Bio

Academic Appointments


Administrative Appointments


  • Assistant Clinical Professor, University of California San Francisco, Department of Physiologic Nursing (2007 - Present)

Professional Education


  • PhD, University of California San Francisco, Doctor of Philospophy (2006)
  • MSN, University of Pennsylvania, Oncology Nursing (1989)
  • BSN, University of Wisconsin Madison, Nursing (1980)

Research & Scholarship

Clinical Trials


  • Obinutuzumab in cGVHD After Allogeneic Peripheral Blood Stem Cell Transplantation Recruiting

    This research study is studying a drug called obinutuzumab as a means of preventing chronic Graft vs. Host Disease (cGVHD).

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  • Safety and Efficacy of KTE-C19 in Combination With Atezolizumab in Adults With Refractory Diffuse Large B-Cell Lymphoma (DLBCL) Not Recruiting

    The primary objective of phase 1 is to evaluate the safety of KTE-C19 and atezolizumab combination regimens. The primary objective of phase 2 is to evaluate the efficacy of KTE-C19 and atezolizumab, as measured by complete response rate in participants with refractory diffuse large B-cell lymphoma (DLBCL).

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • Social Adaptation in Long Term Survivors of Blood and Marrow Transplantation Not Recruiting

    1. To explore specific aspects of social adaptation such as social connectedness, occupational outcomes and family relationships in lymphoma patients after autologous blood or marrow transplantation (BMT). 2. To investigate how social adaptation varies with time lapsed since BMT and with the life stage as determined by patient?s age. Understanding both the positive and negative aspects of cancer and cancer therapy leads to opportunities to promote adaptive strategies.

    Stanford is currently not accepting patients for this trial. For more information, please contact Kate Tierney, (650) 725 - 7063.

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Publications

All Publications


  • Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Burns, L. J., Abbetti, B., Arnold, S. D., Bender, J., Doughtie, S., El-Jawahiri, A., Gee, G., Hahn, T., Horowitz, M. M., Johnson, S., Juckett, M., Krishnamurit, L., Kullberg, S., LeMaistre, C. F., Loren, A., Majhail, N. S., Murphy, E. A., Rizzo, D., Roche-Green, A., Saber, W., Schatz, B. A., Schmit-Pokorny, K., Shaw, B. E., Syrjala, K. L., Tierney, D. K., Ullrich, C., Vanness, D. J., Wood, W. A., Denzen, E. M. 2018; 24 (6): 1111?18

    Abstract

    The goal of patient-centered outcomes research (PCOR) is to help patients and those who care for them make informed decisions about healthcare. However, the clinical research enterprise has not involved patients, caregivers, and other nonproviders routinely in the process of prioritizing, designing, and conducting research in hematopoietic cell transplantation (HCT). To address this need the National Marrow Donor Program/Be The Match engaged patients, caregivers, researchers, and other key stakeholders in a 2-year project with the goal of setting a PCOR agenda for the HCT community. Through a collaborative process we identified 6 major areas of interest: (1) patient, caregiver, and family education and support; (2) emotional, cognitive, and social health; (3) physical health and fatigue; (4) sexual health and relationships; (5) financial burden; and (6) models of survivorship care delivery. We then organized into multistakeholder working groups to identify gaps in knowledge and make priority recommendations for critical research to fill those gaps. Gaps varied by working group, but all noted that a historical lack of consistency in measures use and patient populations made it difficult to compare outcomes across studies and urged investigators to incorporate uniform measures and homogenous patient groups in future research. Some groups advised that additional pre-emptory work is needed before conducting prospective interventional trials, whereas others were ready to proceed with comparative clinical effectiveness research studies. This report presents the results of this major initiative and makes recommendations by working group on priority questions for PCOR in HCT.

    View details for DOI 10.1016/j.bbmt.2018.01.029

    View details for PubMedID 29408289

    View details for PubMedCentralID PMC5993588

  • Long-term implications of autologous HCT for caregiver quality of life: how does the survivor's health matter? Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Stepanikova, I., Powroznik, K., Cook, K., Tierney, D. K., Laport, G. 2018

    Abstract

    This study examines caregiver quality of life (CQOL) 3-26 years after autologous hematopoietic cell transplantation (HCT) for patients with lymphoma. Using a framework that views the patient-caregiver dyad as a system of mutual influence, we argue that CQOL is associated with survivor functional health status and sense of personal control.Ninety-nine autologous HCT survivor-caregiver dyads participated. CQOL was measured using the Caregiver Quality of Life Scale-Cancer. Survivor functional health status was assessed using the Functional Assessment of Cancer Therapy-General. Sense of control was examined using an instrument from the MIDUS II study. Clinical measures were collected from medical records.After controlling for sociodemographic and clinical covariates, caregivers with higher sense of control had higher CQOL. Poorer survivor functional health was associated with lower CQOL but only when the survivor reported low personal control. When the survivor reported high personal control, functional health was not a factor. Lower CQOL was observed for younger and more educated caregivers. In contrast, more education among survivors was linked to higher CQOL.These results (1) support using a mutuality framework for the study of long-term outcomes of caregivers, (2) suggest the importance of ongoing support for caregivers, and (3) help identify caregivers at risk for poorer adaptation. Poorer survivor functional health is a risk factor, but its adverse implications can be offset by higher caregiver and survivor sense of control, a psychological resource aiding caregiver adaptation. These findings can inform the development of support programs for long-term caregivers.

    View details for PubMedID 29926161

  • Long-term implications of cancer for work and financial wellbeing: Evidence from autologous hematopoietic cell transplantation (HCT) survivors MATURITAS Stepanikova, I., Powroznik, K., Cook, K. S., Tierney, D., Laport, G. 2017; 105: 119?25

    Abstract

    Little is known about how long-term cancer survivors adapt in the realm of work and finances, and whether there are differences in these adaptations based on overall health status. We hypothesize that survivors with better health-related quality of life (HQL) have better work and financial outcomes.Cross-sectional study with 200 adult recipients of autologous hematopoietic cell transplantation (HCT) 3-26 years after transplant using self-administered questionnaires and medical records extraction.Questionnaires assessed work status, financial satisfaction, and perceived improvements in financial status since transplant.Nearly half the survivors were employed (37.2% full-time, 8.7% part-time); 37.2% had retired. Higher scores on the functional HQL were linked to a lower relative risk of having retired (RRR 0.85, CI 0.75-0.98) and of being neither in the workforce nor retired (RRR 0.84, CI 0.72-0.99) compared with working full-time. Higher functional HQL also related to higher financial satisfaction (b 0.06, CI 0.01-0.10) and increased odds of perceived improvements in one's financial situation since transplant (OR 1.15, CI 1.04-1.17). Patients receiving HCT at age ?60 were more likely than counterparts receiving HCT at age 18-39 to work part-time (RRR 18.24, 95% CI 1.19-280.24) and to have retired (Model 1 RRR 579.14, 95% CI 49.53-6771.54) than to be working full-time.Survivors with poorer HQL may be at risk for overall poorer work and financial adaptation. Interventions targeting this group and specifically focusing on re-integration into the world of paid work should be considered.

    View details for PubMedID 28780252

  • National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Bevans, M., El-Jawahri, A., Tierney, D. K., Wiener, L., Wood, W. A., Hoodin, F., Kent, E. E., Jacobsen, P. B., Lee, S. J., Hsieh, M. M., Denzen, E. M., Syrjala, K. L. 2017; 23 (4): 538-551

    Abstract

    In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.

    View details for DOI 10.1016/j.bbmt.2016.09.011

    View details for Web of Science ID 000397364300003

  • National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: Consensus Recommendations for Patient-Centered Outcomes. Biology of blood and marrow transplantation Bevans, M., El-Jawahri, A., Tierney, D. K., Wiener, L., Wood, W. A., Hoodin, F., Kent, E. E., Jacobsen, P. B., Lee, S. J., Hsieh, M., Denzen, E. M., Syrjala, K. L. 2016

    Abstract

    In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.

    View details for DOI 10.1016/j.bbmt.2016.09.011

    View details for PubMedID 27660168

  • Exploring long-term cancer survivors' experiences in the career and financial domains: Interviews with hematopoietic stem cell transplantation recipients JOURNAL OF PSYCHOSOCIAL ONCOLOGY Stepanikova, I., Powroznik, K., Cook, K. S., Tierney, D. K., Laport, G. G. 2016; 34 (1-2): 2-27

    Abstract

    Using semi-structured interviews with 50 hematopoietic stem cell transplantation (HSCT) recipients who were 2 to 22 years post-transplant, this study investigates cancer survivors' interpretations of their economic and work-related experiences during and after treatment. Survivors described a variety of challenges in these areas, including job insecurity, discrimination, career derailment, the lack of career direction, delayed goals, financial losses, insurance difficulties, constraints on job mobility, and physical/mental limitations. Survivors described the ways these challenges were offset by external factors that helped them to navigate these difficulties and buffered the negative financial and career-related impacts. Good health insurance, favorable job characteristics, job accommodations, and financial buffers were prominent offsetting factors. Most survivors, however, were also forced to rely on individual behavioral and interpretative strategies to cope with challenges. Behavioral strategies included purposeful job moves, retraining, striving harder, and retiring. Some strategies were potentially problematic, such as acquiring large debt. Interpretive strategies included reprioritizing and value shifts, downplaying the magnitude of cancer impact on one's life, denying the causal role of cancer in negative events, making favorable social comparisons, and benefit finding. Post-treatment counseling and support services may assist survivors in identifying available resources and useful strategies to improve long-term adaptation in the career and financial realms.

    View details for DOI 10.1080/07347332.2015.1101040

    View details for Web of Science ID 000372131100002

    View details for PubMedID 26492184

  • Survivorship Issues BMTCN Certification Review Manual Tierney, D., Pinner, L. edited by FAiman, B. Oncology Nursing Society. 2016; 1: 233?248
  • Sexuality Following Hematopoietic Cell Transplantation Thomas' Hematopoietic Cell Transplantation Tierney, D. edited by Forman, S. J., Negrin, R. S., Antin, J. H., Appelbaum, F. R. Wiley Blackwell. 2016; 5: 399?406
  • Intensive Care Utilization for Hematopoietic Cell Transplant Recipients BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Jenkins, P., Johnston, L. J., Pickham, D., Chang, B., Rizk, N., Tierney, D. K. 2015; 21 (11): 2023-2027

    Abstract

    Blood and marrow transplantation (BMT) is a potentially curative therapy for a number of malignant and nonmalignant diseases. Multiple variables, including age, comorbid conditions, disease, disease stage, prior therapies, degree of donor-recipient matching, type of transplantation, and dose intensity of the preparative regimen, affect both morbidity and mortality. Despite tremendous gains in supportive care, BMT remains a high-risk medical therapy. A critically ill BMT recipient may require transfer to an intensive care unit (ICU) and the specialized medical and nursing care that can be provided, such as mechanical ventilation and vasopressor support. Mortality for BMT recipients requiring care in an ICU is high. This paper will describe the experience of the Stanford Blood and Marrow Transplant Program in developing and implementing guidelines to maximize the benefit of intensive care for critically ill BMT recipients.

    View details for DOI 10.1016/j.bbmt.2015.07.026

    View details for Web of Science ID 000363357200024

    View details for PubMedID 26238809

  • Sexuality, Menopausal Symptoms, and Quality of Life in Premenopausal Women in the First Year Following Hematopoietic Cell Transplantation ONCOLOGY NURSING FORUM Tierney, D. K., Palesh, O., Johnston, L. 2015; 42 (5): 488-497

    Abstract

    To describe sexuality, menopausal symptoms, and quality of life (QOL) in premenopausal women in the first year following hematopoietic cell transplantation (HCT). .One-year prospective longitudinal study..Stanford University Medical Center in California..63 premenopausal female recipients of HCT with a mean age of 34.5 years..Three instruments were used.Sexuality, menopausal symptoms, and QOL..At one year post-HCT, women reported absent to low desire and arousal, adequate lubrication less than half of the time, absent or rare orgasm, pain during vaginal penetration more than half the time, and dissatisfaction with overall sex life. Women also reported moderate to severe vasomotor symptoms, including hot flashes, night sweats, and sweating. Twenty-one women were avoiding sexual activity, and 25 women were not sexually active. Mean QOL scores significantly increased (p = 0.028) in the first year, signifying an improvement in QOL. Variables predictive of improved QOL at one year post-HCT include decreased psychosocial and physical symptoms, sexual satisfaction, and pre-HCT QOL score..One year post-HCT, women reported sexual dysfunction, sexual dissatisfaction, and menopausal symptoms, which negatively affect QOL. .Nurses and other healthcare providers working with recipients of HCT can provide anticipatory guidance on potential changes in sexuality and menopausal symptoms to facilitate adaptation by reducing discordance between expectations and new realities. .

    View details for DOI 10.1188/15.ONF.488-497

    View details for Web of Science ID 000363892900010

    View details for PubMedID 26302277

  • Palliative care of hematopoietic cell transplant recipients and families. Seminars in oncology nursing Tierney, D. K., Passaglia, J., Jenkins, P. 2014; 30 (4): 253?61

    Abstract

    To provide support for the early integration of palliative care into the care of hematopoietic cell transplant (HCT) recipients and families with the goal of improving care.Journal articles and on-line databases.Early integration of palliative care for HCT recipients at high risk for complex symptom clusters, non-relapse mortality, or relapse offers an opportunity to clarify goals of care, advanced care planning, and improving the quality of care for both recipients and families.The palliative care service can support the HCT nurse in providing complex care to HCT recipients who are faced with significant side effects, toxicities, and complications of transplant.

    View details for DOI 10.1016/j.soncn.2014.08.007

    View details for PubMedID 25361877

  • Mobilization of Hematopoietic Stem Cells for Use in Autologous Transplantation CLINICAL JOURNAL OF ONCOLOGY NURSING Devine, H., Tierney, D. K., Schmit-Pokorny, K., McDermott, K. 2010; 14 (2): 212-222

    Abstract

    Autologous hematopoietic stem cell transplantation (HSCT) is a potentially curative therapeutic approach for various malignant hematologic and lymphoid diseases. Hematopoietic stem cells (HSCs) may be collected from the blood or the bone marrow. HSCs are capable of self-renewal and give rise to progenitor cells, multipotent cells that differentiate and proliferate into the mature cells of the blood and immune system. HSCs and progenitor cells are released from the bone marrow into the peripheral blood through a process called mobilization. HSCs then are collected from the blood in a process called apheresis and cryopreserved for administration following the high-dose preparative regimen. This article reviews stem cell biology, current mobilization strategies, use of novel mobilization agents, and nursing care of patients during the mobilization phase of autologous HSCT. Understanding the biology and process of HSC mobilization is critical for transplantation nurses to deliver and coordinate care during this complex phase of autologous HSCT.

    View details for DOI 10.1188/10.CJON.212-222

    View details for Web of Science ID 000276587700017

    View details for PubMedID 20350895

  • Hematopoietic stem cell transplantation nursing: a practice variation study. Oncology nursing forum Bevans, M., Tierney, D. K., Bruch, C., Burgunder, M., Castro, K., Ford, R., Miller, M., Rome, S., Schmit-Pokorny, K. 2009; 36 (6): E317?25

    Abstract

    To examine practice variation in hematopoietic stem cell transplantation (HSCT) nursing and to identify the gap between recommended standards of practice and actual practice across settings. Additional practices relevant to HSCT nursing also were explored.Cross-sectional, descriptive survey.National and international cancer centers.A convenience sample was obtained from the 2006 Oncology Nursing Society Blood and Marrow Stem Cell Transplant Special Interest Group membership list (N = 205). Most participants were women (94%) with a median age of 45 years. The primary role was bedside nurse (46%), with an adult-only population (78%) in an academic (84%), inpatient (68%-88%) center. 39 (94%) U.S. states and 7 (6%) non-U.S. countries were represented.Survey development was guided by Dillman Mail and Internet survey design. Electronic questionnaires were conducted with Zoomerang Market Tools.Infection control practices across bone marrow transplantation settings.Descriptive statistics revealed minimal practice variation regarding infection control across transplantation types or conditioning regimens. Practices regarding implementation of restrictions on patients' hygiene, diet, and social interactions varied by phase of transplantation, with the greatest variations occurring during the post-transplantation phase. Sixty-two percent of respondents reported using published guidelines; 72% reported using organization-specific policies.Although published standards are under consideration, practice variation exists across transplantation centers. Whether the variation is caused by a lack of compliance with published guidelines or by the poor delineation of details for providers to translate the guidelines into practice is not known.Identifying gaps in the literature and inconsistencies in HSCT practices is an important first step in designing evidence-based projects that can be used to standardize practice and link best practices to improved patient outcomes.

    View details for DOI 10.1188/09.ONF.E317-E325

    View details for PubMedID 19887345

    View details for PubMedCentralID PMC3459318

  • Sexuality: a quality-of-life issue for cancer survivors. Seminars in oncology nursing Tierney, D. K. 2008; 24 (2): 71-79

    Abstract

    To provide an overview of the broad, multidimensional construct of sexuality addressing physiologic, psychological, and social dimensions.Research articles, abstracts, standards of care, international reports.Multiple insults to the physiologic, psychological, and social dimensions of sexuality can occur following the diagnosis and treatment of cancer. The incidence of altered sexuality in cancer survivors is high, long lasting, and can diminish the quality of life of both the cancer survivor and the sexual partner. Additional research is needed to address these alterations.Nurses and other health care professions can begin to help cancer survivors adapt to changes in sexuality related to cancer and cancer treatment by initiating a discussion of sexuality at the time of diagnosis and throughout the trajectory of disease.

    View details for DOI 10.1016/j.soncn.2008.02.001

    View details for PubMedID 18442670

  • Altered sexual health and quality of life in women prior to hematopoitetic cell transplantation EUROPEAN JOURNAL OF ONCOLOGY NURSING Tierney, K. D., Facione, N., Padilla, G., Blume, K., Dodd, M. 2007; 11 (4): 298-308

    Abstract

    The purpose of this cross-sectional descriptive study is to define sexual dysfunction and menopausal symptoms in women following cytotoxic or immunosuppressive medication for the treatment of malignant or life-threatening hematolymphoid diseases. These women were preparing to undergo hematopoietic cell transplantation (HCT) as the next step in their treatment plan. It is assumed that sexual dysfunction and symptoms of premature menopause are more pronounced post-HCT due to the intensity of the preparative regimen on the hypothalamic-pituitary-gonadal axis. This study included 48 pre-menopausal women and 28 spouses/partners. Data were collected using five self-report instruments (demographic and medical, the Female Sexual Function Index, the Menopause-specific Quality of Life, the Psychosocial Adaptation to Illness Scale, and a global quality of life score). The main research variables were female sexual functioning, symptoms of menopause, and quality of life. The findings indicate that 73% of women report decreased libido and 48% report dissatisfaction with their overall sex life. Hot flashes, the most common symptom of menopause are reported by 46% and 27% report the hot flashes moderate to severe in intensity. Vaginal dryness was reported by 35% with 23% reporting the vaginal dryness to be moderate to severe. The mean quality of life (QOL) score in women was 69+/-25 with a range of 2-100 (on a scale of 0-100 with 100 being an excellent QOL). The findings indicate that women treated with standard dose chemotherapy and immunosuppressive therapy for malignant and life-threatening hematolymphoid diseases experience alterations in sexual health and symptoms of premature menopause. The results show that the desire, arousal, and orgasm phase of the sexual response cycle are altered. Additionally, nearly half of the women are experiencing hot flashes, the most common symptom of menopause and over a third report vaginal dryness. There are statistically significant correlations between altered sexual health, menopausal symptoms, and QOL scores.

    View details for DOI 10.1016/j.ejon.2006.10.009

    View details for Web of Science ID 000250795400002

    View details for PubMedID 17196431

  • Response shift - A theoretical exploration of quality of life following hematopoietic cell transplantation CANCER NURSING Tierney, K., Facione, N., Padilla, G., Dodd, M. 2007; 30 (2): 125-138

    Abstract

    Quality of life (QOL) has become an important outcome measure for evaluating the impact of cancer therapy, especially aggressive cancer therapies such as hematopoietic cell transplantation (HCT). Despite the intense interest in examining the phenomenon of QOL, fundamental concerns remain. Most published QOL studies of HCT recipients do not state the theoretical model on which the investigation was designed. The absence of a theoretical foundation results in difficulties for healthcare professions to interpret the study's outcomes, generalize the findings and design and test theory-based interventions. Most HCT recipients report good to excellent QOL despite ongoing treatment-related sequela. This article explores the theoretical model of response shift as a means of understanding how HCT recipients maintain or improve their QOL after the treatment of life-threatening illness. Finally, a proposal for studying the QOL of HCT recipients based on the response shift model is offered, which includes a discussion of theory-based interventions.

    View details for Web of Science ID 000247113000005

    View details for PubMedID 17413778

  • Randomized, placebo-controlled, double-blind study of a cytomegalovirus-specific monoclonal antibody (MSL-109) for prevention of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Boeckh, M., Bowden, R. A., Storer, B., Chao, N. J., Spielberger, R., Tierney, D. K., Gallez-Hawkins, G., CUNNINGHAM, T., Blume, K. G., Levitt, D., Zaia, J. A. 2001; 7 (6): 343-351

    Abstract

    MSL-109 is a monoclonal antibody specific to the cytomegalovirus (CMV) glycoprotein H with high neutralizing capacity. In a prospective, randomized, double-blind study, allogeneic hematopoietic stem cell transplantation (HSCT) recipients with positive donor and/or recipient serology for CMV before transplantation received either 60 mg/kg MSL-109 (n = 59), 15 mg/kg MSL-109 (n = 60), or placebo (n = 60) intravenously every 2 weeks from day -1 until day 84 after transplantation. CMV pp65 antigenemia, CMV-DNA load in plasma, and viremia by culture were tested weekly. Primary end points were development of pp65 antigenemia at any level and/or viremia for which ganciclovir was given. There was no statistically significant difference in CMV pp65 antigenemia or viremia among patients in the 60-mg group (pp65 antigenemia, 47%; viremia, 15%), the 15-mg group (52%; 23%), and the placebo group (45%; 17%). There was also no difference in maximum levels of pp65 antigenemia, time to clearance of pp65 antigenemia after start of ganciclovir, CMV disease, invasive bacterial and fungal infections, time to neutrophil and platelet engraftment, acute graft-versus-host disease, days of hospitalization, and overall survival rate among the 3 groups. However, a subgroup analysis of CMV-seronegative recipients with a seropositive donor (D+/R-) showed a transiently improved survival rate by day 100 in MSL-109 recipients (mortality: 60-mg group, 1/13; 15-mg group, 1/12; placebo group, 6/10 [P = .02 for 60-mg versus placebo groups; P = .08 for 15-mg versus placebo groups]); by the end of follow-up, the difference was no longer statistically significant. The improved survival rate in D+/R- patients could not be attributed to a reduction in CMV disease; however, MSL-109 was associated with improved platelet engraftment and less grade III to IV acute graft-versus-host disease in this subgroup. In a subgroup analysis of CMV-seropositive recipients of MSL-109 (D+/R+ and D-/R+), overall mortality was increased compared to that of the placebo group (P = .12 for the 60-mg versus placebo groups, P = .05 for the 15-mg versus placebo groups, and P = .04 for the dose levels combined versus placebo). MSL-109 was well tolerated and no immune response to the drug was observed. Thus, MSL-109 was safe but did not reduce CMV infection in allogeneic HSCT recipients. The transient survival advantage seen early after transplantation in CMV D+/R- patients and the negative effect on survival in seropositive patients remain unexplained. Thus, there is no evidence that MSL-109 is beneficial in CMV-seropositive HSCT recipients.

    View details for Web of Science ID 000169804000005

    View details for PubMedID 11464977

  • Transplantation of highly purified CD34(+)Thy-I+ hematopoietic stem cells in patients with metastatic breast cancer BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Negrin, R. S., Atkinson, K., Leemhuis, T., Hanania, E., Juttner, C., Tierney, K., Hu, W. W., JOHNSTON, L. J., Shizuru, J. A., Stockerl-Goldstein, K. E., Blume, K. G., Weissman, I. L., Bower, S., Baynes, R., Dansey, R., Karanes, C., Peters, W., Klein, J. 2000; 6 (3): 262-271

    Abstract

    We report here the transplantation of extensively purified "mobilized" peripheral blood CD34Thy-1 hematopoietic stem cells from 22 patients with recurrent or metastatic breast cancer. Patients were mobilized with either high-dose granulocyte colony-stimulating factor (G-CSF) alone or cyclophosphamide plus G-CSE Median purity of the stem cell product at cryopreservation was 95.3% (range, 91.1%-98.3%), and viability was 98.6% (range, 96.5%-100%). After high-dose chemotherapy with carmustine, cisplatin, and cyclophosphamide, CD34+Thy-1 cells at a median dose of 11.3 x 10(5) per kilogram (range, 4.7-163 x 10(5) per kilogram) were infused. No infusion-related toxicity was observed. Neutrophil recovery was prompt, with median absolute neutrophil count >500/microL by day 10 (range, 8-15 days) and >1000/microL by day 11 (range, 8-17 days). Median platelet recovery (>20,000/microL) was observed by day 14 (range, 9-42 days) and >50,000/microL by day 17 (range, 11-49 days). Tumor cell depletion below the limits of detection of a sensitive immunofluorescence-based assay was accomplished in all patients who had detectable tumor cells in apheresis products before processing. Although CD4+ T-cell reconstitution was slow, no unusual infections were observed. Neither early nor late graft failure was observed, and no patient required infusion of unmanipulated backup cells. At a median follow-up of approximately 1.4 years and a maximum follow-up of 2.5 years, 16 of the 22 patients remain alive, with 9 free of disease progression, and have stable blood counts. In summary, highly purified CD34+Thy-1+ cells used as the sole source of the hematopoietic graft result in rapid and sustained hematopoietic engraftment.

    View details for Web of Science ID 000090022300006

    View details for PubMedID 10871151

  • High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin's lymphoma BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Alvarnas, J. C., Negrin, R. S., Horning, S. J., Hu, W. W., Long, G. D., Schriber, J. R., Stockerl-Goldstein, K., Tierney, K., Wong, R., Blume, K. G., Chao, N. J. 2000; 6 (3A): 352-358

    Abstract

    Central nervous system (CNS) involvement by non-Hodgkin's lymphoma (NHL) carries a poor patient prognosis whether it occurs as a primary site of disease or secondarily in patients with systemic disease. In a group of 481 patients undergoing high-dose therapy with hematopoietic cell transplantation (HCT) for NHL, 15 patients (3.1%) were identified with CNS involvement. Two patients had primary CNS lymphoma, and 13 had secondary disease. All patients received intrathecal chemotherapy, and 13 received CNS radiotherapy before transplantation. Fourteen patients received systemic chemotherapy. At the time of transplantation, both patients with primary CNS lymphoma and 8 patients with secondary disease had achieved a complete response, 3 patients had achieved a partial response, 1 had failed induction therapy, and 1 had progression of CNS disease before high-dose therapy. Fourteen patients received carmustine, etoposide, and cyclophosphamide as the preparative regimen, and 1 patient received fractionated total body irradiation instead of carmustine. The 2 patients with primary CNS lymphoma were alive and free of disease, 1 at 1,085 days after HCT and 1 at 3,704 days after HCT. The actuarial 5-year event-free survival (EFS) was 46% +/- 26%, and overall survival (OS) was 41% +/- 28%. The median EFS and OS were 2.2 and 1.5 years, respectively. Three patients experienced symptomatic memory loss or intellectual decline after therapy, 1 patient developed paraplegia, and 1 patient had a thrombotic stroke 20 months after HCT. Despite treatment-related toxicities, 7 patients responding to quality-of-life questions at approximately 1 year after HCT gave their overall quality of life a median rating of 9 out of a possible 10 (range, 6-10). High-dose therapy with autologous HCT can produce extended EFS in patients with secondary CNS lymphoma and possibly in those with primary CNS NHL.

    View details for Web of Science ID 000090022500008

    View details for PubMedID 10905773

  • Equivalence of 2 effective graft-versus-host disease prophylaxis regimens: Results of a prospective double-blind randomized trial BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Chao, N. J., Snyder, D. S., Jain, M., Wong, R. M., Niland, J. C., Negrin, R. S., Long, G. D., Hu, W. W., Stockerl-Goldstein, K. E., JOHNSTON, L. J., Amylon, M. D., Tierney, D. K., O'Donnell, M. R., Nademanee, A. P., Parker, P., Stein, A., Molina, A., Fung, H., Kashyap, A., Kohler, S., Spielberger, R., Krishnan, A., Rodriguez, R., Forman, S. J., Blume, K. G. 2000; 6 (3): 254-261

    Abstract

    We have previously demonstrated a decrease in the incidence of acute graft-versus-host disease (GVHD) with the addition of methotrexate (MTX) to cyclosporine (CSP) and prednisone (PSE) chemotherapy in patients with leukemia. We have now completed a prospective randomized trial comparing the 3-drug regimen (CSP/MTX/PSE, including 3 doses of MTX) to the standard 2-drug regimen (CSP/MTX, including 4 doses of MTX) to investigate the benefit of PSE used up front for the prevention of acute and chronic GVHD. In the trial, 193 patients were randomized and 186 were included in the final analysis. All patients received a bone marrow graft from a fully histocompatible sibling donor. The preparatory regimen consisted of fractionated total-body irradiation (fTBI) and etoposide in all but 13 patients, who received fTBI and cyclophosphamide. The patients were randomized to receive either CSP/MTX/PSE or CSP/MTX. The 2 groups were well balanced with respect to diagnosis, disease stage, age, donor-recipient sex, and parity. In an intent-to-treat analysis, the incidence of acute GVHD was 18% (95% confidence interval [CI] 12-28) for the CSP/MTX/PSE group compared with 20% (CI 10-26) for the CSP/,MTX group (P = .60), with a median follow up of 2.2 years. Overall survival was 65% for those receiving CSP/MTX/PSE and 72% for those receiving CSP/MTX (P = .10); the relapse rate was 15% for the CSP/MTX/PSE group and 12% for the CSP/MTX group (P = .83). The incidence of chronic GVHD was similar (46% versus 52%; P = .38), with a follow-up of 0.7 to 6.0 years. Of interest, 21 patients went off study due to GVHD (5 in the CSP/MTX/PSE group and 16 in the CSP/MITX group [P = .02]), and 11 patients went off study because of alveolar hemorrhage (3 in the CSP/MTX/PSE group and 8 in the CSP/MTX group [P = .22]). The addition of PSE did not result in a higher incidence of infectious complications, bacterial (66% versus 58%), viral (77% versus 66%), or fungal (20% versus 20%), in those receiving CSP/MTX/PSE versus CSP/MTX, respectively. These data suggest that the addition of PSE was associated with a somewhat lower incidence of early posttransplantation complications but did not have a positive impact on the incidence of acute or chronic GVHD or event-free or overall survival.

    View details for Web of Science ID 000090022300005

    View details for PubMedID 10871150

  • A daily flowsheet for an outpatient bone marrow transplant treatment center. Oncology nursing forum Burns, J. M., Tierney, D. K. 1996; 23 (8): 1313-1316

    Abstract

    To develop a flowsheet for an outpatient bone marrow transplant treatment center that would decrease the time required to complete documentation and facilitate verbal reports.Oncology nursing standards of care, clinical experience, and published books and articles.A comprehensive daily flowsheet was developed to provide consistency in assessments and documentation of a complex outpatient population.The implementation of the new flowsheet decreased the amount of nursing time spent on written documentation and verbal reports. Patients' daily assessments are tracked more easily using this form.Staff satisfaction can be increased by reducing the amount of time spent on patient documentation.

    View details for PubMedID 8883076

  • Paradoxical effect of thalidomide prophylaxis on chronic graft-vs.-host disease. Biology of blood and marrow transplantation Chao, N. J., Parker, P. M., Niland, J. C., Wong, R. M., Dagis, A., Long, G. D., Nademanee, A. P., Negrin, R. S., Snyder, D. S., Hu, W. W., Gould, K. A., Tierney, D. K., Zwingenberger, K., Forman, S. J., Blume, K. G. 1996; 2 (2): 86-92

    Abstract

    Thalidomide has been reported to be an effective agent for the treatment of chronic graft-vs.-host disease (GVHD). To determine its efficacy as a prophylactic agent for the prevention of chronic GVHD, a prospective randomized double-blind study was performed. A total of 59 patients were randomized to receive either placebo or thalidomide (200 mg orally twice a day) beginning 80 days after allogeneic bone marrow transplantation (BMT). Fifty-four evaluable patients were analyzed, 26 received placebo, and 28 received thalidomide. The characteristics of patients were well-balanced between the two groups. Following the first interim analysis conducted by the Data Safety Monitoring Board using an intent-to-treat approach, a statistically significant difference in the incidence of chronic GVHD was found. Patients receiving thalidomide developed chronic GVHD more often than patients receiving placebo (p = 0.06). Moreover, an apparent overall survival advantage was noted for patients receiving placebo compared to those receiving thalidomide (p = 0.006). Adjustment for possible confounding factors did not eliminate these negative effects of thalidomide. These results demonstrate that while thalidomide is an effective agent for the therapy of chronic GVHD, its use at the doses administered for the prophylaxis of chronic GVHD resulted in a paradoxical outcome with a higher incidence of chronic GVHD and a lower overall survival. We conclude that the early use of thalidomide results in a shift in the balance between GVHD and induction of tolerance. These data demonstrate again the importance of phase III double-blind controlled randomized studies.

    View details for PubMedID 9118303

  • Critical pathway for administering high-dose chemotherapy followed by peripheral blood stem cell rescue in the outpatient setting. Oncology nursing forum Burns, J. M., Tierney, D. K., Long, G. D., Lambert, S. C., CARR, B. E. 1995; 22 (8): 1219-1224

    Abstract

    To explain the rationale and process of outpatient critical pathway development for sequential high-dose chemotherapy followed by peripheral blood stem cell transplantation.Published books and journal articles.Complex treatment for patients with metastatic breast cancer is shifting to the outpatient area. To make this therapy safe and cost effective, a process for monitoring this type of outpatient care needs to be developed.Collaboration with a multidisciplinary team is important in ensuring quality of care for complex outpatient treatment protocols. Critical pathway development can serve as a road map for delivering this care.As team leaders, nurses should oversee the critical pathway development and implementation. Nurses also should maintain their role of patient advocacy through monitoring pathway compliance.

    View details for PubMedID 8532546

  • GRANULOCYTE-COLONY-STIMULATING FACTOR AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION BLOOD Schriber, J. R., Chao, N. J., Long, G. D., Negrin, R. S., Tierney, D. K., KUSNIERZGLAZ, C., Lucas, K. S., Blume, K. G. 1994; 84 (5): 1680-1684

    Abstract

    Hematopoietic growth factors have been shown to be effective in reducing the period of neutropenia after autologous bone marrow transplantation (BMT). Initial concerns over potential aggravation of graft-versus-host disease (GVHD) and increase in the incidence of relapse in patients with myeloid leukemias influenced the number of studies using hematopoietic growth factors after allogeneic BMT. We report the experience with 50 patients treated at a single institution using granulocyte colony-stimulating factor (G-CSF) after allogeneic sibling (n = 30) and matched unrelated (n = 20) BMT. The time to an absolute neutrophil count > or = 500/microL was significantly faster in patients who received G-CSF and cyclosporine and prednisone for GVHD prophylaxis when compared with historical control patients receiving the same GVHD prophylaxis (10 v 13 days, P < .01). A similar accelerated myeloid engraftment was observed for those patients who received the addition of methotrexate for GVHD prophylaxis when compared with historical control patients receiving the same GVHD prophylaxis regimen (16 v 19 days, P < .05). The median time to engraftment for patients receiving a matched unrelated BMT and G-CSF was 17 days (range 13 to 26). We did not observe any increase in GVHD or early mortality in the matched related sibling BMT. The incidence of acute GVHD in the matched unrelated BMT recipients was also low at 21%; however, 9 patients (45%) died within 100 days of the date of BMT, similar to the experience reported with granulocyte-macrophage CSF. This study confirms the efficacy of G-CSF in accelerating myeloid engraftment after allogeneic matched sibling BMT. The higher early mortality associated with patients receiving matched unrelated BMT suggests that randomized controlled trials using G-CSF after allogeneic BMT should be performed.

    View details for Web of Science ID A1994PE38700041

    View details for PubMedID 7520782

  • AUTOLOGOUS BONE-MARROW TRANSPLANTATION - A REVIEW OF THE PRINCIPLES AND COMPLICATIONS CANCER NURSING Lin, E. M., Tierney, D. K., Stadtmauer, E. A. 1993; 16 (3): 204-213

    Abstract

    High-dose chemotherapy and autologous bone marrow transplantation (ABMT) is now used routinely in an attempt to cure patients with poor-prognosis malignant diseases. This aggressive and intensive treatment requires a highly trained health-care team. Nurses specializing in the care of these patients are essential to maintain patient well-being and ensure a good outcome. High-dose therapy leads to myelosuppression and tissue damage, and the resultant infections, bleeding, and organ toxicities are frequently either unusual or more severe than those seen with conventional-dose antineoplastic therapies. Organ toxicities can affect both short-term and long-term functional status. Disabling or even fatal consequences of treatment can occur during the transplant or months or years later. A specialized knowledge base and an understanding of the way this therapy affects the patient is required not only for the acute inpatient period, but also for the long term. A team approach to these complex patients with a central role for the nurse clinician will lead to optimal patient care.

    View details for Web of Science ID A1993LK62800006

    View details for PubMedID 8348528

  • DYNAMIC ASSESSMENT OF QUALITY-OF-LIFE AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION BLOOD Chao, N. J., Tierney, D. K., Bloom, J. R., Long, G. D., Barr, T. A., STALLBAUM, B. A., Wong, R. M., Negrin, R. S., Horning, S. J., Blume, K. G. 1992; 80 (3): 825-830

    Abstract

    To determine the quality of life in adult patients after autologous bone marrow transplantation (BMT), we administered a questionnaire to a cohort of patients seen at a single referral-based center. The sample included adults 18 years and older during the 1 year following an autologous BMT. Both disease-free patients and those who relapsed with 1-year of follow-up data available were included. Of 59 eligible patients, 58 (98%) responded to the questionnaire. Patients completed a telephone questionnaire administered by a nurse specialist in the field of BMT approximately every 90 days. At the time of initial contact on day +90, the mean quality of life was 7.8 (range, 1 to 10) on a scale of 1 to 10, with 10 being the best. By the end of the first year of follow-up, the mean quality of life was 8.9 (range, 3 to 10). Seventy-eight percent of the patients were employed. Twenty-one percent lost weight during the first year, with the majority reporting voluntary weight loss. Fourteen percent reported difficulties with sexual activity. Only 5% reported difficulty with sleeping or with frequent colds. One patient felt that her appearance was worse, and none of the patients reported a poor appetite. Eighty-eight percent of surviving adult patients reported an above-average to excellent quality of life 1 year following autologous BMT. This outcome is encouraging and suggests that this procedure is not associated with long-term morbidity in the surviving adult patient.

    View details for Web of Science ID A1992JF85500033

    View details for PubMedID 1638031

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