High-Dose Methotrexate Seems to Benefit Only to Standard-Risk BCP-ALL Patients with Good Early Response to Chemotherapy: Final Analysis of the FRALLE93B Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 10-10
Author(s):  
Thierry Leblanc ◽  
Judith Landman-Parker ◽  
Marie-Françoise Auclerc ◽  
Krystell Desseaux ◽  
Christiane Vermylen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Final Analysis ◽  
Early Response ◽  
P Value ◽  
High Dose ◽  
Response To Chemotherapy ◽  
Group A ◽  
Group B ◽  
Standard Risk

Abstract From 06/93 to 12/99, 1395 children and adolescents were included in the FRALLE 93 protocol: group A (Very Low Risk): 182, B (Standard risk): 672 and C (High risk including T-ALL): 541. The median FU is 9.5 yr. Inclusion criterias in group B were: age between 1 and 15 yr, WBC< 100,000, BCP phenotype and no poor-prognosis cytogenetic feature (MLL rearrangement or Ph1). Group B pts were randomised in a 2-steps schedule: at inclusion: daunorubicin (DNR: 40 mg/m2 × 2) vs idarubicin (IDA: 8 mg/m2 × 2), and at consolidation: high-dose IV methotrexate (HD-MTX): 4 × 8g/m2 at D1, D15, D29 and D42, vs low-dose po MTX (LD-MTX): 4 × 25 mg/m2; the number of triple IT was the same for both arms (N = 18). Pts with CNS leukemia were not randomized for MTX. During induction, pts were also classified on D21 bone marrow aspiration according to the level of residual blasts: M1 (< 5%): n=555, M2 (6–25%): n=71 and M3 (> 25%): n=41; M2/M3 pts received 1 more antracyclin infusion at D22 and M3 pts were subsequently treated according to the HR group and not randomized for MTX. Both M1 and M2 pts who reached CR were randomized for MTX. The overall group B EFS, DFS and OS were respectively 80±2, 81±2, and 91±1%. Globally there is no statistically significant impact of 1st or 2nd randomization on the outcome of patients. When we look at the outcome according to the D21 status, the EFS are very different: M1: 84±2%, M2: 63±6% and M3: 74±7%. The very poor EFS of M2 pts, who can not actually be classified as SR pts, and the fact that M1 pts represent 90% of pts randomized for MTX led us to analyse separately M1 pts. For M1 pts there is no interaction between 1st and 2nd randomization for survival, EFS and relapse rate (Gail and Simon test, p = 0.51); therefore pts were pooled for 2nd randomization analysis. Among M1 pts, 271 pts were randomized for HD-MTX and 264 for LD-MTX; there is no difference regarding age or leucocytosis between the 2 arms. Results are as follows: 5-yr EFS Relapses CI iBM relapses CI Other relapses CI 5-yr OS (EFS: event-free survival, CI: cumulative incidence, iBM: isolated bone-marrow, OS: overall survival) HD-MTX 87.82±1.99% 0.12±0.04 7.01±0.02 5.17±0.02 95.20±1.30 LD-MTX 79.92±2.47% 0.20±0.06 10.6±0.03 9.10±0.03 88.64±1.95 Test log-rank Gray Gray Gray log-rank p value 0.028 0.037 0.16 0.18 0.07 At the contrary, among M2 pts there is no difference in EFS for pts treated with HD-MTX (61±7%) and LD-MTX (65±9%) Conclusion: HD-MTX seems to benefit to pts with standard-risk BCP-ALL and good early response to chemotherapy, and the benefit is associated with a reduction in the number of relapses. No benefit is demonstrated in M2 pts with SER who have a very poor outcome and do require a more intensive treatment; the better EFS of M3 patients treated with double delayed intensification is in favour of this hypothesis.

CONVENTIONAL VERSUS THREE-DIMENSIONAL CONFORMAL EXTERNAL RADIOTHERAPY IN CANCER CERVIX: A COMPARATIVE STUDY FOR COMPLIANCE, RESPONSE AND TOXICITY

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Richa Gupta ◽  
Piyush Kumar ◽  
D. P. Singh ◽  
Arvind Kumar Chauhan ◽  
Kamal Sahni
Keyword(s):  
Clinical Response ◽  
Three Dimensional ◽  
Common Side Effect ◽  
P Value ◽  
High Dose ◽  
Cancer Cervix ◽  
Conventional Radiotherapy ◽  
Radiation Fields ◽  
Group A ◽  
Group B

INTRODUCTION: Cervical cancer is the second most frequent cancer among Indian women. Radiotherapy is the cornerstone of treatment in all its stages. Three-dimensional conformal radiotherapy (3DCRT) combines multiple radiation fields to deliver precise dose of radiation to the affected area. Tailoring each of the radiation fields to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue. The present study is done to compare conventional radiotherapy versus 3DCRT in cancer cervix for compliance, clinical response and toxicity. MATERIAL AND METHODS: Fifty patients were enrolled and randomised into two radiotherapy plans with radical intent - Group A treated by conventional radiotherapy and group B treated by 3DCRT. Concurrent cisplatin was delivered on weekly (35mg/m2) or tri-weekly (75mg/m2) basis during external beam Radiotherapy and was followed by High Dose Radiotherapy Brachytherapy. Clinical response and complication assessment were evaluated.Collected data was analyzed using standard statistical methods and softwares to calculate level of significance using “p” value by chi square test. RESULTS: In this study mean age of the patients was 48 years (26-67 years). The anemia was the most common side effect seen in both groups (96% vs 88%, p=0.29). Neutropenia was more in group B (36% vs 44%, p= 0.56). Lower GI toxicity was seen only in patients in group A (20% vs 0%, p=0.018). In follow up there were no significant early rectal and bladder reactions in both groups and 2 patients in each group had late rectal reactions of grade I and II (p= 0.312). No significant skin, bladder and small intestinal toxicity were seen in both groups. CONCLUSION: Conventional radiotherapy gives equally efficacious response though accompanied by toxicities which were acceptable.

Evaluation of the changes in Tei-index (myocardial performance index) in Doppler echocardiography before and after treating with anthracycline combinations in children with malignancy

2021 ◽  
Author(s):  
Majid Naderi ◽  
Maryam Judi ◽  
Maryam Yazdanparast ◽  
Sima SavadKuhi ◽  
Saeedeh Yaghoubi
Keyword(s):  
Performance Index ◽  
Myocardial Performance Index ◽  
P Value ◽  
High Dose ◽  
Healthy Children ◽  
Myocardial Performance ◽  
Tei Index ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Cardiomyopathy usually causes a cardiac dysfunction resistant to treatment due to anthracycline. This study aimed to evaluate the changes in Tei-Index (myocardial performance index) in patients with malignancies treated with anthracycline. Material and Methods: This case-control study was done on 15 children who were treated with low-dose anthracycline (1-199mg/kg) called group A and 15 children who were treated with high dose (>200mg/kg) anthracycline called group B after acquiring consent from their parents. Children with no abnormality in Echo-Doppler results were included in this study. The patients’ age range between 1- 17 years with a mean age of 6.57 years. Another group of healthy children were assigned to group C as a control group who had not received chemotherapy. The first echo was performed right before the treatment and the second one, two weeks after completing chemotherapy.  Data were analyzed by the SPSS statistical software. Results: Changes in mean Tei-index in group A were 0.36 ± 0.04 before treatment and 0.43 ± 0.11 after treatment. Changes in mean Tei-index in group B were 0.37 ± 0.04 before treatment and 0.45 ± 0.06 after treatment. There was no significant difference between the two groups using the independent T-test. (p-value= 0.57). No significant correlation between the changes in mean ejection fraction (EF) and treatment was found in the three groups (p-value=0.45). Conclusion: This study showed a change in the Tei-index (MPI) in patients receiving anthracycline; regardless of the dosage, they got in their regimen. Given the use of anthracycline, any abnormal cardiac finding can alert the physicians to the possibility of cardiomyopathy, hence scheduling routine follow-ups are necessary.

Treatment Outcome of Discontinued L-Asparaginase in Children with Standard-Risk Acute Lymphoblastic Leukemia: Tokyo Children’s Cancer Study Group (TCCSG) Study L99-15.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 878-878 ◽  
Author(s):  
Chitose Ogawa ◽  
Akira Ohara ◽  
Atsushi Manabe ◽  
Ryoji Hanada ◽  
Hiroyuki Takahashi ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Risk Groups ◽  
High Risk Group ◽  
P Value ◽  
Group A ◽  
Group B ◽  
Standard Risk

Abstract BACKGROUND: L-asparaginase (L-asp) is one of the key drugs in the treatment of acute lymphoblastic leukemia (ALL) in children. However, L-asp often produces severe adverse effects including anaphylaxis resulting in its discontinuation. OBJECTIVE: To evaluate retrospectively the outcome of discontinuation of L-asp in patients with ALL. PATIENTS AND METHODS: Children newly diagnosed as ALL between 1999 and 2003 were consecutively enrolled on the TCCSG L99-15 study. Risk stratification was based on the age, initial white blood cell count, immunophenotype, cytogenetics and the response to prednisolone monotherapy. Totally, 267 (35%) out of 770 children were categorized into a standard-risk group (SR), 317 (41%) into a high-risk group (HR) and 186 (24%) into a very high-risk group (HEX). Allogeneic stem cell transplantation was indicated approximately in 50% of the HEX patients. L-asp was used 9 times in the induction phase in all the risk groups. The total number of L-asp administration all through the treatment was 19 in SR, 20 in HR and at least 10 in HEX. Patients were divided into two groups in the analysis: group A patients who received at least 50% of scheduled doses of L-asp and group B patients who received less than 50%. RESULTS: Remission was obtained in 259 (97%) patients in SR, 311 (98%) in HR and 171(92%) in HEX. In the patients who achieved remission and were analyzed, 195 (83.7%) in SR, 223 (78.8%) in HR and 123 (83.7%) in HEX received all the scheduled doses of L-asp. Event-free survival (EFS) (SE) and overall survival (OS) (SE) at 5 years for all the risk groups are shown in the table. Notably, EFS in group A (92.9%) and in group B (74.1%) in SR was significantly different (p=0.025). CONCLUSION: The outcome in patients who received less than 50% of scheduled dose of L-asp was inferior to that in the patients who received more than 50% of the scheduled dose. This suggests that modification or intensification of the treatment should be considered for the patients who discontinued L-asp in SR. EFS and OS in each group Risk group EFS ± SE(%) OS ± SE(%) (No. in A /B) group A group B p value group A group B p value SR (223 /10) 92.9±2.4 74.1±16.1 0.025 97.8±1.1 88.9±10.5 0.066 HR (269 /14) 78.5±3.2 66.7±19.2 0.969 88.9±2.6 50.0±25.0 0.158 HEX (142 /5) 58.2±5.5 75.5±21.7 0.514 75.6±4.3 80.0±17.9 0.873

A Useful Flow Cytometry Panel To Exclude Myelodysplastic Syndrome.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4848-4848
Author(s):  
Ling Zhang ◽  
Jean R. Lopatequi ◽  
Sharron E. Kelly ◽  
Tobi Neer ◽  
Stephen Lee
Keyword(s):  
Bone Marrow ◽  
Flow Cytometry ◽  
Test Group ◽  
Bone Marrow Examination ◽  
Normal Group ◽  
P Value ◽  
Aberrant Expression ◽  
Cd10 Expression ◽  
Group A ◽  
Group B

Abstract Background: Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders, which can be difficult to diagnose based only on morphologic bone marrow examination. Karyotyping can be useful in diagnosing borderline cases. However, only 40% of patients with MDS have an abnormal karyotype. Flow cytometry(FCM) approaches have been described but not clearly defined in MDS due to use of different criteria. We devised a 10-parameter FCM panel, mainly including myeloid and erythroid maturation markers, to differentiate MDS marrows from normal marrows. Design: Bone marrow from 91 patients with cytopenia(s) or anemia were included in the study(10/2005–7/2006). Cases were divided into 3 groups: normal, not morphologically suspicious for MDS, 46 cases, equivocal, morphologically suggestive but not diagnostic of MDS, 20 cases, morphologically diagnostic of MDS, 25 cases. 10 FCM paremeters were performed and scored: hypogranularity,aberrant expression of CD56,lack of CD10 expression,decreased CD64 expression,&lack of CD13 or CD33 expression,&abnormal CD13/CD16 or CD16/CD11b pattern,increase of CD 34 expression gating on all cells excluding erythrocytes,decreased expression of CD71/Glycophorin gating on erythroid precursors. Karyotypings were analyzed. Results: and (see Table 1 and 2). Karyotyping were anlayzed in 86 cases. Cytogenetic abnormalities were found in 2.2% (1/44) of normal group, 5.3% (1/19) of equivocal group and 34.8% (8/43) of MDS group. In MDS group 7 of 8 patients (87.5%) who had both morphologic and cytogenetic diagnosis of MDS were scored >=3 of 8 FCM parameters. Conclusions: Study showed the 8-parameter FCM panel was more predictive of MDS than 10-parameters one. Both CD13/CD16 & CD16/CD11b patterns were considered to be non-specific. In 8-parameter panel, zero score tended to rule out MDS, while score >=3 suggested MDS. The most specific FCM parameters were hypogranularity, CD34, aberrant expression of CD56 or lack of CD10 expression by mature granulocytes. CD71/Glycophorin A might be useful in identifying dysplasia in erythroid lineage. Table 1. Comparison of FCM Parameters in Patients with/without MDS Parameters/Group Normal Group(A)(n=46) Equivocal Group(B)(n=20) MDS Group(C)(n=25) CHITEST(P value)(GRoup A vs C) * These two parameters were deleted in the 8-parameter panel due to their high frequency seen in normal group. Hypogranularity 4 (8.7%) 6 (30%) 18 (72%) 0.0001 CD56 0 (0.0%) 1 (5%) 6 (24%) 0.0005 CD10 7 (15.2%) 7 (35%) 15 (60%) 0.0001 CD64 6 (13.1%) 2 (10%) 6 (24%) 0.2396 CD13 0 (0.0%) 0 (0.0%) 2 (8.0%) 0.0516 CD33 0 (0.0%) 2 (10 %) 0 (0%) 0 CD13/CD16* 23 (50.0%) 7 (35%) 21 (84%) 0.0047 CD34 8 (17.4%) 7 (35%) 13 (52%) 0.0026 CD71 2 (4.3%) 5 (25%) 12 (48%) 0.0001 CD16/CD11b* 27 (58.7%) 8 (40%) 22 (88%) 0.0107 Table 2. Scoring with 8 FCM Parameters in Patients with/without MDS Score/Group Normal Group (A)* (n=46) Equivocal Group (B)* (n=20) MDS Group (C)* (n=25) * Fish Exact T Test: Group A vs C: p<0.0001, A vs B: p=0.0006, B vs C: p=<0.0001 Score=0 21 (45.7%) 3 (15%) 0 (0.0%) Score=1–2 25 (543 %) 14 (70%) 8 (32 %) Score>3 0 (0.0%) 3 (15%) 17 (68%) *Mean score +/− SD 0.65+/−1.06 1.55+/−1.54 2.8+/−1.65

scholarly journals Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Rashida Parveen ◽  
Mehnaz Khakwani ◽  
Sobia Tabassum ◽  
Sajjad Masood
Keyword(s):  
Controlled Trial ◽  
Final Analysis ◽  
Study Groups ◽  
P Value ◽  
Creative Commons ◽  
Threatened Miscarriage ◽  
Vaginal Progesterone ◽  
Group A ◽  
Group B ◽  
Micronized Progesterone

Objectives: This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage. Methods: This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation. Results: In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164). Conclusion: The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage. doi: https://doi.org/10.12669/pjms.37.3.3700 How to cite this:Parveen R, Khakwani M, Tabassum S, Masood S. Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3700 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Rituximab Given after High Dose Therapy and Autologous Stem Cell Transplantation Induces Durable Clearance of Minimal Residual Disease in about Half of the Patients with Follicular Non Hodgkin’s Lymphoma : 36 Months Results of a Multicenter Open Label Phase II Trial (M39012 Trial).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 747-747 ◽  
Author(s):  
Franck Morschhauser ◽  
Christian Recher ◽  
Noel Milpied ◽  
Remi Gressin ◽  
Gilles Salles ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Residual Disease ◽  
Post Treatment ◽  
High Dose ◽  
Molecular Response ◽  
High Dose Therapy ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Minimal Residual

Abstract In patients with follicular non hodgkin’s lymphoma (FL), high dose therapy and autologous stem cell transplantation (ASCT) can improve disease free survival. However, patients with minimal residual disease (MRD) after ASCT relapse in most cases. The use of immunotherapy in patient with a MRD state after ASCT is an attractive strategy. Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy alone or in combination with chemotherapy in FLNH. The purpose of the present study is to evaluate the efficacy of rituximab on MRD after ASCT. Methods : Three months after ASCT, 39 patients (median age: 48 years) including 14 patients with clinical MRD (group A: nodal or extra-nodal mass > 1 cm but < to 3 cm; bone marrow infiltration less than 30% allowed) and 25 patients with molecular MRD (group B: complete clinical response but bcl-2 gene rearrangement detectable by clonospecific PCR in blood and/or marrow) were eligible to receive Rituximab (375 mg/m2 IV, once a week for 4 weeks). Clinical examination, imaging and blood and bone marrow sampling for centralized molecular MRD studies by clonospecific PCR (sensitivity of the PCR assay : 10-6) were performed at day 50 and every 6 months post treatment. Results: In group A, overall clinical response rate was 36 % (5/14) at day 50 and 71 % (10/14) at 12, 24 and 36 months post treatment, respectively. Median time to response was 183 days. Median Progression free survival (PFS) was not reached and PFS was 62 % at M36. In responders, no relapse was observed. In group B, molecular response (conversion from PCR positive to PCR negative status) was achieved in 12/23 (52 %), 11/22 (50 %), 10/22 (45 %) and 11/24 (46 %) assessable patients at day 50, 12, 24 and 36 months post treatment, respectively. Median time to response was 185 days. Four molecular responders became persistently PCR positive and had a clinical relapse. Median clinical PFS was not reached. Treatment was well tolerated. Only one serious adverse event (AE) was reported as related during the study (grade 3 NCI granulocytopenia). No patient was withdrawn for AE. Conclusion: Rituximab is effective in 71 % of the patients with clinical MRD after ASCT with a response maintained at 3 years. The molecular response induced by rituximab persisted after 3 years of follow-up in 46 % of the patients. These results demonstrate that in FL patients with MRD after ASCT, Rituximab is well tolerated and effective completing the effect of intensive chemotherapy and inducing durable response. Further studies are required to identify the most effective program in combination with rituximab which may result in a chance of cure.

12-Year Experience with High-Dose Rituximab-Containing Autologous Stem Cell Transplantation for SOX11-Positive Mantle Cell Lymphoma Patients in First Remission: Emerging Lymphoma-Free Survival Plateau After 3 Years,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4138-4138
Author(s):  
Zaher I Chakhachiro ◽  
Rima M Saliba ◽  
Grace-Julia Okoroji ◽  
Martin Korbling ◽  
Amin M Alousi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Lymph Node ◽  
Cell Lymphoma ◽  
High Dose ◽  
Ki 67 ◽  
Free Survival ◽  
Mantle Cell ◽  
Group A ◽  
Group B

Abstract Abstract 4138 Background: The addition of high-dose rituximab to conditioning regimens has been shown to improve outcomes of autologous stem cell transplantation (ASCT) for mantle cell lymphoma (MCL) patients (pts) in first partial (PR) or complete remission (CR)(Tam C et al. Blood 2009,113:4144). It has been suggested that absence of SOX11 expression can identify a subtype of indolent MCL with excellent outcomes that might be managed more conservatively than conventional MCL. We now report updated results of ASCT for 40 MCL pts treated at our center between 05/99 and 10/10. We also report on SOX-11 expression in a subset of these pts. Methods and Patients: Pts had a median age of 54 years (range, 38–72), and 30% were older than 60 years. At diagnosis, 60% had IPI>1, 30% had intermediate/high MIPI, 88% had stage IV disease, and 78% had bone marrow involvement. 28% had blastic features and Ki-67 was ≥30% in 11/23 (52%) pts who were tested. Pts were treated with R-CHOP or R-hyper-CVAD × 4 cycles induction in 30% and 45% respectively (Group A). Since 2001, pts were referred to ASCT only if they failed to achieve CR with >4 cycles of R-hyper-CVAD induction (n= 10, 25%) (Group B). Prior to transplant, CR (or CR unconfirmed-CRu) was present in 62% pts; 38% were in PR, and 18% were PET+. Conditioning was R-BEAM and R-Cy-TBI conditioning in 77% and 23% respectively. Pts received R during stem cell collection with R administered at 375 mg/m2 on the day before initiating chemotherapy for stem cell mobilization, and again at 1000 mg/m2, 7 days later. Pts then received additional R at 1000 mg/m2 on days +1 and +8 after ASCT, as previously described. Pts were staged with CT, PET (whenever indicated) scans, bone marrow biopsy, and colonoscopy (if history of GI involvement) every 3 months for the first year, every 6 months for 5 years, then yearly thereafter. Results: a. SOX11: Formalin-fixed, paraffin-embedded tissue biopsy sections were assessed by immunohistochemistry (IHC) using anti-Sox-11 rabbit polyclonal antibody (Abcam, Cambridge, MA; 1:1500). For IHC controls we used a tissue microarray including 13 cases of MCL in addition to one complete section of MCL serving as positive controls, and sections from two cases of small lymphocytic lymphoma involving lymph node serving as negative controls. The 11 cases consisted of five GI biopsies, three lymph node biopsies, two bone marrows and one testis. 10/11 showed positive staining for SOX11. The case with negative staining, a GI biopsy, had scattered positive cells. b. Clinical outcome : Following transplantation, CR/CRu was achieved in 100% pts. With a median follow-up of 37 months (range, 6–145), 10 pts experienced recurrent disease. All progressions occurred within 3 years, with a clear plateau emerging subsequently (Figure). The projected lymphoma-free-survival at 10-year, was 65% (95%CI, 44–80). A tendency for a higher risk of relapse was observed in R-hyper-CVAD resistant pts (Group B) pts [4/10 pts (40%) vs 6/30 (20%) in Group A; HR 2.5 (95%CI, 0.7–9.2), p=0.2)], and in pts with ki-67 ≥30% [HR 2.2 (95%CI, 0.4–11), p=0.3). MIPI, blastic histology, age (> 60 years), disease status at transplant (CR/PR) and conditioning were not found to be of prognostic value in our study. 2 pts (5%) developed myelodysplasia, one of which was concurrent with progression. Conclusions: ASCT with high-dose rituximab has the potential to cure a proportion of pts with MCL after response to induction chemotherapy. Our results are favorable despite the inclusion of pts who were resistant to R-hyper-CVAD. Randomized studies comparing this strategy to conventional chemo-immunotherapy are warranted. The prognostic significance of Ki-67 level needs to be assessed in a larger cohort of patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Efficacy of growth hormone in improving the pregnancy rate in poor responders in ART

2017 ◽  
Vol 6 (7) ◽  
pp. 2883
Author(s):  
Nisha E. ◽  
Sunitha H. B. ◽  
Vidya V. Bhat ◽  
K. M. Guddy
Keyword(s):  
Growth Hormone ◽  
Pregnancy Rate ◽  
Statistical Significance ◽  
Pregnancy Rates ◽  
P Value ◽  
Poor Responders ◽  
High Dose ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Poor responders impose a great challenge to ART clinicians. Research to improve their pregnancy rate is going on. This study was conducted to analyze the effect of growth hormone in poor responders in ART.Methods: This study was done from January 2015 to December 2015. It was a retrospective, single centre, cohort study in which 36 poor responders were selected and allotted into group A (18) with growth hormone and group B (18) without growth hormone. High dose of gonadotrophins was used for ovarian stimulation and antagonist protocol was followed in all patients. Group A received 4 IU of growth hormone along with usual treatment from day 2 till ovulation trigger with HCG injection, group B usual protocol.Results: Statistical analysis was done with independent T test, and p value <0.05 was considered significant. Higher number of mature oocytes and pregnancy rates were observed in growth hormone group. Number of MII oocytes was 5.8, on an average in group A and 3.7 in group B, the difference was statistically significant (p 0.0000001).  Clinical pregnancy rates were 27.7% in group A and 16.6% in group B, statistical significance (p 0.02).Conclusions: Addition of growth hormone shows increase in number of oocytes retrieved and pregnancy rates in poor responders in ART patients.

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

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