1.
Home-Based Spirometry Telemonitoring After Allogeneic Hematopoietic Cell Transplantation: Mixed Methods Evaluation of Acceptability and Usability
Sheshadri, A., Makhnoon, S., Alousi, A. M., Bashoura, L., Andrade, R., Miller, C. J., Stolar, K. R., Arain, M. H., Noor, L., Balagani, A., et al
JMIR formative research. 2022;6(2):e29393
Abstract
BACKGROUND Home-based spirometry (HS) allows for the early detection of lung complications in recipients of an allogeneic hematopoietic cell transplant (AHCT). Although the usability and acceptability of HS are critical for adherence, patient-reported outcomes of HS use remain poorly understood in this setting. OBJECTIVE The aim of this study is to design a longitudinal, mixed methods study to understand the usability and acceptability of HS among recipients of AHCT. METHODS Study participants performed HS using a Bluetooth-capable spirometer that transmitted spirometry data to the study team in real time. In addition, participants completed usability questionnaires and in-depth interviews and reported their experiences with HS. Analysis of interview data was guided by the constructs of performance expectancy, effort expectancy, and social influence from the Unified Theory of Acceptance and Use of Technology model. RESULTS Recipients of AHCT found HS to be highly acceptable despite modest technological barriers. On average, participants believed that the HS was helpful in managing symptoms related to AHCT (scores ranging from 2.22 to 2.68 on a scale of 0-4) and for early detection of health-related problems (score range: 2.88-3.12). Participants viewed HS favorably and were generally supportive of continued use. No significant barriers to implementation were identified from the patient's perspective. Age and gender were not associated with the patient perception of HS. CONCLUSIONS Study participants found HS acceptable and easy to use. Some modifiable technical barriers to performing HS were identified; however, wider implementation of pulmonary screening is feasible from the patient's perspective.
2.
Risk factors for bronchiolitis obliterans syndrome after initial detection of pulmonary impairment
Alkhunaizi, M., Patel, B., Bueno, L., Bhan, N., Ahmed, T., Arain, M. H., Saliba, R., Rondon, G., Dickey, B. F., Bashoura, L., et al
Transplantation and cellular therapy. 2022
Abstract
INTRODUCTION Pulmonary chronic graft-vs-host-disease (cGVHD), or bronchiolitis obliterans syndrome (BOS), is a highly morbid complication of hematopoietic cell transplant. The clinical significance of a single instance of pulmonary decline not meeting BOS criteria is unclear. METHODS We conducted a retrospective analysis on a cohort of patients who had an initial post-HCT decline in the absolute value of FEV(1) of ≥ 10% or mid-expiratory flow rates of ≥ 25% but not meeting criteria for BOS (preBOS). We examined the impact of clinical variables in patients with preBOS on the risk for subsequent BOS. RESULTS 1325/3170 (42%) patients developed preBOS, of whom 72 (5%) later developed BOS. Eighty-four patients developed BOS without detection of preBOS by routine screening. Among patients with preBOS, and after adjusting for other significant variables, airflow obstruction (HR 2.0, 95% confidence interval [CI] 1.1-3.7, p=0.02), percent-predicted FEV(1) upon decline (HR 0.98, 95% CI 0.97-1.0 p=0.02), active cGVHD (HR 7.7, 95% CI 3.1-19.3, p<0.001), peripheral blood stem cell source (HR 3.8, 95% CI 1.7-8.6, p=0.001), and myeloablative conditioning (HR 2.0, 95% CI 1.1-3.5, p=0.02) were associated with subsequent BOS. The absence of airflow obstruction and cGVHD had a negative predictive value of 100% at six months for subsequent BOS, but the positive predictive value of both factors was low (cGVHD: 3%, any obstruction: 4%, combined: 6%). CONCLUSIONS Several clinical factors at the time of preBOS, particularly active cGVHD and airflow obstruction, increase the risk for subsequent BOS. These factors merit consideration to be included in screening practices to improve the detection of BOS, with the caveat that the predictive utility of these factors is limited by the overall low incidence of BOS among patients with preBOS.
3.
Azithromycin may increase hematologic relapse rates in matched unrelated donor hematopoietic cell transplant recipients who receive anti-thymocyte globulin, but not in most other recipients
Sheshadri, A., Saliba, R., Patel, B., Ahmed, T., Bueno, L. C., Arain, M. H., Mehta, R. S., Popat, U. R., Hosing, C. M., Rondon, G., et al
Bone marrow transplantation. 2020