共查询到20条相似文献,搜索用时 31 毫秒
1.
Multiple transplant-related complications (MTRC) represent a severe condition after bone marrow transplantation (BMT) and
are supposed to reflect systemic endothelial damage. Soluble thrombomodulin (sTM) and plasminogen activator inhibitor type-1
(PAI-1) were investigated as markers of endothelial dysfunction in 35 patients after autologous or allogeneic BMT and compared
with the occurrence of the typical complications sepsis, veno-occlusive disease of the liver (VOD), graft-versus-host disease
(GVHD), and capillary leakage syndrome (CLS). PAI-1 was assessed by an assay of functional activity and sTM by antigenic determination.
In patients who had undergone allogeneic BMT and had no transplant-related complications (TRC), PAI-1 peaked on day +14 (20±5
units/ml), and sTM doubled in comparison to the starting range, to 60–80 ng/ml between days +14 and +49. In contrast, PAI-1
and sTM were unchanged following autologous BMT. PAI-1 was increased in sepsis, CLS, and VOD to 39–49 units/ml (p<0.05, compared with patients without TRC), and in GVHD to 16–47 units/ml (not significant). Soluble TM increased to 63–309 ng/ml
in patients with sepsis, VOD, or CLS (p<0.05, compared with patients without TRC) and to 79–224 ng/ml in GVHD (not significant). The increase of sTM and PAI-1 was
also positively correlated to the number of complications, so that in patients with three complications PAI-1 was increased
2.8-fold and sTM 3.5-fold over patients with no complications at all. We conclude that endothelial dysfunction is a feature
of VOD, sepsis, CLS, and to lesser extent of GVHD and is worse in patients with multiple complications.
Received: 27 October 1997 / Accepted: 1 December 1997 相似文献
2.
Reiter E Greinix H Rabitsch W Keil F Schwarzinger I Jaeger U Lechner K Worel N Streubel B Fonatsch C Mitterbauer G Kalhs P 《Annals of hematology》2000,79(7):374-377
Structural rearrangements of the long arm of chromosome 3 involving bands 3q21 and 3q26 and leading either to a paracentric
inversion inv (3)(q21q26) or a translocation between both homologous chromosomes – t (3;3)(q21q26) – have been reported in
patients with acute myelogenous leukemia (AML), myelodysplastic syndromes, myeloproliferative disorders, and chronic myelogenous
leukemia in blast crisis. We describe three patients with de novo AML with these structural abnormalities who received multiple
courses of conventional chemotherapy followed by unrelated donor (n=2) and autologous (n=1) bone marrow transplantation (BMT). All three patients had early relapse: patients 1 and 2 had relapse 69 days and 306 days
after BMT, respectively, and patient 3 immediately after autologous BMT. Despite further chemotherapy, they died without achieving
another remission. These findings, together with other recorded similar cases, show that AML with structural abnormalities
of the long arm of chromosome 3 as described has an extremely poor prognosis even with the most potent anti-leukemic treatment
modalities.
Received: 30 June 1999 / Accepted: 14 December 1999 相似文献
3.
C. Salat E. Holler M. Schleuning B. Eisele B. Reinhardt H. Kolb R. Pihusch R. Domrath E. Hiller 《Annals of hematology》1995,71(6):271-274
Capillary leak syndrome (CLS) is a severe complication after bone marrow transplantation (BMT). To investigate whether there is a pathogenetic role of the complement system, we monitored the levels of the terminal complement complex C5b-9 (TCC) and C3a-desArg as indicators of an activation of the complement system and the inhibitor of the classical pathway of the complement cascade, C1 inhibitor (C1-INH), in 48 bone marrow transplant recipients from 1 week before to 5 weeks after transplantation.Capillary leak syndrome developed in 7 out of 48 patients between days 1 and 12 after BMT. Complement activation as indicated by TCC levels was more pronounced in patients with CLS (n=7) from day –8 to +28 (p<0.05; day –1) and the elevation of TCC levels lasted longer in CLS patients (peak day 21) than in patients without this complication (peak day 7). Mean C3a-desArg levels were highest in patients with CLS reaching a peak at day 7. During the early posttransplant period a significant elevation of C1-INH levels (p<0.01 and p<0.05 respectively) compared with baseline levels (day –8) was found in patients with and without CLS, which was more pronounced in those patients with CLS (p<0.05).Although we could not observe an absolute C1-INH deficiency as compared to healthy individuals our data support the presence of a relative deficiency of the inhibitor which might explain the reported beneficial effects of C1-INH substitution in BMT related CLS. 相似文献
4.
Greinix HT Loidolt H Rabitsch W Schulenburg A Keil F Mitterbauer M Laczika K Lechner K Dieckmann K Fischer G Jäger U Rosenmayr A Knöbl P Schwarzinger I Höcker P Mannhalter C Hinterberger W Haas OA Fonatsch C Kalhs P 《Annals of hematology》2000,79(4):206-213
Between February 1982 and 1999, 118 consecutive patients (65 male, 53 female) with acute myelogenous leukemia (AML), with
a median age of 35 years (range 17–56 years), received stem-cell grafts from a human leukocyte antigen-identical sibling (n=71), one-antigen-mismatched family member (n=2), matched unrelated donor (n=15), one-antigen-mismatched unrelated donor (n=4) or an autologous (n=26) graft. At the time of transplant, 56 patients were in the first complete remission (CR), 27 in the second CR, 6 in untreated
relapse, 17 in primary refractory, and 12 in refractory relapse. The French-American-British classification (FAB) subtypes
were as follows: M1 (n=25), M2 (n=28), M3 (n=11), M4 (n=32), M5 (n=16), M6 (n=6). For conditioning, most patients underwent total body irradiation-containing regimens. As of 28 February, 1999, probability
of leukemia-free survival (LFS) is 58% for patients after related and 45% after unrelated stem-cell transplantation (SCT).
The probability of LFS is 70% for patients given allogeneic transplants in the first CR compared with 33% for those beyond
the first CR at SCT. In autologous stem-cell graft recipients, the probability of LFS is 37%. Transplant-related mortality
was 28% after related, 20% after unrelated, and 4% after autologous SCT. Probability of relapse for patients given related-donor
stem-cell grafts in the first CR and beyond the first CR is 30% and 67%, 55% after unrelated and 63% after autologous stem-cell
grafting. Thus, myeloablative therapy followed by allogeneic stem-cell infusion has a high curative potential for patients
with AML in remission and offers substantial benefits to patients in advanced disease.
Received: 26 May 1999 / Accepted: 20 August 1999 相似文献
5.
Michael Doubek Frantisek Folber Zdenek Koristek Yvona Brychtova Marta Krejci Miroslav Tomiska Milan Navratil Petra Mikulasova Jiri Mayer 《Annals of hematology》2009,88(9):881-887
The role of autologous hematopoietic stem cell transplantation (autoHSCT) in adult acute lymphoblastic leukemia (ALL) is still
unclear. We retrospectively analyzed the results of the autoHSCT and maintenance therapy, with oral 6-mercaptopurine and methotrexate,
in comparison to conventional-dose chemotherapy in the consolidation treatment of adult ALL and lymphoblastic lymphoma (LBL).
The patients, with HLA identical sibling donor, underwent allogeneic transplantation, while the others were treated with autoHSCT
and maintenance therapy with oral 6-mercaptopurine and methotrexate, or by conventional-dose chemotherapy (patient’s decision,
no autologous hematopoietic stem cells harvest). Sixty consecutive adult patients (median age 35.2 years; range 17.3 to 70.7)
with ALL (n = 52), LBL (n = 7), and acute biphenotypic leukemia (n = 1) were treated in our center from 1997 to 2007. Patients treated with chemotherapy alone (n = 35) had a shorter median progression-free survival (PFS) compared to patients who underwent autoHSCT plus maintenance therapy
(n = 18), 8.4 and 46.8 months, respectively (p = 0.017). Patients treated with chemotherapy alone had also a shorter median overall survival (OS) compared to patients treated
with autoHSCT: 13.0 vs. 46.8 months (p = 0.046). The differences remained statistically significant even after excluding patients with Ph positivity. We can conclude
that, in our case, autoHSCT followed by maintenance chemotherapy is a good option for adult patients with ALL and, in standard-risk
and high-risk patients, provides more favorable OS and PFS rates compared to patients treated by chemotherapy alone. However,
we are aware of the fact that our analysis may have been distorted by the fact that the analysis is retrospective, that treatment
with autoHSCT was based on patient’s decision, and that chemotherapy may have been administered to negatively selected patients. 相似文献
6.
C1 esterase inhibitor concentrate for capillary leakage syndrome following bone marrow transplantation 总被引:3,自引:0,他引:3
The prognosis of patients with severe capillary leakage syndrome (CLS) after bone marrow transplantation (BMT) is dismal
despite aggressive use of intensive care therapy. Because the activated classical pathway of complement and relatively low
levels of C1 esterase inhibitor (C1 INH) acitivity are known features in these patients, we evaluated the efficacy of a therapy
using purified, human C1 INH concentrate. Severe CLS was defined as increase in body weight by more than 3% within 24 h combined
with generalized edema, impaired hemodynamic system (tachycardia and/or decreased blood pressure), and non-responsiveness
to furosemide. Of 142 patients, 22 developed severe CLS. The first seven patients whom we diagnosed with this complication
were assessed as control patients. Fifteen patients with severe CLS were treated with C1 INH concentrate using a cumulative
dose of 180 units/kg body wt. (initial dose: 60 units/kg, followed by two doses at 30 units/kg and four doses at 15 units/kg,
every 12 h). The survival rate of patients with CLS was 57% at 1 year after BMT in the C1 INH treatment group, compared with
14% in the control group (p=0.008). Eight of 15 treated patients are alive at a median of 9 months (range: 4–55) after BMT. The plasma levels of the
complement activation parameters C4d and C5a were 3±1.1 mg/dl (mean±S.D.) and 0.3±0.1 μg/l, respectively, prior to BMT, increasing
to 8.2±2.1 mg/dl and 1.3±0.4 μg/l, respectively, at diagnosis of CLS. After infusion of C1 INH concentrate the plasma levels
of C5a and C4d normalized. The activity of C1 INH rose to 139±10% of normal human plasma NHP pool (mean±S.D.) after infusion.
The CH50 values were not significantly altered. The fluid status normalized within 11 days in 14 of 15 treated patients. The
results of this study suggest that therapy with C1 INH concentrate improves the prognosis of patients with CLS after BMT.
This has to be confirmed in a randomized, controlled trial.
Received: 6 June 1997 / Accepted: 7 August 1997 相似文献
7.
N. Schmitz B. Glass P. Dreger T. Haferlach H. -A. Horst J. Ollech-Chwoyka M. Suttorp W. Gassmann H. Löffler 《Annals of hematology》1993,66(5):251-256
Summary Fifty-one consecutive patients with Hodgkin's disease (HD) have been treated with high-dose chemotherapy (HDT) and transplantation of autologous bone marrow (BM) (n=44), autologous BM plus peripheral blood stem cells (PBSC) (n=2), PBSC (n=1), syngeneic (n=1), or allogeneic BM (n=3). All patients had received standard salvage chemotherapy prior to HDT and were classified as sensitive (n=33) or resistant (n=17) to this treatment; one patient was in untreated relapse prior to BMT. The preparative regimens for patients receiving autologous BM and/or PBSC consisted of cyclophosphamide, VP 16, and BCNU (CVB) (n=44) or BCNU, etoposide, ara-C, and melphalan (BEAM) (n=3). The patients receiving allogeneic transplants were treated with the CVB regimen (n=2) or busulfan (16 mg/kg body wt.) and cyclophosphamide (200 mg/kg body wt.). With a median follow-up of 12 months, overall survival for 44 patients grafted with autologous BM is 61%±9%, progression-free survival for patients with sensitive disease is 44%±11%; no patient with resistant relapse survived beyond 1 year post transplant. Two of three patients grafted with allogeneic BM still survive 15 and 24 months after BMT with Karnofsky performance scores of 70% and 100%, respectively. The main toxicity encountered with the CVB regimen was interstitial pneumonia (IP), seen in four of 15 patients (27%) receiving 600 mg/m2 of BCNU. Three of these patients have died. The results show that HDT followed by hematopoietic stem cell rescue may effectively salvage an important fraction of patients with relapsed HD who respond to standard chemotherapy. The same approach is largely unsuccessful in patients with proven refractoriness to standard chemotherapy. Whether HDT followed by BMT or PBSC support is superior to intensive chemotherapy without stem cell support can be answered only by a prospectively randomized trial. 相似文献
8.
M. Kopp H. Schweigkofler B. Holzner D. Nachbaur D. Niederwieser W. W. Fleischhacker B. Sperner-Unterweger 《Annals of hematology》1998,77(1-2):27-32
Quality of life (QoL) was investigated in 56 BMT recipients. The objective was to compare QoL in terms of physical, emotional,
and social functioning between patients within the first year after BMT (n=15) and patients who were alive more than 1 year after BMT (n=41). The Functional Assessment of Cancer Therapy Scale (FACT-BMT) and the EORTC-Quality of Life Questionnaire (EORTC-QLQ
C30) were used to evaluate QoL as perceived by the patients. Results show a significantly reduced general QoL in patients
within the first year after BMT. Specific differences were identified on the dimensions of physical and emotional well-being
and the symptom scales of appetite loss, fatigue, pain, dyspnea, and nausea and vomiting. QoL improves significantly with
time after BMT. We suggest that there should be more integration of QoL expectancy into the pre-BMT information process. Patients
should be informed about potential deficits in physical and emotional well-being within the first year after BMT. This could
enhance insight and compliance in the critical period early after BMT.
Received: July 23, 1997 / Accepted: April 16, 1998 相似文献
9.
10.
Controversy remains regarding the transplant outcomes of human leukocyte antigen-identical related bone marrow transplantation
(BMT) and peripheral blood stem cell transplantation (PBSCT) for the treatment of patients with hematological malignancies.
To provide an estimate of the effect of BMT and PBSCT on clinical outcomes in patients with hematological malignancies, we
conducted a meta-analysis based on time-to-event data from 17 randomized controlled trials. PubMed, EMBASE, and Cochrane Central
Register of Controlled Trials (CENTRAL), from 1972 through July 2010, and conference proceedings through July 2009 and reference
lists, without any language restriction, of randomized trials that compared the transplant outcomes after BMT and PBSCT in
patients with hematological malignancies were searched for details. Two independent reviewers extracted the data. The outcomes
examined were engraftment, graft-versus-host disease (GVHD), relapse, transplant-related mortality (TRM), leukemia-free-survival
(LFS), and overall survival (OS). Compared to PBSCT, BMT had lower neutrophil (HR, 2.08; 95% CI, 1.80 to 2.42; p < 0.00001) and platelet (HR, 2.77; 95% CI, 1.78 to 4.30; p < 0.00001) engraftment. BMT was associated with a significant decrease in the development of grades II–IV (HR, 0.75; 95%
CI, 0.63 to 0.90; p = 0.002) and III–IV (HR, 0.63; 95% CI, 0.47 to 0.84; p = 0.001) acute GVHD as well as overall (HR, 0.70; 95% CI, 0.59 to 0.83; p < 0.0001) and extensive (HR, 0.60; 95% CI, 0.39 to 0.91; p = 0.002) chronic GVHD. BMT was associated with a higher incidence of relapse (HR, 1.91; 95% CI, 1.34 to 2.74; p = 0.0004). Comparable TRM (1.08; 95% CI, 0.56 to 2.10; p = 0.81), LFS (HR, 1.04; 95% CI, 0.83 to 1.30; p = 0.73), and OS (HR, 1.06; 95% CI, 0.81 to 1.39; p = 0.65) were demonstrated for both treatments. An inverse linear relationship was observed between the acute GVHD difference
(PBSCT minus BMT) and the outcome of OS (p = 0.016). Our meta-analysis suggest that BMT leads to slower hematological recovery, increasing rates of relapse, and a lower
risk of GVHD, but no significant difference in LFS and OS. A lower incidence of acute GVHD is associated with a superior OS. 相似文献
11.
H. T. Greinix F. Keil S. A. Brugger E. Reiter W. Linkesch K. Lechner B. Schneider K. U. Dieckmann G. Fischer I. Schwarzinger O. Haas W. Hinterberger C. Mannhalter K. Geissler P. Höcker U. Jäger P. Kalhs 《Annals of hematology》1996,72(2):53-59
Between February 1982 and April 1995, 62 patients (37 male, 25 female) with acute myelogenous leukemia (AML) with a median age of 32 years (19–51 years) received allogeneic marrow grafts from an HLA-identical sibling (n=60) or an HLA-mismatched family member (n=2). At the time of transplant, 35 patients were in first complete remission (CR), five in second CR, eight were primary refractory, eight were in untreated relapse and six in refractory relapse. The FAB subtypes were as follows: M1 (n=17), M2 (n=13), M3 (n=6), M4 (n=19), M5 (n=6), M6 (n=1). For conditioning most patients were given total body irradiation combined with cyclophosphamide (CY,n=50) or CY and busulfan (n=9). For graft-versus-host disease prophylaxis patients received cyclosporin A (CSA) and methotrexate (MTX) (n=32), MTX alone (n=12), CSA and methylprednisone (n=5), or CSA alone (n=13). As of April 1995, probability of leukemia-free survival projected at 10 years after BMT was 60% for patients transplanted in first CR compared with 10% for patients transplanted beyond first CR. Transplant-related mortality was 11% after BMT in first CR and 39% after BMT beyond first CR. Probability of relapse projected at 10 years after BMT is 32% for patients who received transplants in first CR and 81% for patients who received transplants beyond first CR. Thus, high-dose chemo/radiotherapy followed by allogeneic marrow infusion has a high curative potential for patients with AML who receive transplants in first CR and offers the chance of long-term disease-free survival for some patients with advanced disease. 相似文献
12.
Comparison of transplant outcomes from matched sibling bone marrow or peripheral blood stem cell and unrelated cord blood in patients 50 years or older
下载免费PDF全文
![点击此处可从《American journal of hematology》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Takaaki Konuma Nobuhiro Tsukada Junya Kanda Naoyuki Uchida Yuju Ohno Shigesaburo Miyakoshi Heiwa Kanamori Michihiro Hidaka Toru Sakura Makoto Onizuka Naoki Kobayashi Masashi Sawa Tetsuya Eto Yoshiko Matsuhashi Koji Kato Tatsuo Ichinohe Yoshiko Atsuta Koichi Miyamura Donor/Source Working Group of the Japan Society for Hematopoietic Cell Transplantation 《American journal of hematology》2016,91(5):E284-E292
Older recipient and donor age were associated with higher incidences of severe graft‐versus‐host disease (GVHD) and mortality after allogeneic hematopoietic stem cell transplantation from matched sibling donors (MSDs) and matched unrelated donors. Since a lower incidence of severe GVHD is advantageous in unrelated cord blood transplantation (CBT), a higher incidence of GVHD using older MSDs could be overcome using cord blood for older patients. We retrospectively analyzed Japanese registration data of 2,091 patients with acute myeloid leukemia, acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome aged 50 years or older who underwent MSD bone marrow transplantation (BMT) (n = 319), MSD peripheral blood stem cell transplantation (PBSCT) (n = 462), or unrelated CBT (n = 1,310) between 2007 and 2012. Median age of MSD was 56 (range, 38–74) years. Compared with CBT, the risk of developing extensive chronic GVHD was higher after BMT (hazard ratio [HR], 2.00; P = 0.001) or PBSCT (HR, 2.38; P < 0.001), and transplant‐related mortality was lower after BMT (HR, 0.61; P < 0.001) or PBSCT (HR, 0.63; P < 0.001). Relapse rates were not significant difference between three groups. Although overall mortality was lower after BMT (HR, 0.67; P < 0.001) or PBSCT (HR, 0.75; P = 0.002) compared with CBT, the rates of a composite endpoint of GVHD‐free, relapse‐free survival (GRFS) were not significant difference between three groups. These data showed that MSDs remain the best donor source for older patients, but CBT led to similar GRFS to BMT and PBSCT. Am. J. Hematol. 91:E284–E292, 2016. © 2016 Wiley Periodicals, Inc. 相似文献
13.
Serum levels of soluble CD30 in autologous peripheral blood stem cell transplantation 总被引:1,自引:0,他引:1
Nagahama M Nomura S Katsura K Ozaki Y Yoshimura C Kagawa H Fukuhara S 《Journal of cancer research and clinical oncology》2000,126(2):101-106
High-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT) has become an important method of treatment
for hematological and solid tumors. We examined levels of interleukin(IL)-4, interferon (IFN)γ, soluble (s) CD30, and sIL-2
receptor (R) before and after autologous PBSCT, and compared findings for PBSCT with those for bone marrow transplantation
(BMT). We found significantly higher IL-4 levels 1 and 3 weeks after PBSCT than before PBSCT, while IFNγ levels remained almost
unchanged after PBSCT. IFNγ levels were increased 3 weeks after BMT, although no increase in IL-4 level was observed. The
serum sCD30 level was significantly higher 3 weeks after PBSCT, but not following BMT. For 34 samples on days 0 and 21 from
17 patients undergoing PBSCT, a strong correlation was observed between sCD30 and sIL-2R levels (r = 0.43, P < 0.01). However, no significant correlation between sCD30 and sIL-2R levels was found for BMT patients. These findings suggest
that sCD30 is a useful marker for evaluating immunological activity following autologous PBSCT, and that the immunological
conditions after autologous PBSCT may be associated with helper-T-cell-2-type immune responses.
Received: 31 May 1999 / Accepted: 20 September 1999 相似文献
14.
Aims/hypothesis Raised N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with a poor cardiac outcome in non-diabetic populations.
Elevated NT-proBNP predicts excess morbidity and mortality in diabetic patients with an elevated urinary albumin excretion
rate. This study investigated the prognostic value of NT-proBNP in a cohort of type 2 diabetic patients.
Subjects, materials and methods In a prospective observational follow-up study, 315 type 2 diabetic patients with normoalbuminuria (n=188), microalbuminuria (n=80) and macroalbuminuria (n=47) at baseline were followed for a median (range) of 15.5 (0.2–17.0) years. Plasma NT-proBNP concentrations were determined
by immunoassay at baseline. Endpoints were overall and cardiovascular mortality.
Results Of the patients, 162 died (51%), 119 of them (74%) due to cardiovascular causes. All-cause mortality was increased in patients
with NT-proBNP in the second and third tertiles (hazard ratios [95% CI] compared with the first tertile, 1.70 [1.08–2.67]
and 5.19 [3.43–7.88], p<0.001). These associations persisted after adjustment for urinary albumin excretion rate, glomerular filtration rate and
conventional cardiovascular risk factors (covariate adjusted hazard ratios 1.46 [0.91–2.33] and 2.54 [1.56–4.14], p<0.001). This increased mortality was attributable to more cardiovascular deaths in the second and third NT-proBNP tertile
(unadjusted hazard ratios 1.63 [0.96–2.77] and 4.88 [3.01–7.91], p<0.001; covariate adjusted 1.37 [0.79–2.37] and 2.26 [1.27–4.02], p=0.01). When patients with normo-, micro- and macroalbuminuria were analysed separately, NT-proBNP levels above the median
(62 ng/l) were consistently associated with increased overall and cardiovascular mortality in all three groups (p<0.001).
Conclusions/interpretation In patients with type 2 diabetes, elevated circulating NT-proBNP is a strong predictor of the excess overall and cardiovascular
mortality, this predictor status being independent of urinary albumin excretion rate and conventional cardiovascular risk
factors. 相似文献
15.
Lee MY Chiou TJ Hsiao LT Yang MH Lin PC Poh SB Yen CC Liu JH Teng HW Chao TC Wang WS Chen PM 《Annals of hematology》2008,87(4):285-289
The use of monoclonal antibody, rituximab, had been reported to be associated with some severe viral infections. The inference
of rituximab therapy and post-transplant cytomegalovirus (CMV) infectious complications in non-Hodgkin’s lymphoma (NHL) patients
is still unclear now. From 2002 to 2005, 46 patients with relapsed indolent or high-risk aggressive B cell NHL who received
rituximab (17 patients) or not (29 patients) before autologous hematological stem cell transplantation (HSCT) in one institute
were retrospectively analyzed for the risk factors of CMV complications after transplantation. Pre-transplant and post-transplant
CMV infectious conditions, conditioning regimens, transplant types, and post-transplant complications were recorded. Post-transplant
infectious complications were followed up until 6 months after transplantation.Seventeen of 46 patients received rituximab
before HSCT. Three of them suffered from CMV infection and two of them developed CMV disease. All of the patients with CMV
disease recovered after ganciclovir and CMV-specific immunoglobulin therapy. Twenty-nine of 46 patients without rituximab
treatment before HSCT did not have CMV complications after HSCT. The risks to develop CMV infections after autologous HSCT
were higher in rituximab-treated patients (17.6% vs 0%, p = 0.045, Fisher exact test, two-sided). The risks to develop CMV diseases had higher trend with rituximab therapy than without
rituximab therapy (11.7% vs 0%, p = 0.131, Fisher exact test, two-sided). The NHL patients receiving rituximab therapy had higher risk to develop CMV infectious
complications after autologous HSCT. 相似文献
16.
This study evaluated the prognostic value of minimal residual disease (MRD) monitoring by four-color flow cytometry (FCM)
in patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
MRD was examined with four-color FCM at different time points in 139 patients (including pediatric and adult patients) with
ALL after allo-HSCT. Real-time quantitative polymerase chain reaction (RQ-PCR) was applied to evaluate the MRD of Philadelphia
chromosome-positive ALL (Ph+ ALL) patients. Patients who were FCM-positive (FCM+) after transplantation had a lower event-free
survival (EFS) of 0.54 and a higher cumulative incidence of relapse (CIR) of 0.54 compared to an EFS of 0.80 and a CIR of
0.08 in FCM-negative (FCM−) patients (EFS, p < 0.001; CIR, p < 0.001). Similar results were obtained in high-risk patients and Ph+ ALL patients. Moreover, a FCM+ status after the second
month post-HSCT (defined as MRD positive) proved to be a predictor of leukemia relapse. Multivariate analysis for EFS, OS
and CIR showed that MRD status after transplantation was an independent prognostic factor (p < 0.001, p = 0.013, and p < 0.001, respectively). A good correlation was found between the MRD results of FCM and RQ-PCR (n = 126 pairs, Spearman r = 0.8139, p < 0.001). MRD monitoring by four-color FCM post-transplantation is an important tool for relapse prediction in ALL patients.
Prompt and appropriate pre-emptive anti-leukemia treatment could be considered based on the status of MRD after HSCT. 相似文献
17.
Scholl S Sayer HG Mügge LO Kasper C Pietraszczyk M Kliche KO Clement JH Höffken K 《Journal of cancer research and clinical oncology》2004,130(12):704-710
Purpose Acute graft-versus-host disease (GvHD) is a constant and severe complication after allogeneic stem cell transplantation regularly involving skin, liver, gut, and lungs. The cytokine interleukin-18 (IL-18) has been shown to increase in patients who develop acute GvHD after bone marrow tranplantation (BMT).Materials and methods Here, we measured IL-18 serum levels after peripheral blood stem cell transplantation (PBSCT) at several characteristic time points in 24 patients (median age 46 years). Patients received a median of 7.3×106/kg bodyweight CD34-positive blood stem cells from HLA-matched family donors (n=5), matched unrelated donors (n=18), and one mismatched unrelated donor. GvHD prophylaxis consisted of cyclosporin A alone or combined with methotrexate and/or mycophenolate mofetil.Results In 14 patients we observed no GvHD or only GvHD grade I whereas ten patients developed GvHD grade II–IV post transplant. Low, intermediate, and high levels of serum IL-18 were found in patients after allogeneic PBSCT independently of GvHD after transplantation. In contrast to GvHD arising after BMT, there was no clear correlation between absolute IL-18 serum levels and GvHD grade after PBSCT. However, the individual time course of IL-18 serum level after engraftment correlates with acute GvHD after PBSCT. In detail, an increase of serum IL-18 of at least 1.6-fold after engraftment is associated with acute GvHD II or higher with a sensitivity of three out of four. Using the 1.6 cut-off for IL-18 increase after engraftment, a specificity of up to 100% can be achieved.Conclusion The time course of IL-18 serum levels might be used for GvHD prediction after PBSCT comparable to absolute serum levels after BMT.S. Scholl and H. G. Sayer contributed equally to this work. 相似文献
18.
R.?R.?Holman S.?Paul A.?Farmer L.?Tucker I.?M.?Stratton H.?A.?W.?Neil 《Diabetologia》2009,52(1):50-59
Aims/hypothesis The aim of the study was to examine the impact of statin or omega-3-acid ethyl esters 90 (omega-3 EE90; omega-3-acid ethyl
esters 90 refers to a mixture of ethyl esters of n-3 fatty acids) on estimated cardiovascular disease (CVD) risk in community-based people with type 2 diabetes but without
known CVD and not taking lipid-lowering therapy.
Methods A central computer randomised 800 patients in 59 UK general practices to atorvastatin (n = 401, 20 mg/day) or placebo (n = 399) and omega-3 EE90 (n = 397, 2 g/day) or placebo (n = 403) in a concealed factorial manner. Participants with LDL-cholesterol <2.6 mmol/l, triacylglycerol <1.5 mmol/l and estimated
10-year CVD risk <20% were compared at 4 months.
Results Mean (SD) age was 63.5 (11.7) years, HbA1c 6.9 (1.1) % and known diabetes duration (median [interquartile range]) was 4 (2–8) years. Fifty-seven per cent were men,
90% white and 74% had an estimated 10-year CVD risk ≥20%. Of 732 patients with 4-month data, more allocated atorvastatin (n = 371) compared with placebo (n = 361) achieved LDL-cholesterol <2.6 mmol/l (91% vs 24%, p < 0.001) and had estimated 10-year CVD risks <20% (38% vs 26%, p < 0.001). No differences were seen between those allocated omega-3 EE90 (n = 371) compared with placebo (n = 361) for participants achieving triacylglycerol <1.5 mmol/l (65% vs 60%, p = 0.18) or estimated 10-year CVD risks <20% (34% vs 30%, p = 0.18). There were no side effects of note.
Conclusions/interpretation Many community-based diabetic patients without known CVD remain at high CVD risk despite statin treatment and require additional
risk-reduction strategies. The impact of omega-3 EE90 on CVD risk will remain uncertain until clinical endpoint trial results
are available.
Trial registration: ISRCT no. 76737502
Funding: The study was funded by Pfizer.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users. 相似文献
19.
Keith Siau C. J. Laversuch P. Creamer K. P. O��Rourke 《Rheumatology international》2011,31(5):641-645
The pathophysiological relationship between scleroderma and malignancy remains poorly understood. Although some previous studies
have demonstrated an increased malignancy risk in patients with scleroderma, others have been inconclusive. We aimed to determine
if patients with scleroderma had an increased risk of malignancy compared to an age- and sex-matched local South West England
population, and if there were any important differences between scleroderma patients with and without malignancy. Methods
of this study are as follows. Notes were obtained on all local scleroderma patients (n = 68) locally, and those diagnosed with malignancy verified by contacting each patient’s general practitioner. Expected malignancy
figures were obtained from age- and sex-stratified regional prevalence data provided by the South West Cancer Intelligence
Service registry. Among the patients, 22.1% with scleroderma were identified with concurrent malignancy. Affected sites were
of the breast (n = 5), haematological system (n = 5), skin (n = 4), and unknown primary (n = 1). Overall, malignancy risk was found to be increased in scleroderma (RR = 3.15, 95% CI 1.77–5.20, p = 0.01). In particular, this risk was the highest for haematological malignancies (RR = 18.5, 95% CI 6–43, p = 0.03), especially for non-Hodgkin’s lymphoma (RR = 25.8, 95% CI 5–75, p = 0.10). The majority of patients (86.7%) developed malignancy after the onset of scleroderma (mean = 6.9 years). Age of
>70 and patients with limited scleroderma were significant risk factors for a patient with scleroderma to have a concurrent
malignancy; however, no increased risk was found in patients with any particular pattern of organ involvement, cytotoxic usage
or serology. To conclude, in this small patient cohort, we have found that scleroderma is associated with an increased risk
of malignancy. This risk is statistically significant in patients with limited scleroderma. Patients who are elderly and those
with limited disease should be closely scrutinized at follow-up appointments. 相似文献
20.
Kim J Konyalian V Huynh R Mittal R Stamos M Kumar R 《International journal of colorectal disease》2007,22(12):1493-1497
Background Blood transfusion is associated with higher postoperative complication. With the availability of autologous blood and erythropoietin,
it would be advantageous to identify patients who are at higher risk for requiring blood transfusion. Our aim is to identify
possible predictive factors for perioperative blood transfusion in patients undergoing colorectal resection. We examined 206
patients who underwent colorectal resections.
Materials and methods We analyzed factors including preoperative hematocrit, age, history of radiation, type of resection, operative blood loss,
additional surgical procedure, surgery duration, and comorbidity.
Results Forty-one patients (19.9%) received perioperative blood transfusion. Twenty patients (55.6%) with preoperative hematocrit
less than 30 received transfusion (p < 0.0001). Twenty-one patients (12.4%) with preoperative hematocrit greater than 30 received perioperative blood transfusion.
Thirty-three patients (17.9%) under 65 years received transfusion. Eight patients (36.4%) more than the age of 65 received
transfusion (p = 0.05). Ten patients (16.1%) without any comorbidity received transfusion, whereas ten patients (15.1%) with one comorbidity,
ten patients (22.2%) with two comorbidities, and 11 patients (33.3%) with greater than three comorbidities received blood
transfusion (p = 0.07). In the multivariate analysis, relative risk of perioperative blood transfusion was 3.63 for patients with preoperative
hematocrit less than 30 (p < 0.0001), 1.26 for patients more than the age of 65 (p = 0.49), and 1.07 for each comorbidity (p = 0.62). Patients with higher number of comorbidities and age greater than 65 tend to have lower preoperative hematocrit
than other patients.
Conclusion Hematocrit less than 30 is an independent risk factor for requiring perioperative blood transfusion, and patients with hematocrit
less than 30 should be considered for autologous blood transfusion and erythropoietin.
Presented at American Society of Colon and Rectum Surgeons Annual Meeting, Philadelphia, PA, May 3, 2005. 相似文献