skin cancers or tumour types. DESIGN: A Grounded Theory Approach was used to guide sampling, data collection and analysis. METHODS: In-depth interviews were conducted with eleven patients who where purposively sampled. Transcripts were read several times, coded and categorised using the constant comparative method. Emergent categories were discussed with participants. RESULTS: Three emergent categories related to a core category of melanoma-related worry which formed a substantive theory about the strategies patients use to control this. Participants reported needing to have their concerns believed by others prior to and after diagnosis. They discussed discerning whom to share their concerns with depending upon who they felt would not perceive assisting them as being burdensome. They also sought ways to reassure themselves. CONCLUSIONS: Patients need to have their fear and worries acknowledged by others. This includes nurses, healthcare professionals and family members. Patients will also use self-examination and the absence of symptoms to reassure themselves. RELEVANCE TO CLINICAL PRACTICE: Nurses play key roles throughout the patient's care; therefore they need to be sensitive to the fact that patients may consider them a primary source of support. When teaching self-examination it is important that nurses discuss that this may ease worry and aid coping.

A review of the literature on the impact of renal cancer therapy on quality of life.

AIM: To explore the impact of renal cancer treatment on patients' quality of life. BACKGROUND: Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients' quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking. DESIGN: Literature review. METHODS: A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study. RESULTS: From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review. CONCLUSIONS: This review discusses the complex effect of renal cancer upon a patient's quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care. RELEVANCE TO CLINICAL PRACTICE: Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices.

Assessing pain in older people.

This article examines pain assessment and measurement in relation to the specific needs of older people.

Selection of pain measurement tools.

BACKGROUND: Although pain measurement tools have been available for a number of years their reliability and validity cannot be presumed because none holds psychometric stability in every environment. To select the most appropriate tool for an individual patient, nurses need to be aware of those available and their limitations. This article discusses the use of selected tools with specific patient groups. CONCLUSION: A variety of tools are currently used for measuring pain, and each one has its merits and limitations. It is difficult to choose the most suitable tool for clinical settings in which a standard tool is to be used. Patient populations are diverse and can include adults of any age, with acute, chronic or malignant pain and cognitive or physical impairments of varying origin. There will be occasions when the tool used is inappropriate for an individual patient or a patient cannot complete the tool. Patients and nurses need to be educated about pain measurement tools to ensure their successful use.