Autologous hematopoietic stem cell transplantation in multiple myeloma and lymphoma: an analysis of factors influencing stem cell collection and hematological recovery

Autologous stem cell transplantation is standard treatment for newly diagnosed younger patients with multiple myeloma and for relapsed or refractory Hodgkin or non-Hodgkin lymphoma. Patient characteristics influencing the yield from stem cell collection and time from transplant to platelet recovery were retrospectively analyzed in 630 consecutive patients, attempting to define adequate amounts of CD34+ cells to collect and reinfuse; 509/630 patients (81%) mobilized the requested CD34+ cell number. Factors influencing the harvest yield were age (P < 0.001) and gender, where 85% of men and 78% of women (P < 0.02) attained the requested stem cell amount. Time to platelet recovery was significantly faster for multiple myeloma patients compared to all other diagnoses (14.6 days compared to 19.8, P < 0.0001). Multiple myeloma patients were older than lymphoma patients but received stem cell transplant up-front as opposed to second line therapy for other patient groups. Multivariate analysis revealed that the most important factor influencing platelet recovery was diagnosis, followed by the amount of reinfused CD34+ cells (P < 0.001, P < 0.05). Blood group O+ had the fastest platelet recovery, whereas blood group A harvested the highest cell amounts. In conclusion, we demonstrate a significant importance of the number of reinfused CD34+ cells on the time to platelet recovery.     

Tools to assess the nutritional status of acutely ill older adults

Nurses are responsible for identifying patients who are malnourished or at risk of malnutrition. They are also expected to follow-up patients' nutritional status and to initiate preventive and caring interventions. The aim of this Swedish study was to explore whether simple assessment tools used during hospital admission could identify older adults at risk of malnutrition.     

Effects of nitric oxide on human spermatozoa activity, fertilization and mouse embryonic development

This study was conducted to investigate the effects of nitric oxide (NO) on human sperm activity, human sperm-oocyte fusion and mouse embryonic development. Results showed that various concentrations of NO synthase blocker, N(omega)-nitro-L-arginine methyl ester, did not affect sperm cell motility at 0, 1, 2 or 4 hr, respectively. In contrast, sodium nitroprusside (SNP) significantly inhibited sperm cell motility and caused apoptosis. The adversely dose-dependent effect was only observed if SNP was freshly prepared. Adenosine triphosphate reversed the hazardous effect of SNP on sperm activity/viability. Hemoglobin neutralized the adverse effect of SNP. In hemi-zona sperm fusion test, the number of sperm bound to the zona in the presence of 10(-4) M SNP was significantly less than the control group. SNP at 10(-4) M caused all mouse embryonic development arrest. 46% and 56% of zygote reached the blastocyst stage with the treatment of 10(-6) M and 10(-8) M SNP, respectively, while the control reached 70%. NO adversely affected human sperm activity, human sperm-zona binding and embryonic development. It would appear that high concentration of NO may potentially decrease fertility.     

Influence of acetazolamide on AQP1 gene expression in testis and on sperm count/motility in epididymis of rats

Acetazolamide (Ace) is a putative inhibitor of carbonic anhydrase (CA), an enzyme that catalyzes the equilibration of carbon dioxide and carbonic acid and plays a key role in HCO(3)(-) and water reabsorption and acid secretion. Aquaporins (AQPs) are channel-forming membrane glycoproteins that mediate water reabsorption by the renal tubules and other organs of mammals. AQP1 and CAII or CAIV share many common biological properties. Previous studies have shown that AQP1 and CA are located at the same sites in cells of the male reproductive tract. In the present study, Ace at a dose of 40 mg/kg/d x 14, administered per os, suppressed AQP1 gene expression and inhibited CA activity in rat testis. On day 7 of treatment the epididymal sperm motility was significantly reduced, while on day 14 a decrease in sperm count occurred. Ace caused a marked downregulation of AQP1 gene expression; significant suppression occurred on days 7 and 14. Moreover, CA activity was totally blocked throughout the treatment period. The present findings suggest that the reduction of rat sperm motility and count by Ace can be attributed to its capacity to downregulate AQP1 water channel gene expression.     

Comparison of terbutaline Turbuhaler and albuterol chlorofluorocarbon (CFC) inhaler in middle-aged and elderly patients with obstructive lung disease.

The aim of the present study was to compare the effect of terbutaline Turbuhaler (0.5 mg qid) with that of albuterol chlorofluorocarbon (CFC) inhaler (0.2 mg qid) in middle-aged and elderly patients with obstructive lung disease. The study was performed as an open cross-over (2 x 2 weeks) and randomized study in 85 patients. A significant increase in PEF was seen after inhalation from both devices (P less than .001). Baseline PEF values before inhalation were higher with Turbuhaler than with the CFC inhaler both in the mornings and in the evenings. Fifty-six percent of the patients preferred terbutaline Turbuhaler and 26% albuterol CFC inhaler (P = .004).     

Treatment costs and survival in patients with grades III-IV acute graft-versus-host disease after allogenic hematopoietic stem cell transplantation during three decades

To determine development of treatment, costs, and survival for patients with grades III/IV acute graft-versus-host disease (GVHD), data from 88 patients with grades III/IV acute GVHD were collected. The patients were divided into three groups: patients who received transplants from 1977 through 1989 (group A), 1990 through 1999 (group B), and 2000 through 2004 (group C). The costs for treatment, enumerated to year 2003 costs, were calculated. An increased 1-year survival rate was found in group C, at 21% versus 9% and 8% for groups A and B, respectively (P=0.02). Death by acute GVHD was increased by repeat transplantation (P<0.001), grade IV acute GVHD (P<0.001), human leukocyte antigen mismatch (P=0.009), and transplantation before 2000 (P=0.015). Transplantation after 1990 (P=0.003) and grade IV acute GVHD (P=0.03) were associated with higher treatment costs. It was found that the time the patients had GVHD did not differ among the three groups. In conclusion, the costs and survival rates associated with severe acute GVHD has increased in recent years.     

Costs of allogeneic hematopoietic stem cell transplantation

BACKGROUND: This study aims to determine the total costs after allogeneic hematopoietic stem cell transplantation (ASCT) and factors associated with increases or decreases in costs. METHODS: We collected all in- and outpatient costs during 5 years in 93 patients who had undergone ASCT in 1998 and 1999 at our unit. The inpatient costs included all those related to a patient from the first day of admission until discharge and then all costs of readmission in the Stockholm area. RESULTS: The total median cost of five posttransplant years was 139,414 (52,095-345,640) euros (euros) or 167,296 US dollars (the rate of 1 euro is approximately 1.2 US dollars). The costs were highest during the first year-median inpatient and outpatient costs 100,650 euros and 13,066 euros, respectively. The total costs during the first year were higher in patients with acute graft-versus-host disease grades III-IV (relative hazards [RH] 1.35, P = 0.003), bacteremia (RH 1.33, P = 0.005), veno-occlusive disease of the liver (RH 1.32, P = 0.005), prophylaxis with granulocyte colony-stimulating factor (G-CSF; RH 1.31, P = 0.01), acute leukemia (RH 1.32, P = 0.008), and treatment in hospital instead of at home (RH 1.20, P < 0.07). During the early transplant period, a second transplantation (RH 1.28, P = 0.014) and hemorrhagic cystitis (HC; RH 1.24, P = 0.03) were also associated with higher costs. The total 5-year cost declined with longer survival rates (r = 0.4028, P < 0.001) and reduced intensity conditioning (RH 0.79, P=0.024). CONCLUSION: Higher costs of ASCT were associated with retransplantation, acute leukemia, G-CSF prophylaxis, hospital care, myeloablative conditioning, and major transplant-related complications.     

Angiography and scintigraphy of human pancreatic allografts.

Serial graft angiographies and scintigraphies were obtained in 4 human pancreatic allograft recipients. Important information was obtained both of graft morphology and function. Graft rejection was accompanied by characteristic abnormalities, including arterial irregularities and prolonged contrast medium passage time. On scintigraphy, rejection was associated with reduced isotope uptake.