Episode 279: Hematopoietic Stem Cell Transplantation for Scleroderma and Other Autoimmune Diseases

"I think the most amazing thing we see is the softening of the skin, which can occur during the first two weeks of the conditioning regimen. The nurses on the floor see it, and I think it's just a tremendous gratification for them to see the results of something right before your eyes," Tanya Helms, PA-C, from the division of hematological malignancies and cellular therapy at Duke University Medical Center in Durham, NC, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about what oncology nurses should know about transplantation for patients with non-oncologic conditions such as autoimmune disease, how the transplant process differs for non-oncology indications, and the clinical pearls oncology nurses should consider when caring for patients with autoimmune diseases during the transplantation process. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to hematopoietic stem cell transplantation for scleroderma and other autoimmune diseases. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Oncology Nursing Podcast: Episode 173: Oncology Nurses' Role in Stem Cell Transplants for Pediatric Sickle Cell Disease Episode 148: Stem Cell Transplant Nursing in the Home Setting ONS Voice article: What Oncology Nurses Need to Know About Vaccination and Cancer (and other immunocompromised diseases) Clinical Journal of Oncology Nursing article: Early Intervention With Transplantation Recipients to Improve Access to and Knowledge of Palliative Care ONS course: Hematopoietic Stem Cell Transplantation ONS Huddle Card™: Hematopoietic Stem Cell Transplantation National Scleroderma Foundation New England Journal of Medicine article about the SCOT trial: Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma Systemic Sclerosis as an Indication for Autologous Hematopoietic Cell Transplantation: Position Statement from the American Society for Blood and Marrow Transplantation Autologous Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: A Systematic Review and Meta-Analysis To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From Today's Episode "The goal of treatment for patients with scleroderma is to reset the immune system, and there are three main components of the regimen used at Duke—that's total body radiation, cyclophosphamide, and ATG. This targets all the areas where the immune effector cells live. We also use CD34 selection, which is a process that separates CD34-positive cells from the stem cell product that's collected prior to transplant, to eliminate the possibility of reinfusing activated immune cells back into the patients." TS 3:18 "For patients with diffuse scleroderma, you want to offer transplant when they have evidence of significant disease, but they're not so compromised that they can't tolerate or have increased risk of complications from the conditioning regimen. Understanding the patient's rate of disease progression is key when determining to transplant." TS 6:45 "When a patient is referred, we call the patient, and we talk about how the transplant conditioning regimen works to reset the immune system and stop disease progression. We explain the workup visit and go over an example of the timeline needed to collect the cells, admit to the hospital for conditioning, and the recovery process as an outpatient. We want patients to understand the big picture before they ever come to Duke." TS 7:57 "Some patients come to us significantly disabled by their scleroderma. They may be in a wheelchair, so they require special vehicles for travel. Patients whose hands are severely involved need assistance with their ADLs [activities of daily living]." TS 11:43 "There have been three clinical trials that show autologous transplant improves event-free survival and overall survival and has been shown to decrease all-cause mortality. But it does not repair damaged gastrointestinal, pulmonary, or cardiac tissue. Any fibrosis that has happened is permanent." TS 12:22 "The most amazing thing we see is the softening of the skin, which can occur during the first two weeks of the conditioning regimen. The nurses on the floor see it, and I think it's just a tremendous gratification for them to see the results of something right before your eyes." TS 13:01 "Social media has been a huge contributor towards patient self-referrals. Patients are telling their stories on Facebook; patients are asking other questions about how to get referred to a transplant center; and patients whose rheumatologists have not referred them will seek out transplant centers to learn more about transplant for scleroderma." TS 13:48 "For people with hematologic malignancies, it's all about getting that patient to remission and then transplanting them. . . . These patients have experienced chemotherapy and the adverse effects. They know about low blood counts and fatigue and recovery. They know about central lines and transfusions. The scleroderma patients come to transplantation with progressive disease. They've typically not had blood transfusions, but they are now going to receive total body radiation, chemotherapy, and a stem cell transplant over the next six weeks. And it can be overwhelming. . . . Every day is something new for them to process and learn." TS 14:56 "Patients become pancytopenic, and they are heavily immunosuppressed. They are on steroids during the conditioning regimen to prevent scleroderma flares during conditioning. These patients have a central line so monitoring for infections, such as assessing vital signs for signs and symptoms of infection, and being aware that steroids can mask a fever." TS 16:49