ObjectiveTo explore the application and nursing points of donor natural killer cell infusion (DNKI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematologic neoplasms.
MethodsFrom December 2018 to January 2020, a total of 15 patients with hematologic neoplasms who received DNKI after allo-HSCT in Department of Hematology, West China Hospital of Sichuan University were selected as the subjects. The age of patients was (42.6±9.1) years. Among them, there were 2 male patients and 13 females. All the patients were received predictive nursing care. The clinical data related allo-HSCT and DNKI, efficacy and adverse reactions of patients were analyzed retrospectively. And the nursing points of DNKI were summarized. The absolute number and percentage of natural killer (NK) cells in peripheral blood of patients before and after DNKI were compared by Wilcoxon signed rank test. The procedure followed in this study meets the requirements ofHelsinki Declaration of the World Medical Associationrevised in 2013.
Results① In this study, the 15 patients with hematologic neoplasms received 33 cases DNKI. Allo-HSCT was successful in all 15 patients. One month after allo-HSCT, all 15 patients reached the state of donor cells complete chimerism. At a median follow-up time of 11.0 months (4.0-13.5 months), the rates of survival, remission and recurrence were 15/15, 11/15 and 4/15, respectively. The incidence of graft-versus-host disease (GVHD) was 4/15, and all the GVHD patients were with Ⅰ grade GVHD. The infection rate of cytomegalovirus (CMV) was 3/15. ② After receiving DNKI, the absolute number and percentage of NK cells in peripheral blood of 33 cases in this study were 194 cells/μL (162-264 cells/μL) and 21.2%(16.8%-27.4%) respectively, which were higher than those of 91 cells/μL (60.5-119 cells/μL) and 9.2% (7.1%-13.4%) before DNKI, and the differences were statistically significant (T=-8.218,P<0 .01 ;T=-9.841,P<0 .01). ③ in this study, only 3 cases (9.1%, 3/33) had transient fever within 24 h after dnki.
ConclusionsDNKI after allo-HSCT has a significant efficacy in patients with hematologic neoplasms, with minor adverse reactions. In the process of DNKI therapy, predictive nursing intervention measures should be implemented to achieve the best therapeutic effect. However, the results of this study are limited to a retrospective analysis of small sample size, and some cases have a short follow-up time. Therefore, a large sample size prospective study is needed to verify the efficacy and safety of DNKI in hematologic neoplasms patients who received allo-HSCT, and to further explore the nursing points.
