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Nutritional status of patients with acute leukemia during the oncological treatment
Kupilíková, Veronika ; Šťastná-Marková, Markéta (advisor) ; Křížová, Jarmila (referee)
Acute leukemia is defined as a heterogeneous group of malignant hematopoietic stem cell disorders. The aim of this study was to investigate the extent to which nutritional disorders occur in patients with acute leukemia during the cancer treatment, their severity, the most common causes of weight loss, and the extent to which different forms of nutritional intervention are applied in patients. The research was carried out in the Institute of Haematology and Blood Transfusion, during the hospitalization of patients in the inpatient ward, intensive care unit and transplant unit. The study population consisted of 40 patients diagnosed with acute leukemia. Outcomes from nutritional status screening (MNA questionnaire, BMI, weight, mid arm circumference, calf circumference, BIA, biochemical nutritional parameters), and functional assessment (ECOG PS, Chair-stand test, Hand grip test) were used to process the practical part and answer the research questions. Measurements were performed twice with approximately one month intervals. The study confirmed weight loss since the onset of the disease in 95 % of patients. The dominant cause of weight loss was identified in 80 % as lack of appetite. Nutritional screening by MNA evaluated the patient population with a mean score of 22,8 ± 2,9, referring to the risk...
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Lineage plasticity of leukemic blasts. Importance for detection of minimal residual disease and study of hematopoesis
Vakrmanová, Barbora ; Mejstříková, Ester (advisor) ; Šálek, Cyril (referee) ; Klener, Pavel (referee)
Acute leukemia is the most common malignancy in children. According to the origin of the leukemic blasts, two types of leukemia are distinguished - lymphoid (ALL) and myeloid (AML). The focus of this thesis is lineage plasticity of the leukemic blasts. In about 2-5% of leukemias, blasts share immunophenotypic features of both lymphoid and myeloid lineages. In international retrospective study we showed superior overall survival in patients treated according to lymphoid type of protocol compared to patients treated to myeloid type of protocol, especially in cases with CD19 positivity on the blasts. Another type of the plasticity and diagnostic uncertainty in leukemia is ALL with early switch to monocytic lineage. About 8% of B cell precursor ALL underwent monocytic switch in our consecutive cohort. This phenomenon is more common among DUX4r, PAX5-P80R and ZNF384r leukemias. Discrepancy between minimal residual disease (MRD) measured by flow cytometry and quantitative assessment of immunoreceptor rearrangements method occurs because of the loss of B-lymphoid markers. We investigated transdifferentiation process by mass cytometry. By the multilabel panel we were able to determine the sequence of changes in proteins and transcription factors by new tviblindi algorithm. Targeted treatment, such as...
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Differentiation plasticity of hematopoietic cells
Polgárová, Kamila ; Stopka, Tomáš (advisor) ; Otáhal, Pavel (referee) ; Šálek, Cyril (referee)
Hematopoiesis has been for many years seen as a straightforward process based on sequential restriction of cell fate potential leading to production of mature blood cells. In the last decade, however, several works documented an unexpected plasticity of hematopoietic cells with expanded potential of myeloid development from lymphoid progenitors and vice versa. Under physiologic conditions hematopoiesis is tightly controlled and the definite cell fate is denominated by multiple factors that all lead to changes in regulatory networks that include transcription factors, epigenetic changes and post-transcriptional modulations. Any disruption of this strict regulation, caused by mutations or other events, affects the proliferation and lineage fidelity of hematopoietic precursors. This may lead to clonal growth of variable significance or leukemogenesis and may possibly affect the treatment sensitivity of the hematological malignancies. For better understanding of hematopoietic regulation we described gene expression changes during physiological development of lymphoid and myeloid lineages and in leukemic specimens using our own simplified real-time PCR based platform. We investigated expression of 95 genes connected with lymphoid and myeloid differentiation or with leukemogenesis in sorted hematopoietic...
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The use of novel technologies in the identification of unique molecular markers for minimal residual disease assessment in acute leukemia patients
Jančušková, Tereza ; Peková, Soňa (advisor) ; Jarošová, Marie (referee) ; Lysák, Daniel (referee)
Acute leukemias (AL) comprise a heterogeneous group of hematologic malignancies, and individual patient responses to treatment can be difficult to predict. Monitoring of minimal residual disease (MRD) is thus very important and holds great potential for improving treatment strategies. Common MRD targets include immunoglobulin heavy chain or T-cell receptor gene rearrangements, recurrent cytogenetic abnormalities and mutations in important hematological genes. Whereas in the majority of adult acute lymphoblastic leukemia patients a suitable MRD target can be identified, in adult acute myeloid leukemia patients well-characterized targets are found in only half of cases. The identification of new specific molecular markers of leukemic blasts for MRD assessment, particularly in AML patients, is therefore highly desirable. Our aim was to develop a flexible strategy for mapping of cytogenetically identified unique clone-specific abnormalities down to the single nucleotide level and, based on the sequence, design a specific real-time PCR assay for MRD assessment in AL patients without any previously described MRD marker. Using a combination of cytogenetic (chromosome banding, chromosome microdissection), molecular cytogenetic (mFISH, mBAND) and molecular biological (next- generation sequencing, long-range...
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The use of novel technologies in the identification of unique molecular markers for minimal residual disease assessment in acute leukemia patients
Jančušková, Tereza
Acute leukemias (AL) comprise a heterogeneous group of hematologic malignancies, and individual patient responses to treatment can be difficult to predict. Monitoring of minimal residual disease (MRD) is thus very important and holds great potential for improving treatment strategies. Common MRD targets include immunoglobulin heavy chain or T-cell receptor gene rearrangements, recurrent cytogenetic abnormalities and mutations in important hematological genes. Whereas in the majority of adult acute lymphoblastic leukemia patients a suitable MRD target can be identified, in adult acute myeloid leukemia patients well-characterized targets are found in only half of cases. The identification of new specific molecular markers of leukemic blasts for MRD assessment, particularly in AML patients, is therefore highly desirable. Our aim was to develop a flexible strategy for mapping of cytogenetically identified unique clone-specific abnormalities down to the single nucleotide level and, based on the sequence, design a specific real-time PCR assay for MRD assessment in AL patients without any previously described MRD marker. Using a combination of cytogenetic (chromosome banding, chromosome microdissection), molecular cytogenetic (mFISH, mBAND) and molecular biological (next- generation sequencing, long-range...
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Differentiation plasticity of hematopoietic cells
Polgárová, Kamila ; Stopka, Tomáš (advisor) ; Otáhal, Pavel (referee) ; Šálek, Cyril (referee)
Hematopoiesis has been for many years seen as a straightforward process based on sequential restriction of cell fate potential leading to production of mature blood cells. In the last decade, however, several works documented an unexpected plasticity of hematopoietic cells with expanded potential of myeloid development from lymphoid progenitors and vice versa. Under physiologic conditions hematopoiesis is tightly controlled and the definite cell fate is denominated by multiple factors that all lead to changes in regulatory networks that include transcription factors, epigenetic changes and post-transcriptional modulations. Any disruption of this strict regulation, caused by mutations or other events, affects the proliferation and lineage fidelity of hematopoietic precursors. This may lead to clonal growth of variable significance or leukemogenesis and may possibly affect the treatment sensitivity of the hematological malignancies. For better understanding of hematopoietic regulation we described gene expression changes during physiological development of lymphoid and myeloid lineages and in leukemic specimens using our own simplified real-time PCR based platform. We investigated expression of 95 genes connected with lymphoid and myeloid differentiation or with leukemogenesis in sorted hematopoietic...
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The use of novel technologies in the identification of unique molecular markers for minimal residual disease assessment in acute leukemia patients
Jančušková, Tereza
Acute leukemias (AL) comprise a heterogeneous group of hematologic malignancies, and individual patient responses to treatment can be difficult to predict. Monitoring of minimal residual disease (MRD) is thus very important and holds great potential for improving treatment strategies. Common MRD targets include immunoglobulin heavy chain or T-cell receptor gene rearrangements, recurrent cytogenetic abnormalities and mutations in important hematological genes. Whereas in the majority of adult acute lymphoblastic leukemia patients a suitable MRD target can be identified, in adult acute myeloid leukemia patients well-characterized targets are found in only half of cases. The identification of new specific molecular markers of leukemic blasts for MRD assessment, particularly in AML patients, is therefore highly desirable. Our aim was to develop a flexible strategy for mapping of cytogenetically identified unique clone-specific abnormalities down to the single nucleotide level and, based on the sequence, design a specific real-time PCR assay for MRD assessment in AL patients without any previously described MRD marker. Using a combination of cytogenetic (chromosome banding, chromosome microdissection), molecular cytogenetic (mFISH, mBAND) and molecular biological (next- generation sequencing, long-range...
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The use of novel technologies in the identification of unique molecular markers for minimal residual disease assessment in acute leukemia patients
Jančušková, Tereza ; Peková, Soňa (advisor) ; Jarošová, Marie (referee) ; Lysák, Daniel (referee)
Acute leukemias (AL) comprise a heterogeneous group of hematologic malignancies, and individual patient responses to treatment can be difficult to predict. Monitoring of minimal residual disease (MRD) is thus very important and holds great potential for improving treatment strategies. Common MRD targets include immunoglobulin heavy chain or T-cell receptor gene rearrangements, recurrent cytogenetic abnormalities and mutations in important hematological genes. Whereas in the majority of adult acute lymphoblastic leukemia patients a suitable MRD target can be identified, in adult acute myeloid leukemia patients well-characterized targets are found in only half of cases. The identification of new specific molecular markers of leukemic blasts for MRD assessment, particularly in AML patients, is therefore highly desirable. Our aim was to develop a flexible strategy for mapping of cytogenetically identified unique clone-specific abnormalities down to the single nucleotide level and, based on the sequence, design a specific real-time PCR assay for MRD assessment in AL patients without any previously described MRD marker. Using a combination of cytogenetic (chromosome banding, chromosome microdissection), molecular cytogenetic (mFISH, mBAND) and molecular biological (next- generation sequencing, long-range...
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Etiology of childhood acute leukemia
Burjanivová, Tatiana ; Zuna, Jan (advisor) ; Mihál, Vladimír (referee) ; Haškovec, Cedrick (referee)
Childhood acute leukaemias are a heterogeneous group of malignant diseases. Based on cell origin, clinical manifestations, and molecular/chromosomal changes, we distinguish two main subtypes: acute myeloid leukaemia and acute lymphoblastic leukaemia. Acute lymphoblastic leukaemia (ALL) is the most frequent form of childhood leukaemia. Acute myeloid leukaemia (AML) is predominantly found in adults, being rarer in childhood. In the Czech Republic, the ALL is in childhood diagnosed approximately five times more often compared to AML. Despite the intensive research, aetiology of leukaemia has not been entirely clarified. So far, we only have knowledge of certain risk factors (ionising radiation, some chemicals and viruses) but in the vast majority of cases the aetiopathogenesis has not yet been made clear. Some of the answers may be provided by studies dealing with the presence of (pre)-leukaemic cells in a material archived prior to the clinical onset of the disease. Such are for example the so-called Guthrie cards, the dried blood samples collected immediately after birth and used in screening of the newborns for metabolic disorders. The better availability of material collected before the diagnosis of a secondary leukaemia (originally meant for the follow-up of the primary malignancy) might help us in better...
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The quality of life at children with oncology desease
HERKUCZOVÁ, Lenka
This diploma thesis is trying to figure out how is oncological disease and it´ s treatment affecting survivors life after curing the disease. Acute leukemia and its challenging and often aggressive treatment leaves many different late effects. Quality of life is a subjective assessment which to some extent depends on the nature of the individual. Even so, it is necessary to evaluate and examine the quality of life beacuse the results of researches can help other patients, but also nurses, doctors, psychologists and other helping professions. The theoretic part of the thesis describes the current state of the problem, introduces the basic and fundamental specifics of children's cancer, the treatment, the after-effects, deals with the description of the psychological problems of patients and their caregivers, which provides diagnosis itself, but also the treatment of the disease. It also introduces the psychological care about oncological ill patiens and the roles of the nurses in careing for the oncological patiens. Another part of the theoretical work is an introduction to the measurement and evaluation of quality of life. Work also introduces the leukemia disease, which is one of the most commonly diagnosed cancer diseases in children. The thesis has three goals. The first one is to determine how the treatment of the oncological disease affects life of survivors. The second one is to determine how children perceive various limitations of social contact that the treatment brings. The last third objective is to determine whether the cancer experience affects the attitude of the survivor children to live. In the practical part of the research was used quantitative research. The technique of data collection was standardized questionnaire Minneapolis Manchester Quality of Life Instrument which is divided into two versions for younger and older children. The research was also used for statistical evaluation of hypotheses. The questionnaire was distributed to children aged 8 - 18 years who were 2 - 5 years after treatment. The control group were the same aged healthy peers. Four hypotheses were determined. H1: Cured children have more difficulties in social functioning than healthy children. It was found that cured children have better outcomes in social functioning than their peers, hypothesis H1 is thus not confirmed. H2: Cured children have less energy for physical activities than healthy children. This hypothesis was confirmed neither in older or younger children. H3: Cured children are more satisfied with their appearance than healthy children. This hypothesis was based on the research and statistical verification verified. Last investigated hypothesis was H4: Cured children have more problems in cognitive functioning than healthy children. Based on the statistical verification hypothesis was not confirmed. The research and statistical studies show that cured children have the same or in some areas even better quality of life than their healthy peers 2 - 5 years after the end of active treatment. The nurse should be able to help and advise the patient and should emphatically and nicely cooperate with the family for which it is often even worse than for the patients themselves. This diploma thesis will be used for making of an internal seminars for nurses working at the Clinic of Pediatric Oncology. Nurses working at the bedsides of the patiens can use this theses as a feedback of thein work. Knowledge of late effects of anticancer therapy is essential to providing a high - quality care and application of evidence - based nursing in practice.
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