Factors affecting PBSC mobilization and collection in healthy donors.

Peripheral blood stem cells are widely used as stem cell source for allografting. Progenitor cells can be effectively mobilized into peripheral blood in majority of healthy donors with a brief administration of G-CSF. A mobilization course in 111 donors (median age 40years) was retrospectively studied and the factors influencing the efficacy of mobilization were analyzed. The median number of CD34+ cells per kg recipient weight 5.1x10(6) was obtained after a median of two aphereses. The target cell dose (4.0x10(6)/kg) was reached in 69% of donors. Circulating CD34+ count and CD34+ yield were negatively associated with donor's age. Other independent factors associated with superior yield were precollection platelet and WBC counts. In multivariate analysis only CD34+ precount predicted for CD34+ yield. G-CSF had an acceptable short-term safety profile. Our data confirm that apheresis is a safe procedure in healthy including aged donors and suggest that older donors could be poorer mobilizers than younger.     

Factors influencing collection and engraftment of CD34+ cells in patients with breast cancer following high-dose chemotherapy and autologous peripheral blood progenitor cell transplantation

Although autologous PBPC transplantation is being used increasingly for the treatment of breast cancer, there are few data on factors influencing mobilization and engraftment in these patients. We have analyzed these factors in 70 patients with advanced or metastatic breast cancer undergoing autologous PBPC transplantation. All patients were mobilized after stimulation with G-CSF, and a median of 3.16 x 10(6)/kg CD34+ cells (range 0.75-23.33) were infused. All patients received conditioning with a combination of cyclophosphamide, thiotepa, and carboplatin, and postinfusion G-CSF was administered to 60 patients. The median times to reach 0.5 x 10(9)/L and 1 x 10(9)/L neutrophils were 10 and 11 days, respectively. The median times to obtain 20 x 10(9)/L and 50 x 10(9)/L platelets were 12 and 18 days, respectively. An analysis of factors that influence CD34+ cell collection was performed by linear regression. Previous radiation therapy and increasing age were associated with lower numbers of CD34+ cells collected. Those variables that could influence the tempo of engraftment were examined by multivariate analysis using Cox regression models. The number of CD34+ cells infused was found to influence both neutrophil and platelet recovery. The use of G-CSF after transplant, accelerated neutrophil recovery, and having more than six cycles of previous chemotherapy was an unfavorable factor for recovering >50 x 10(9)/L platelets.     

Automated immature reticulocyte counts are early markers of engraftment following autologous PBSC transplantation in patients with lymphoma

The traditional indicators of engraftment following PBSC transplantation (PBSCT) are the rising total WBC count and ANC. Reticulocytes may be an earlier indicator, since as reticulocytes mature, there is a gradual loss of cellular RNA, which can be measured using methylene blue and light scatter with an Abbott CD 3500 automated counter (Abbott Laboratories, Maidenhead, U.K.). Reticulocytes can be divided into three fluorescence ratios depending on the amount of light scatter generated, high, medium, and low. The most immature are the high fluorescence reticulocytes (HFR). Standard engraftment parameters together with HFR were measured in a homogeneous group of 25 patients with lymphoma after PBSCT using a standard conditioning protocol. An ANC of 0.5 x 10(9)/L was achieved after a median of 10 days (mean 11.2 days, range 9-22). The recovery of the HFR to 2% of the total reticulocytes was significantly shorter, with a median of 8 days (mean 7.5 days, range 6-10) (p < 0.0001). The values of HFR to 2% preceded the ANC of 0.5 x 10(9)/L in 24 of the 25 patients by a median of 3 days (mean 3.8 days, range 2-12 days). On this basis, it can be determined that in 96% of cases, engraftment was indicated earlier by HFR measurement. The HFR to 2% even preceded the ANC of 0.1 x 10(9)/L in 23 of the 25 patients, showing that engraftment was indicated earlier in 92% of patients. Immature reticulocytes appearing in peripheral blood can be reliably measured by automated cytometers, and HFR can, therefore, be used as an earlier indicator of engraftment following PBSCT. This information provides the opportunity for earlier cessation of antibiotics and growth factors and could lead to earlier discharge from hospital, with cost savings.     

Successful PBSC mobilization with high-dose G-CSF for patients failing a first round of mobilization.

PBSC are the preferred source of stem cells for autologous transplantation. However, regardless of the mobilization procedure used, 10%-20% of patients fail to collect an adequate number to ensure prompt engraftment. There is as yet no standard mobilization procedure for patients who fail a first mobilization attempt. Here, we describe a highly efficient strategy to obtain an adequate number of stem cells for patients who failed a first mobilization attempt. Seventy-four patients with various hematologic malignancies underwent initial mobilization with various regimens including hematopoietic growth factors with or without chemotherapy. In 72% of patients, > or =2 x 10(6) CD34+ stem cells/kg were collected in the initial mobilization attempt, and patients engrafted in a median of 10 days for neutrophils and 12 days for platelets. Eighteen patients failed to mobilize adequate numbers of stem cells, defined as the inability to collect 0.2 x 10(6) CD34+ stem cells/kg/day in the first 2-3 days. These patients had their apheresis halted. Patients were immediately given G-CSF (32 microg/kg/day) for 4 days as a second attempt at mobilization. Eighty-eight percent of these patients achieved the target of > or =2 x 10(6) CD34+ cells/kg, with a median duration of apheresis of 5 days (including the first and second mobilizations). The mean CD34+ cells/kg/day increased after administration of high-dose G-CSF from 0.16 after the first mobilization attempt to 0.61 (p = 0.0002) after the second mobilization. All patients engrafted in a median of 11 and 13 days for neutrophils and platelets, respectively. We conclude that patients whose apheresis yield is <0.4 x 10(6) CD34+ cells/kg after the first two apheresis collections can be successfully mobilized if high-dose G-CSF is administered immediately and continued until achieving > or =2 x 10(6) CD34+ stem cells/kg.     

乳腺癌化疗患者认知功能障碍发生状况及影响因素

目的探讨乳腺癌化疗患者后认知功能障碍发生状况及影响因素,为临床诊治提供依据。方法对300例乳腺癌化疗患者采用蒙特利尔认知评估量表评定认知功能,统计其临床资料,并采用单因素及多因素Logistic回归分析探讨患者认知功能障碍的影响因素。结果本组300例乳腺癌化疗患者,认知功能正常228例(76.0%),存在认知功能障碍72例(24.0%)。认知功能障碍患者年龄(≥60岁)、乳腺癌知识了解程度较差、家庭月收入(≤5000元)、运动情况(<3次·周-1)、无医疗保险、化疗时间(>3个周期)占比显著高于认知功能正常患者。Logistic回归分析显示,年龄(≥60岁)、乳腺癌知识了解程度较差、家庭月收入(≤5000元)、运动情况(<3次·周-1)、无医疗保险、化疗时间(>3个周期)是乳腺癌化疗患者发生认知功能障碍的危险因素(OR>1,P<0.05)。结论部分乳腺癌化疗患者存在认知功能障碍,其影响因素众多,应对其予以有针对性的干预,改善其认知功能。     

Factors influencing engraftment in autologous peripheral hematopoetic stem cell transplantation (PBSCT).

Autologous peripheral blood stem cells transplantation (PBSCT) is a therapeutic option which can be used in various hematological neoplastic disorders; and it can prolong disease free survival and total survival and at times it may be curative. In this study, we investigated variables influencing PBSCT in 91 patients who had undergone PBSCT between 1998 and 2002 in our center, retrospectively. PBSC collection was performed after mobilization with G-CSF or chemotherapy plus growth factor. Only high dose chemotherapy was used for conditioning regimes. The median number of CD34+ was 11.5 x 10(6)/kg. Posttransplant neutrophil engraftment (>500/microL) was requiring a median of 10 days, it was 13 days for platelet engraftment (>20,000/microL). For neutrophil and platelet engraftment, we investigated; sex, age, diagnosis and CD34+ cells, the time interval between diagnosis and transplantation, number of apheresis, conditioning regime, growth factor initiation day as independent variables. In univariate analysis CD34+ cell number (>10 x 10(6)/kg), time interval more than one year between diagnosis and transplantation and BEAM conditioning was found to be significant for neutrophil engraftment. But in multivariate analysis none of them was found to be significant. For platelet engraftment in univariate analysis CD34+ cell number (>7 x 10(6)/kg), primary diagnosis of multiple myeloma initiation day of growth factor (>2 day) was found to be significant. In multivariate analyses only CD34+ cell count was found to be significant (p=0.005). In conclusion, as in previous studies we found that the only predictor of engraftment kinetics was CD34+ cell count.     

Management of patients with metastatic breast cancer

Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.     

Efficacy of lower dose capecitabine in patients with metastatic breast cancer and factors influencing therapeutic response and outcome

OBJECTIVE: Capecitabine exerts considerable therapeutic efficacy in metastatic breast cancer (MBC) patients previously treated with anthracyclines and taxanes. MATERIALS AND METHODS: In this study, the efficacy and safety of lower dose capecitabine (2000 mg/m(2)/d) in patients with anthracycline- and taxane-pretreated MBC were studied with a special emphasis on the potential predictors of time to tumor progression (TTP) and response to the capecitabine treatment. RESULTS: The overall response rate (ORR) was 17%. The median TTP was 5 months. Among various factors analyzed, univariate analysis showed that a performance status (PS) of 2 and the presence of visceral metastases were inversely correlated with TTP. Multivariate analysis showed that a poor PS score was associated with impaired TTP. CONCLUSIONS: Our study indicates that lower dose capecitabine has substantial antitumor activity and a favorable safety profile in the treatment of anthracycline- and taxane-pretreated MBC. Also, only performance score was demonstrated to be a significant parameter affecting TTP.     

Treatment and care of patients with metastatic breast cancer

This article provides an overview of the treatment options available for patients diagnosed with metastatic breast cancer. The article focuses on the four common organ sites affected by metastatic breast cancer, including the bone, lungs, liver and brain. The implications for nursing care are addressed, highlighting common side effects of treatment and frequent areas of concern for patients.     

乳腺癌化疗病人应对方式及影响因素的研究

乳腺癌的发病率位居女性恶性肿瘤的首位[1],与西方国家相比,我国乳腺癌的发病率增长速度更快,发病年龄更年轻[2].罹患乳腺癌和接受化疗会给病人的生理和心理带来巨大影响,采用何种应对方式应对这一事件直接关系到病人的心理状况,并影响病人的生存质量.本研究旨在描述我国乳腺癌化疗病人应对方式的状况并识别其影响因素.     

乳腺癌化疗患者生命意义感现状及其影响因素分析

目的 了解化疗期乳腺癌患者生命意义感现状,并分析其影响因素.方法 采用便利抽样方法,选取在本院住院治疗的185例乳腺癌化疗患者为调查对象,采用一般资料调查表、生命意义感量表(得分范围9～36分)、家庭功能指数评分问卷(得分范围0～100分)及创伤后成长评定量表(得分范围0～100分)对患者进行横断面调查.采用多重线性回...     

影响肝移植术后病人舒适度的因素及护理

通过对6例肝移植术后病人的临床观察,根据病人的主诉,采用问卷调查分析,总结出影响肝移植术后病人舒适度的因素是焦虑、恐惧,术后留置气管插管,体位不适,缺乏休息,伤口疼痛,留置胃管、尿管、腹腔引流管,T型管等。制定相应的护理措施：(1)给予病人全身心护理;(2)做好病人留置气管捕管前的解释工作及插管期间的护理;(3)创造舒适的环境,保证病人休息;(4)保持舒适体位,预防褥疮;(5)做好疼痛的护理,减轻病人心理的负面影响;(6)做好留置尿管、腹腔引流管、胃肠减压管、T型管的护理。使病人积极配合治疗,安全,舒适地度过围手术期,加快病人康复。     

乳腺癌术后化疗病人心理弹性水平及其影响因素调查

[目的]调查乳腺癌术后化疗病人心理弹性水平并分析其影响因素。[方法]采用中文版Connor-Davidson心理弹性量表和一般情况调查表对南京市某三级甲等医院133例乳腺癌术后化疗病人进行问卷调查并分析其影响因素。[结果]乳腺癌术后化疗病人心理弹性得分为(61.86±11.84)分,其中坚韧性维度得分为(3 0.3 8±6.78)分,自强维度得分为(20.14±4.63)分,乐观维度得分为(10.35±2.42)分;化疗疗程、家庭月收入、肿瘤分期是心理弹性水平的预测因子。[结论]乳腺癌术后化疗病人心理弹性水平较低,临床护理中应该重视病人的心理弹性水平,尤其是术后化疗初期、经济状况差、肿瘤分期较高的病人。