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Management of iron overload in the Canadian hematology/oncology population: Implications for nursing practice.

ABSTRACT: Red blood cell (RBC) transfusions are vital for many patients with chronic anemias associated with oncologic/hematologic disorders. However, repeated transfusions over time can lead to iron overload, which, if left untreated, can increase the risk of further malignancy and end-organ damage. Nurses and other health care professionals may not be aware of the significant implications of RBC transfusions and iron overload in patients with hematological/oncological disorders. This article was developed by a group of Canadian nurse practitioners and specialized oncology nurses to help improve health care professionals' understanding of iron overload in oncology patients and its associated risks, as well as provide a practical guide for the management of patients receiving treatment for this potentially serious condition.

SUBMITTER: Murray C

PROVIDER: S-EPMC6516318 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Management of iron overload in the Canadian hematology/oncology population: Implications for nursing practice.

Murray Cindy C De Gelder Tammy T Pringle Nancy N Johnson J Colleen JC Doherty Mary M

Canadian oncology nursing journal = Revue canadienne de nursing oncologique 20160201 1

Red blood cell (RBC) transfusions are vital for many patients with chronic anemias associated with oncologic/hematologic disorders. However, repeated transfusions over time can lead to iron overload, which, if left untreated, can increase the risk of further malignancy and end-organ damage. Nurses and other health care professionals may not be aware of the significant implications of RBC transfusions and iron overload in patients with hematological/oncological disorders. This article was develop ...[more]

PMID: 31148725

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Project description:BackgroundMolecular characterization has the potential to advance the management of pediatric cancer and high-risk hematologic disease. The clinical integration of genome sequencing into standard clinical practice has been limited and the potential utility of genome sequencing to identify clinically impactful information beyond targetable alterations has been underestimated.MethodsThe Precision in Pediatric Sequencing (PIPseq) Program at Columbia University Medical Center instituted prospective clinical next generation sequencing (NGS) for pediatric cancer and hematologic disorders at risk for treatment failure. We performed cancer whole exome sequencing (WES) of patient-matched tumor-normal samples and RNA sequencing (RNA-seq) of tumor to identify sequence variants, fusion transcripts, relative gene expression, and copy number variation (CNV). A directed cancer gene panel assay was used when sample adequacy was a concern. Constitutional WES of patients and parents was performed when a constitutionally encoded disease was suspected. Results were initially reviewed by a molecular pathologist and subsequently by a multi-disciplinary molecular tumor board. Clinical reports were issued to the ordering physician and posted to the patient's electronic medical record.ResultsNGS was performed on tumor and/or normal tissue from 101 high-risk pediatric patients. Potentially actionable alterations were identified in 38% of patients, of which only 16% subsequently received matched therapy. In an additional 38% of patients, the genomic data provided clinically relevant information of diagnostic, prognostic, or pharmacogenomic significance. RNA-seq was clinically impactful in 37/65 patients (57%) providing diagnostic and/or prognostic information for 17 patients (26%) and identified therapeutic targets in 15 patients (23%). Known or likely pathogenic germline alterations were discovered in 18/90 patients (20%) with 14% having germline alternations in cancer predisposition genes. American College of Medical Genetics (ACMG) secondary findings were identified in six patients.ConclusionsOur results demonstrate the feasibility of incorporating clinical NGS into pediatric hematology-oncology practice. Beyond the identification of actionable alterations, the ability to avoid ineffective/inappropriate therapies, make a definitive diagnosis, and identify pharmacogenomic modifiers is clinically impactful. Taking a more inclusive view of potential clinical utility, 66% of cases tested through our program had clinically impactful findings and samples interrogated with both WES and RNA-seq resulted in data that impacted clinical decisions in 75% of cases.

Dataset Information

Management of iron overload in the Canadian hematology/oncology population: Implications for nursing practice.

Publications

Management of iron overload in the Canadian hematology/oncology population: Implications for nursing practice.

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