RESUMO
Bone marrow harvesting is a means to obtain stem cells to treat certain hematologic conditions in related or unrelated individuals. The most cited complication after bone marrow harvesting is surgical site pain. We developed a protocol incorporating regional anesthesia to improve pain control and reduce opioid use. A retrospective chart review was performed on three pediatric patients who underwent bone marrow harvesting for a sibling recipient and were managed via a standardized regional pain protocol. Each patient was treated with bilateral quadratus lumborum blocks in the operating room, prior to incision. Anesthesia records were reviewed for opioid administration intraoperatively and postoperatively. Two of three patients underwent successful QL blocks as evidenced by pain scores of 0/10 and lack of opioid administration in the post-anesthesia care unit. One patient was found to have a failed block and exhibited pain in the immediate and post-discharge time frame. Following this outpatient procedure, all patients were discharged home to the care of their parents, and no patients required admission due to pain. By utilizing the framework of a successful regional anesthesia model adapted from our adult bone marrow donor patients, we were able to employ a minimal opioid anesthetic and reunite patients with their families efficiently. We continue to use quadratus lumborum blocks in our pediatric patients to facilitate perioperative analgesia.
RESUMO
BACKGROUNDCurrently, no laboratory tests exist to stratify for the risk of developing sinusoidal obstruction syndrome (SOS), an early endothelial complication after hematopoietic cell transplantation (HCT). Risk biomarkers of SOS have not been verified in a prospective cohort accounting for differences between practices across institutions. Herein, we aimed to define risk groups for SOS occurrence using 3 proteins: L-ficolin, hyaluronic acid (HA), and stimulation 2 (ST2). METHODSBetween 2017 and 2021, we prospectively accrued 80 pediatric patients across 4 US centers. Biomarkers were tested by ELISA blind to patient groupings and associated with SOS incidence on day 35 after HCT, and overall survival (OS) on day 100 after HCT. Cutpoints were identified using retrospective cohorts and applied to the prospective cohort.RESULTSCombination of the 3 biomarkers measured on day 3 after HCT in the prospective cohort provided 80% (95% CI 55%-100%) sensitivity and 73% (95% CI 62%-83%) specificity for risk of SOS occurrence. Patients with low L-ficolin were 9 times (95% CI 3-32) more likely to develop SOS, while patients with high HA and ST2 were 6.5 (95% CI 1.9-22.0) and 5.5 (95% CI 2.3-13.1) times more likely to develop SOS. These 3 markers also predicted worse day 100 OS - L-ficolin: HR, 10.0 (95% CI 2.2-45.1), P = 0.0002; HA: HR, 4.1 (95% CI 1.0-16.4), P = 0.031; and ST2: HR, 3.9 (95% CI 0.9-16.4), P = 0.04.CONCLUSIONL-ficolin, HA, and ST2 levels measured as early as 3 days after HCT improved risk stratification for SOS occurrence and OS and may guide risk-adapted preemptive therapy.TRIAL REGISTRATIONClinicalTrials.gov NCT03132337.FUNDINGNIH.
