Does quality of life improve for clients with autoimmune or neuromuscular  disorders who received stem cell replacement? 

Please cite the attached references in the paper. Also please utilize the rubrix attached

This is due by Sunday May 31, 2020

Série IV – n.º 19 – OUT./NOV./DEZ. 2018Revista de Enfermagem Referência

pp. 29 – 36

ISSNe: 2182.2883 | ISSNp: 0874.0283

Coping strategies used during treatment by patients submitted
to hematopoietic stem cell transplantation
Estratégias de enfrentamento utilizadas durante o tratamento por pacientes submetidos
ao transplante de células-tronco hematopoiéticas
Estrategias de afrontamiento utilizadas durante el tratamiento por pacientes sometidos
a trasplante de células madre hematopoyéticas
Ana Paula Szczepanik* ; Angela da Costa Barcellos Marques** ; Mariluci Alves Maftum*** ;
Rosibeth Del Carmen Muños Palm**** ; Maria de Fátima Mantovani***** ; Luciana Puchalski Kalinke******

Background: Coping strategies in the process of treatment with hematopoeitic stem cell transplantation are crucial to the
improvement of the quality of life of these patients.
Objective: To describe coping strategies used during treatment by patients submitted to hematopoietic stem cell transplantation.
Methodology: Qualitative, descriptive, and exploratory research, with 5 participants, conducted from July to November
2017, in a hospital of reference for this treatment in Brazil. Data were collected by means of semi-structured and self-applied
video interview and analysed by the content analysis technique.
Results: Coping strategies such as family support and spirituality were the most used, present in every stage of transplant,
followed by the increase of feeling of appreciation of life after overcoming this experience.
Conclusion: Patients develop coping strategies to endure therapy effects. The knowledge of the strategies can contribute
to the enlightenment and stimulation of future patients regarding coping with treatment, as well as to the assistance of
health professionals, especially nursing teams in care practice.
Keywords: hematopoietic stem cell transplantation; bone marrow transplantation; adaptation, psychological; oncology nursing

Enquadramento: Estratégias de enfrentamento no processo de
tratamento do transplante de células-tronco hematopoiéticas
são determinantes para uma melhor recuperação dos pacientes.
Objetivo: Descrever estratégias de enfrentamento utilizadas
durante tratamento por pacientes submetidos ao transplante
de células-tronco hematopoiéticas.
Metodologia: Pesquisa qualitativa, descritiva e exploratória,
com 5 participantes, de julho a novembro de 2017, em hospital
referência para este tratamento no Brasil. Os dados foram
obtidos por vídeo-entrevista semiestruturada, auto aplicada,
e analisados pela técnica análise de conteúdo.
Resultados: Estratégias de enfrentamento como o apoio fami-
liar e a espiritualidade foram as mais utilizadas, estando presente
em todas as etapas do transplante, seguido do aumento do
senso de valorização da vida após a vivência desta experiência.


Efficacy and safety of autologous hematopoietic stem-cell
transplantation in multiple sclerosis: a systematic
review and meta-analysis

Fangfang Ge1 & Hong Lin1 & Zhuyi Li1 & Ting Chang1

Received: 19 March 2018 /Accepted: 29 November 2018 /Published online: 10 December 2018
# Fondazione Società Italiana di Neurologia 2018

Background Autologous hematopoietic stem-cell transplantation (AHSCT) has been utilized as a treatment option for multiple
sclerosis (MS) since 1995. However, this procedure has not been widely implemented in clinical practice owing to its mortality
risk. Here, we conduct a meta-analysis to evaluate the long-term efficacy and safety of AHSCT in MS treatment, aiming to
optimize the benefit/risk ratio of this therapeutic strategy.
Methods We searched the PubMed Web site and databases. The efficacy endpoints were progression-free
survival (PFS) and disease activity-free survival. The safety outcomes were transplant-related mortality (TRM) and overall
Results Eighteen eligible studies with a total of 732 participants were enrolled. The PFS was 75% (95% CI, 0.69–0.81), and the
estimate of disease activity-free survival was 61% with 48-month follow-up. Subgroups analysis showed that low- and
intermediate-intensity regimens were associated with higher PFS 80%. Relapsing remitting MS (RRMS) benefited more from
AHSCT than other MS subtypes with PFS 85%. Patients with Gd+ lesions at baseline MRI responded better to AHSCTwith PFS
77%. The estimate of TRM was 1.34% (95% CI, 0.39–2.30), and the overall mortality was 3.58%. TRM was significantly higher
in high-intensity regimen studies (3.13%) and in older studies (1.93%) performed before 2006.
Conclusions This meta-analysis provides evidences that AHSCT can induce long-term remissions for MS patients with a high
degree of safety. We indicate low- and intermediate-intensity regimens and RRMS patients with the presence of Gd+ lesions at
baseline MRI can obtain the optimal benefit/risk ratio from AHSCT.

Keywords Multiple sclerosis . Autologous hematopoietic stem-cell transplantation . Meta-analysis . Systematic review .



Multiple sclerosis (MS) is an immune-mediated and CNS de-
myelinating disease affecting more than two million people

worldwide especially manifests in young adults. This disorder
can give rise to permanent disability, impair quality of life, and
shorten life expectancy. During the past two decades, disease-
modifying treatments (DMTs) have become available and
shown to reduce clinical relapse, suppress disease activity in
patients with relapsing remitting MS (RRMS). However,
DMTs showed little benefit in disability progression and could
not effectively treat other subgroups of MS: progressive and
treatment-refractory MS [1, 2]. Given B cells and humoral
immunity play a key role


Neuromuscular complications after hematopoietic stem
cell transplantation

Susanne Koeppen & Abhiyrahmi Thirugnanasambanthan &
Michael Koldehoff

Received: 19 December 2013 /Accepted: 20 March 2014 /Published online: 29 March 2014
# Springer-Verlag Berlin Heidelberg 2014

Purpose The aim of this study was to analyze the occurrence
of neuromuscular symptoms in recipients of allogeneic hema-
topoietic stem cell transplantation (HSCT) for treatment of
malignant hematopoietic disease.
Methods Among 247 outpatients after allogeneic HSCT, we
conducted a prospective non-interventional study between
July 2011 and August 2013. During follow-up visits, clinical
and electrophysiological findings were correlated to the pres-
ence of autoantibodies/alloantibodies and to frequencies of
lymphocyte subpopulations in peripheral blood.
Results Resulting in an incidence of 8.1 %, 20 patients were
diagnosed with neuromuscular complications at a median
onset of 12 months post-transplant. Five patients (25 %) were
identified with polyneuropathy (PNP), ten patients (50 %)
with combined PNP and myopathy, four patients (20 %) with
myopathy or polymyositis (PM), and one patient (5 %) with
myasthenia gravis (MG). Immune-mediated sensorimotor
PNP after HSCT is characterized by a predominantly axonal
lesion and can be overlapping with neurotoxic side effects.
The latency between HSCT and development of PM varied
between 60 days and 72 months. In general, PM occurs
parallel to graft-versus-host disease (GvHD) after tapering of
immunosuppressive medication. Typical clinical features are
proximal bilateral limb weakness with muscle atrophy. Auto-
antibodies (Ab) were detected in 12 patients, myositis-specific
Ab only in one patient. In patients with progressive

neurological symptoms, a decrease in the CD4/CD8 T cell
ratio was observed.
Conclusions GvHD-related myositis appeared similar to idi-
opathic myositis regarding clinical and electromyographical
findings. As outcome measure, sequential analysis of lympho-
cyte subpopulations in peripheral blood seems to be more
suitable than Ab measurements. Whereas peripheral neuropa-
thies are commonly observed shortly after HSCT, MG is a rare
complication in the late post-HSCT phase.

Keywords Allogeneic hematopoietic stem cell
transplantation . Graft-versus-host disease . Polyneuropathy .

Polymyositis . Myasthenia gravis

AChR Ab Acetylcholine receptor antibody
AL Acute leukemia
ALL Acute lymphocytic leukemia
ANA Antinuclear antibodies
AML Acute myeloid leukemia
Ab Autoantibodies
CK-MB Creatine kinase-MB
CLL Chronic lymphocytic leukemia
CML Chronic myeloid leukemia
GvHD Graft-versus-host disease
HSCT Hematopoietic stem cell transplantation
ND Not done
MCL Mantle cell lymphoma
MG Myasthenia gravis
MM Multiple myeloma
MPN Myeloproliferative neoplasm
OMF Osteomyelofibrosis
PM Polymyositis


exual dysfunction is one of the most common and persistent long-term
complications following hematopoietic stem cell transplantation
(HSCT) (Syrjala, Langer, Abrams, Storer, & Martin, 2005). Increased
awareness is needed to improve quality of life (QOL) and to manage
and alleviate long-term complications of sexual health in HSCT survi-

vors (Heinonen et al., 2001). An estimated overall 44% decrease in QOL occurs
after HSCT (Claessens, Beerendonk, & Schattenberg, 2006). Although significant
quantitative data exist regarding sexual health among female recipients of HSCT,
qualitative data regarding women’s experiences are lacking.

Experiences in Sexual Health Among Women After
Hematopoietic Stem Cell Transplantation

Purpose/Objectives: To explore the experiences in sexual health among women after
hematopoietic stem cell transplantation (HSCT).

Research Approach: A qualitative phenomenologic approach was used to explore sexual
health after HSCT.

Setting: The leukemia and bone marrow transplantation outpatient clinic at Massachusetts
General Hospital in Boston.

Participants: This study included five women aged 18 years or older with a prior diagnosis
of leukemia or lymphoma requiring HSCT who were at least three months post-HSCT and
were sexually active prior to HSCT. Participants did not experience menopause pre-HSCT
and did not show signs of relapsed disease or vaginal graft-versus-host disease.

Methodologic Approach: A semistructured interview was conducted and included one
open-ended question regarding sexual health after participants’ HSCT and several follow-up
questions. The interviews were audio recorded without participant identifiers. Interviews
were then transcribed and analyzed. Primary investigators and an expert reviewer analyzed
data using content analysis to identify themes from the interviews.

Findings: Six themes emerged from the interviews: (a) relationship changes, (b) significant
and concerning physical changes, (c) sense of loss and powerful emotional impact, (d)
fatigue, (e) body image, and (f) educational needs.

Conclusions: Findings portray women’s experiences in sexual health post-HSCT and
demonstrate the emotional and physical consequences that arise from HSCT-related
complications. A need exists for greater support and education for women regarding
sexual health post-HSCT, as well as improved education among clinicians regarding sexual
health complications experienced by this population. Women articulated their desire for
same-sex providers to educate them on the sexual health side effects of HSCT.

Interpretation: Sexual health education is needed immediately prior to and following
HSCT. Implications for practice include designating time for pre- and post-HSCT education,
improving current sexual health

Role of Stem Cell–Like Memory T Cells in
Systemic Lupus Erythematosus

Ye Ji Lee, Ji Ah Park, Hyunmi Kwon, Youn Soo Choi, Kyeong Cheon Jung,
Seong Hoe Park, and Eun Bong Lee

Objective. Stem cell–like memory T (Tscm) cells
are long-lived memory T cells that have multipotent
capacity to differentiate into different subsets. However,
the role of Tscm cells in autoimmune diseases remains
unclear. Here, we performed phenotypic studies to iden-
tify Tscm cells in patients experiencing systemic lupus
erythematosus (SLE).

Methods. CD4+ and CD8+ Tscm cells were identi-
fied in SLE patients and healthy controls (HCs). In in
vitro culture systems, CD4+ Tscm cells were induced to
differentiate into subsets of T cells, including follicular
helper T (Tfh) cells, and cytokine production patterns
were assessed after stimulation. After confirming induc-
tion of transcription factors for Tfh cells, the capacity of
CD4+ Tscm-derived Tfh cells to help B cells was analyzed
by measuring antibody secretion.

Results. The percentages of CD4+ and CD8+ Tscm
cells among the naive CD4+/CD8+ or total CD4+ T cell
populations were significantly higher in SLE patients than
in HCs. Stimulated Tscm cells from SLE patients could
replenish themselves and differentiate into other T lym-
phocyte subsets, including Tfh cells upon stimulation with
T cell receptor. Production of T cell factor 1, which is an
inducer of Tfh, was also increased. The differentiated Tfh
cells increased antibody production by autologous B cells.

Conclusion. Taken together, these findings suggest
that Tscm cells play a role in the pathogenesis of SLE by
maintaining Tfh cells.

Stem cell–like memory T (Tscm) cells are multipo-
tent progenitor T cells with self-renewal capacity. They
can differentiate into different subsets of mature lympho-
cytes when stimulated via the T cell receptor (TCR). In
the progressive differentiation model, Tscm cells are
regarded as the earliest and least differentiated subset of
memory T cells and are derived from priming of naive T
cells (1). They share surface markers of
CCR7+CD45RO�CD45RA+CD62L+ with naive T cells,
but they also express memory cell–like surface markers
such as CD95 (Fas)high and CD122 (interleukin-2Rb+
[IL-2Rb+]), and express stem cell–associated surface mar-
ker (CD127+) (2). Although expression of CD95 by
human naive CD8+ Tcells is negligible, Tscm cells up-reg-
ulate the expression of CD95 similarly to conventional
memory T cells (1), and the CD95 molecule is one of the
critical surface markers to differentiate Tscm cells from
naive Tcells. Tscm cells play various roles in humans with
respect to protection against or persistence of damage
(3). Tscm cells generated during various microbial infec-
tions have a role in maintaining the microbes’ reservoir
(4–7). Recently, there has been an effort to genetically
modify Tscm cells to acquire long-term anticancer capac-
ity (8). I

559Received: Mar. 20th 2017; Accepted: June 13rd 2017. Rev Rene. 2017 July-Aug; 18(4):559-66.

DOI: 10.15253/2175-6783.2017000400019

Article Review

Nursing care for hematopoietic stem cell transplant recipients and
their families

Cuidados de enfermagem direcionados aos transplantados com células-tronco
hematopoéticas e suas famílias

Isabelle Campos de Azevedo1, Alexandra do Nascimento Cassiano1, Jovanka Bittencourt Leite de Carvalho1,
Marcos Antonio Ferreira Júnior1

Objective: to identify nursing care for hematopoietic stem cell transplant recipients and their families. Methods:
integrative review with searches in the databases SCOPUS; National Library of Medicine; Web of Science,
Cumulative Index to Nursing and Allied Heath Literature and Latin American and Caribbean Literature in Health
Sciences. The selected studies were published between 2008 and 2014. Results: 460 articles were initially
identified, culminating in the final sample of seven studies analyzed in their entirety. Care provided varied in all
studies, from actions directed to health education practices, to the accomplishment of complementary therapies
and the implementation of Advanced Nursing Practice with a view to qualification of care. Conclusion: care
provided includes health education actions, complementary therapies to promote well-being and quality of life,
as well as the implementation of the Advanced Nursing Practice with a view to qualification of care.
Descriptors: Nursing Care; Nursing; Family; Hematopoietic Stem Cell Transplantation.

Objetivo: identificar os cuidados de enfermagem direcionados aos transplantados com células-tronco
hematopoéticas e suas famílias. Métodos: revisão integrativa com buscas nas bases de dados SCOPUS; National
Library of Medicine; Web of Science, Cumulative Index to Nursisng and Allied Heath Literature e Literatura
Latino-Americana e do Caribe em Ciências da Saúde. Os estudos selecionados foram publicados entre 2008
e 2014. Resultados: foram identificados inicialmente 460 artigos, que culminaram na amostra final de sete
estudos analisados na íntegra. Os cuidados variaram em todos os estudos desde ações direcionadas à prática
de educação em saúde, a realização de terapias complementares e a implementação da Prática Avançada em
Enfermagem com vistas à qualificação do cuidado. Conclusão: os cuidados compreendem as ações de educação
em saúde, a realização de terapias complementares para promoção do bem-estar e qualidade de vida, bem
como, a implementação da Prática Avançada de Enfermagem com vistas à qualificação do cuidado.
Descritores: Cuidados de Enfermagem; Enfermagem; Família; Transplante de Celúlas-Tronco Hematopoéticas.

1Universidade Federal do Rio Grande do Norte. Natal, RN, Brazil.

Corresponding author: Isabelle Campos de Azevedo
Universidade Federal do Rio Grande do Norte,

Possible points


· Introduces topic/issue and population


· Discusses significance of topic/issue



· Paragraphs are coherent with the organization of the body.


· Discusses the findings from research related to nursing and collaborative interventions, any comparisons with other intervention modalities, and outcomes from research studies.

· Reflects synthesis and integration of findings and implications as they relate to key concepts or themes, not a description of the details of each study.

· Demonstrates critical thinking regarding findings and how this might impact nursing practice.

· Written in student’s own words with minimal use of quotations.


· Student discusses at least 6 research articles.

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· Includes the student’s thoughts about how the cited research articles reflect evidence-based nursing.


· Includes the student’s thoughts about whether the evidence is strong enough to lead to a change in practice.

· If evidence is strong enough to recommend change – describes specifically how nurses would implement the evidence in practice.

· If evidence is not strong enough to recommend change – describes what additional evidence should be gathered and what type(s) of studies would be used.



· Paper at least 4 full pages in length (not including cover page and references) but no more than 8 pages (not including cover page and references)


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