The Croatian Model of NIH criteria Implementation

Transcription

1 The Croatian Model of NIH criteria Implementation Lana Grkovic, MD, UHC Zagreb, Zagreb, Croatia October 2014, Warsaw, Poland #EBMT2014

2 History of transplant at UHC Zagreb Haplo children Haplo AlloBMT Related donor MAC Autologous BMT UC 1989 AlloBMT Urelated donor 1992 HLA DNA-based RIC

3 AlloBMT at UHC Zagreb

4 RIC MAC

5 unrelated related 5 5

6 Organization of cgvhd program and clinical activity of the multidisciplinary team Visit of Prof. SZ Pavletic to the UHC Zagreb 6 6

7 Multidisciplinary team Professionals from a range of disciplines who work together to deliver comprehensive care that addresses as many of the patient's needs as possible. As a patient's condition changes over time, the composition of the team may change to reflect the changing clinical and psychosocial needs of the patient. Mitchell, G.K., Tieman, J.J. & Shelby-James, T.M. (2008). Multidisciplinary care planning and teamwork in primary care. MJA, 188(8), p.s

8 Results: Established cgvhd multidisciplinary team 8 8

9 Team members Hematology: Damir Nemet, Dražen Pulanić, Lana Grković, Ranka Serventi-Seiwerth, Radovan Vrhovac, Nadira Duraković, Zinaida Perić Pediatric Hematology: Ljubica Rajić, Ernest Bilić Nurse: Nikolina Matić Dental: Marinka Mravak Stipetić Neurology: Ervina Bilić Dermatology: Romana Čeović Ophthalmology: Igor Petriček PT: Tamara Vukić Gynecology: Tajana Klepac Pulanić, Slavko Orešković Nutritional: Dina Ljubas Immunology: Drago Batinić Transfusiology: Ines Bojanić ID: Davorka Dušek, Adriana Vince Molecular: Magdalena Grce, Renata Zadro GI: Željko Krznarić Pathology: Ivana Ilić Endocrinology: Zlatko Giljević HLA: Zorana Grubić PhD student: Ema Prenc Postdoc Iva Prah Steven Živko Pavletić- Collaborator 9 9

10 Day Hospital (Center for cgvhd and long term complications) 10 10

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14 IRB approved informed consent signing H&P Laboratory workup Standard forms (NIH core sheet, form A and B..) Neurologic assessment and pain questionnaire QoL SF-36, Lee symptom scale, QLQ-C

15 cgvhd multidisciplinary team HEMATOLOGY DERMATOLOGY NUTRITION DENTAL PHYSICAL THERAPY HEPATOLOGY/GI ENDOCRINOLOGY PATIENT PULMONARY OPHTALMOLOGY INFECTIOUS DISEASE TRANSFUSIOLOGY GYNECOLOGY NEUROLOGY 15 15

16 Our results 16 16

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18 QLQ-C30 = 30 questions five multi-item functional scales (Physical, Role, Emotional, Cognitive and Social Functioning) + combined Global Health Status/QoL scale Higher scores signify better functioning Nine symptom scales measure fatigue, pain, nausea,vomiting, dyspnea, sleep disturbances, appetite loss, diarrhoea, constipation and financial impact Higher scores represent greater symptomatology or impairments 18 18

19 Evaluation of QOL at UHC Zagreb SF-36 Results 19 19

20 Evaluation of QOL at UHC Zagreb QLQ- C30 Results 20 20

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22 Ministry of science education and sports of the Republic of Croatia; Unity Through Knowledge Fund Project (2 years) Project title: Clinical and biological factors determining severity and activity of chronic Graft-versus-Host Disease after allogeneic hematopoietic stem cell transplantation Approx. $ 300, 000 (funded by World Bank and Ministry) Project Leader and Co-leader : prof. SZ Pavletic i prof. D. Nemet 8 Institutions participating: NCI/NIH, Medical School University of Zagreb, UHC Zagreb, School of Dental Medicine Zagreb, Institute Ruđer Bošković, KROHEM, University Hospital for Infectious Disease Dr. Fran Mihaljevic 22 22

23 CONNECTIVITY, COOPERABILITY, CREATIVITY C3 Mission: To unite scientific and professional potential in Croatia and Diaspora in development of the knowledge based society Goals: Ministry of science education and sports of the Republic of Croatia-Crossing Borders Grant; Unity Through Knowledge Fund Project 1) Supporting research that is competitive on international level 2) Fostering research that creates new values in Croatian economy 3) Supporting projects that help the development of research infrastructure in Croatia 23 23

24 Aims: Crossing Borders Grant To support outstanding Croatian scientists and professionals working and living abroad (Diaspora) in establishing scientific cooperation with local scientists (Croatian and foreign scientists working and living in Croatia), To foster Croatian institutions and enterprises to use potentials of Croatian scientific and professional Diaspora transfer of knowledge and attract investments to Croatian organization through cooperation between Diaspora and local scientists

25 Goals Establishment of the multidisciplinary team Comprehensive clinical, laboratory and imaging evaluation using NIH Consensus criteria Subspeciality evaluations focused on affected organs Creation of database and tissue and sera bank Subprojects New grant proposal application; collaboration with other Centers 25 25

26 First year results 32 cgvhd patients enrolled and 4 controls 8 abstracts published Oral presentation - Croatian society of hematology and transfusiology meeting with international participation, Rovinj, Croatia, March 2014 Grkovic L., Pulanic D., Serventi-Seiwerth R., Matic N., Mravak-Stipetic M., Ceovic R., Bilic E., Ljubas D., Rajic Lj., BIlic E., Durakovic N., Peric Z., Kovac K., Klepac Pulanic T., Dusek D., Bojanic I., Grce M., Petricek I., Batinic D., Vrhovac R., Pavletic S. Z., Nemet D. Formiranje multidisciplinarnog tima za liječenje kronične reakcije davatelja protiv primatelja i dugotrajnih komplikacija nakon transplantacije alogenih krvotvornih matičnih stanica u Kliničkom bolničkom centru Zagreb. Liječ Vjesn. 2014;136 (Supl 1.):

27 4 poster presentations Croatian society of hematology and transfusiology meeting with international participation, Rovinj, Croatia, March 2014 Bilić E., Grković L., Pulanić D., Serventi Seiwerth R., Bilić E., Vrhovac R., Nemet D., Pavletic SZ. Polyneuropathy in cgvhd patients Preliminar results. Liječ Vjesn. 2014;136 (Supl 1.):87. PRIZE FOR THE BEST POSTER Ljubas Kelecic D., Vranesic Bender D., Krznaric Z., Grkovic L., Pavletic S., Nemet D., Serventi Seiwerth R., Vrhovac R., Pulanic D. Nutritional status in patients with chronic GVHD. Liječ Vjesn. 2014;136 (Supl 1.):135. Pulanic D, Mravak-Stipetić M., Grkovic L., Serventi Seiwerth R., Vrhovac R., Nemet D., Sabol I., Grce M., Pavletic SZ. Oral manifestations in u cgvhd patients. Liječ Vjesn. 2014;136 (Supl 1.):89. Perić Z., Grkovic L., Pulanic D., Serventi-Seiwerth R., Matic N., Mravak-Stipetic M., Bilic E., Ceovic R., Ljubas D., Rajic Lj., BIlic E., Durakovic N., Klepac Pulanic T., Kovac K., Dusek D., Bojanic I., Grce M., Batinic D., Vrhovac R., Pavletic SZ., Nemet D. Quality of life after allogeneic stem cell transplantation. Liječ Vjesn. 2014;136 (Supl 1.):

28 EBMT, Milano, Italy, April L. Grkovic, D. Pulanic, R. Serventi-Seiwerth, N. Matic, M. Mravak-Stipetic, E. Bilic, R. Ceovic, D. Ljubas, Lj. Rajic, E. Bilic, N. Durakovic, Z. Peric, T. Klepac Pulanic, K. Kovac, D. Dusek, I. Bojanic, M. Grce, D. Batinic, R. Vrhovac, S.Z. Pavletic, D. Nemet. Implementation and dissemination of chronic Graft-versus-Host Disease NIH criteria and recommendations - formation of a multidisciplinary team and program at the University Hospital Center Zagreb, Croatia. Bone Marrow Transplant 49: S101-S385 (March 2014); doi: /bmt POSTER PRESENTATION M. Mravak-Stipetic, L. Grkovic, D. Pulanic, I. Sabol, M. Grce, D. Nemet, SZ Pavletic. Comprehensive evaluation of oral chronic graft versus host disease (cgvhd) in a cohort of Croatian patients. Bone Marrow Transplant 49: S438-S559 (March 2014); doi: /bmt PUBLICATION ONLY 28 28

29 Oral pressentation at international meeting EFNS-ENS Joint Congress of European Neurology May E. Bilic, L. Grkovic, D. Pulanic, E. Bilic, D. Nemet, SZ Pavletic. Small fiber neuropathy in patients with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation - preliminary results of a prospective study. Europ J Neurology Abstract supplement,

30 Subprojects: Oral GVHD (trombocyte gel from autologous blood) Infections in cgvhd patients (HPV, EBV, CMV, polyoma virus, Candida albicans) Neurological cgvhd manifestations small fiber neuropathy (ENG and QST; pain detect questionnaire) Genital cgvhd Immunology (monocyte analysis from leukapheresis product; (CD16/CD163 i CD64/CD80) 30 30

31 Training at NIH, NCI Croatian members of cgvhd team (Past): Assist. Prof. Drazen Pulanic, MD, PhD (1 year) Ranka Serventi-Seiwerth, MD (3 months) Lana Grkovic, MD (1 year) PhD student and Post Doc hired (Present) PhD student visit to National Institutes of Health (Sep 2014) 31 31

32 Dissemination of the project results Web page 32 32

33 Interview; Croatian National Television 33 33

34 International Symposium Chronic GVHD and long term complications after hematopoietic stem cell transplantation, Zagreb, November

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37 Development of the original database 37 37

38 Proposal submitted 38 38

39 Call PHC : Understanding common mechanisms of diseases and their relevance in comorbidities 39 39

40 Conclusions Multidisciplinary team established Comprehensive clinical, laboratory and imaging evaluation using NIH criteria Scientific activity Database developed PhD sudent and Postdoc hired New grant proposal submitted (HORIZON 2020) 40 40

41 THANK YOU! 41