Clofarabine As the Element of Conditioning Regimen in Matched Related Allogeneic Transplantation – Single Center Experience

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4516-4516
Author(s):  
Patrycja Mensah-Glanowska ◽  
Beata Piatkowska-Jakubas ◽  
Aleksander Skotnicki
Keyword(s):  
Conflicts Of Interest ◽  
Therapeutic Option ◽  
Conditioning Regimen ◽  
Allogeneic Transplantation ◽  
University Hospital ◽  
Second Phase ◽  
Single Center Experience ◽  
Two Phases ◽  
The University ◽  
Refractory Aml

Abstract Abstract 4516 Since June 2010 to July 2012 since in Department of Hematology of the University Hospital in Krakow five patients with advanced hematological malignancies have been subjected to allogeneic transplantation from matched related donors with clofarabine as a part of conditioning regimen. Indications for transplantation were relapsed/refractory acute myeloid leukemia in four patients and CML lymphoblastic crisis in relapse after RIC alloPBSCT in one patient. In a case of three patients conditioning regimen consisted of two phases. First phase: cytoreduction with clofarabine 20mg/m2/day + ARA-C 2000 mg/day for 4 days in 2 patients with refractory AML and Clofarabine 20mg/m2/day + Cyclophosphamide 400mg/day for 4 days in one (CML lymphoblastic crisis). Second phase: Busilvex + Fludarabine (Bu4Flu). Two later patients were treated without cytoreduction. One patient with extramedullary AML in second CR was treated with Clofarabine 30mg/m2 for 4 days + TBI. Last patient with early AML relapse was conditioned with Clofarabine30mg/m2 for 5 days+ Busilvex (BuClo). G-CSF mobilized peripheral blood was used as a source of stem cells in all the patients. Results: One patient died during conditioning regimen after cytoreduction (Clofarabine + Cyclophosphamide). It was the patient with CML lymphoblastic crisis relapse after RIC allogeneic transplantation. The other patients treatment toxicity was moderate (mucositis garde I-III). Aplastic period was complicated in one patient with septic infection. One patient relapsed 5 months after transplantation. He was diagnosed with AML secondary to MDN/MPD with very high cytogenetics (t(3;3) with 7 monosomy) Three of patient series remain in complete remission. All of them were diagnosed with relapse/refractory AML with CR duration 6 months to 26 months. Conclusions: Use of clofarabine as a part of conditioning regimen is valuable therapeutic option especially in the group of patients with relapsed/refractory AML. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Designing and Implementing of An Online Library Managment System

2017 ◽  
Vol 5 (3) ◽  
pp. 278
Author(s):  
Maiwan B. Abdulrazaq ◽  
Omar M. Mustafa
Keyword(s):  
Second Phase ◽  
Short Message ◽  
University Campus ◽  
Library Management ◽  
Library Management System ◽  
System Usability Scale ◽  
Message Service ◽  
Two Phases ◽  
Online Library ◽  
The University

One of the most important fields in education is library. The library is a fast-growing system. The traditional methods of maintaining it are no longer dynamic and efficient. For expeditious retrieval and dissemination of information and better service for the clientele, an application of modern techniques has become absolutely indispensable. A properly computerized library will help its users with quick and prompt services. Therefore, this Paper produces an efficient Online Library Management System (OLMS) for university campus. The main purpose of this Paper is to design and implement the (OLMS). The OLMS consists of two modules: External Pages Module and Internal Pages Module. The first module is with limited operation such as (viewing, searching and registration request). The second module for the personal account can do the operations like (storing, searching, viewing, borrowing, downloading and etc.). The system controllers are two types. The first one is the (Co_Admin) which can manage library operation. The second one is the administrator which can create and manage university libraries and also can create (Co_Admin) for each faculty library. The system can generate different types of reports and can also calculate the (fines) on the users, also any request or response will be done by E-Mail and short message service (SMS). The OLMS was designed and implemented by using (MySQL, HTML, CSS, PHP, JavaScript, JQuery, Ajax and Bootstrap) techniques. The system was tested in two phases: the first phase identifies the views and preferences of users with the specification of the system outputs, depending on the requirements of the proposed system. The second phase measures the abilities of the system through System Usability Scale (SUS) technique with the contribution of 26 potential users of the system and the recorded rate 76% as overall satisfaction of OLMS implementation. A reasonable degree of compatibility and harmony between the university and the system requirements of application has been found in the University of Zakho.

scholarly journals An Audit of Wait Times for Service Offered by the Gynaecology Oncology Unit at the University Hospital in Jamaica: Are We Meeting the Standards?

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 74s-74s
Author(s):  
Ian Bambury ◽  
Christopher Fletcher ◽  
Carole Rattray ◽  
Matthew Taylor ◽  
Charmaine Mitchell ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Conflicts Of Interest ◽  
Waiting Times ◽  
Wait Time ◽  
International Standards ◽  
University Hospital ◽  
Wait Times ◽  
Oncology Unit ◽  
The University ◽  
Mean Time

Abstract 53 Background: The European Board and College of Obstetrics and Gynaecology recommends that time from referral of suspected or proven gynaecological cancers to consultation should be within two weeks and that initiation of treatment should occur within six weeks. It is has been shown that a delay in waiting times beyond these international standards results in significantly increased morbidity and mortality. Methods: An audit of wait times was performed for all patients who presented to the gynaecology oncology unit at the University Hospital in Jamaica for consultation between January 1, 2013 and December 31, 2013. Wait time for consultation was calculated as the date of first referral to the date of initial consultation. Wait time for treatment was calculated as time from consultation to either surgery or initiation of radiation therapy or chemotherapy. Primary site, stage, and the region from which the referrals came were abstracted from the medical record. Results: A total of 1,289 unique patients were seen at least once during the audit period; of these, 108 were new consultations and 1,219 were patients seen for follow-up. 72% were from the greater metropolitan area (Kingston & St. Andrew), while the others were from the surrounding parishes of Jamaica. Of the 108 new patients, malignancy was confirmed in 70 (65%). Case make-up included 23 cases of endometrial cancer (33%); 20 cases of cervical cancer (29%); 16 cases of ovarian cancer (23%); and 11 cases of other gynecologic cancers (vulvar, vaginal, choriocarcinoma) (15%). At presentation, there were 23 patients with stage 1 disease (33%), 16 patients with stage 2 disease (23%), 27 patients with stage 3 disease (38%); and 4 patients with stage 4 disease (6%). 39 out of 70 patients with malignancy (56%) underwent surgery; 11 (15.7%) were treated with radiation therapy; and 22 (31%) were treated with chemotherapy. Among patients with a cancer diagnosis, the mean time from referral to consultation was 2.1 weeks. Mean time from consultation to surgery was 7.6 weeks; mean time from consultation to start of radiotherapy was 16 weeks; and mean time from consultation to start of chemotherapy was 11.6 weeks. 66% of patients underwent surgery within the international standard of six weeks from referral. Only 36% initiated radiation therapy and 14% initiated chemotherapy within six weeks from referral. Conclusion: While the majority of patients met international standards for time to consultation to surgery, wait times for initiation of radiation and chemotherapy were sub-standard. This audit has provided information that will help us to assess the inadequacy of available services and could potentially inform national cancer policies in Jamaica. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

scholarly journals Adrian Cowell e a Amazônia Brasileira

2021 ◽  
Author(s):  
Filipe Freitas Chaves
Keyword(s):  
Conflicts Of Interest ◽  
Road Construction ◽  
Indigenous Populations ◽  
Second Phase ◽  
Hydroelectric Dams ◽  
The People ◽  
Rubber Tappers ◽  
Gold Miners ◽  
Two Phases ◽  
The Impact

This article aims to examine two phases of the English director Adrian Cowell (1934-2011), who documented the Brazilian Amazon for 50 years. The first phase that we intend to examine is when he arrives in the country and meets the Villas Bôas brothers, filming the attempt by the sertanista brothers to attract isolated Indians into the interior of the Xingu National Park, in order to save them from civilization. The second phase we want to analyze is when he returns to the country, in 1980, after a season abroad, and films for a decade what would become his most famous series: The Decade of Destruction. Adrian Cowell followed the entire process of development and destruction of the Amazon, conflicts of interest, the impact of major projects, advances in agriculture and livestock, colonization projects, road construction and hydroelectric dams and their consequences in daily life of the people who live in the region: indigenous populations, rubber tappers, farmers, loggers, gold miners and others. The study of his films is extremely important to encourage debate and awareness about socio-environmental issues, aiming at the preservation of the largest forest in the world.

Organization of Hospital for Extrahospital Emergencies

1985 ◽  
Vol 1 (3) ◽  
pp. 284-285
Author(s):  
E. Tresalti ◽  
G. Rossi ◽  
P. Contegiacomo
Keyword(s):  
Clinical Care ◽  
University Hospital ◽  
Treatment Center ◽  
Second Phase ◽  
Transfusion Center ◽  
Technological Level ◽  
Subsequent Phase ◽  
Set Up ◽  
The University ◽  
Gastro Intestinal Tract

In the last few years various departments of the University Hospital “A. Gemelli” have been engaged in dealing with disasters of different kinds: the earthquakes of Belice, Friuli and Irpinia, the fire of the Todi antique exhibition, and various terrorist attacks. In these events the organization of the care of the survivors took the following four aspects into account: 1) Type and kind of lesions related to the nature of the event. 2) Criteria and collection areas of the injured, casualty clearing and treatments. 3) Distance of the disaster from the treatment center. 4) New structures to be set up for improving efficiency in the future.1) The most frequent clinical problems encountered burns and crushing injuries, and those affecting the musculoskeletal, cardiorespiratory and neuro-muscular systems. In a second phase, together with the possible lack of water, food, clothing, shelter and toilet facilities, infectious diseases of the respiratory and gastro-intestinal tract appear, particularly in old people and children. The treatment of the injured in the emergency phase requires a series of interventions at a very high technological level. In the subsequent phase, which may last for months, the treatment needed comes under normal preventive and clinical care.2) In the emergency period, which in our experience does not generally last longer than ten days, the medical and surgical departments of our hospital mostly concerned were the intensive care units (18 beds), the orthopedics and traumatology sections (122 beds), the surgical wards (309 beds), the transfusion center and the hemodialysis service.

Haploidentical Transplantation (HAPLO) with Post-Transplant High-Dose Cyclophosphamide for Graft Vs Host Disease (GVHD) Prevention in the Treatment of High Risk Hematological Neoplasms

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4545-4545
Author(s):  
Jorge Gayoso ◽  
Mi Kwon ◽  
David Serrano ◽  
Pascual Balsalobre ◽  
Javier Anguita ◽  
...  
Keyword(s):  
High Risk ◽  
Conflicts Of Interest ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Disease Status ◽  
Allogeneic Transplantation ◽  
High Dose ◽  
Unrelated Donor ◽  
Haploidentical Transplantation ◽  
Gvhd Prophylaxis

Abstract Abstract 4545 Introduction: Allogeneic transplantation is the only curative option in the treatment of multiple high risk hematologic neoplasms. Only 25–30% of patients have an HLA identical sibling donor and searching for a compatible unrelated donor or cord blood renders satisfactory results in around 60–70%. Haploidentical transplantation (HAPLO) offers a therapeutic alternative to more than 95% of such patients with the advantages of quick availability, easy programming and a committed donor. Patients and Methods: We evaluate the results of HAPLO with a reduced intensity conditioning regimen (Fludarabine 30 mg/m2 ×5 days (-6 to -2), Cyclophosphamide 14,5 mg/kg ×2 days (-6 and -5), IV Busulfan 3,2 mg/kg × 1–3 days (BUX, days -4 to -2) employing high doses of Cyclophosphamide post graft infussion (50 mg/kg days +3 and +4) as GVHD prophylaxis together with standard doses of cyclosporine and mycophenolate from day +5. Results: From Dec-2007, we have done 26 HAPLO in 4 spanish centers. Median age was 38 years (16–57), 20 were male and all were in advanced phases of their diseases (12 Hodgkin′s, 6 AML, 3 ALL, 2 MM, 1 MDS, 1 MF y 1 NHL). Previous autologous HSCT has been employed in 13 and allogeneic HSCT in 6 (2 MURD and 4 UCB). Disease status at HAPLO was CR in 8, PR in 14 and refractory in 4. Bone marrow was used in 16 and unmodified peripheral blood in 10. The haploidentical donor was patient′s mother (8), father (3), siblings (11) or other relatives (4). BUX was used in 1 dose (15), 2 doses (8) or 3 doses (2) and TBI 200 cGy in 1 case. Mean neutrophils engraftment was achieved on day +18 (13–26) and platelets >50K on day +27 (17–150) in all but 2 cases of graft failure (7.7%) due to progression (MF) or relapse (M7-AML). Main toxicities were grade 1–2 mucositis in 50%, febrile neutropenia in 75% and CMV reactivations in 58% with a 100 days NRM of 3.8% (1/26, VOD and MOF) and 10% NRM at 6 months (2/20). Grade II-IV acute GVHD appeared in 10/23 patients at risk (43%) and grade III-IV in 4/23 (17%). Chronic GVHD affected to 4/15 (27%), being extensive in 1/15 (6.7%). With a median follow-up of 9 months (1–38), 13/22 (59%) are alive in CR, progression or relapse has ocurred in 6/24 (25%). Immune reconstitution seems fast and complete in those evaluated. Conclusions: HAPLO with high-dose cyclophosphamide as GVHD prophylaxis is a useful alternative in the treatment of high risk hematologic tumours, with low toxicity, acceptable GVHD incidence and severity, long lasting remissions, and fast immunological reconstitution. Disclosures: No relevant conflicts of interest to declare.

Azacitidine in Relapsed and Refractory AML: Efficacy for Patients Relapsing As MDS Post AML

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4332-4332
Author(s):  
Sarah Ivanoff ◽  
Emilie Lemasle ◽  
Berengere Gruson ◽  
Lavinia Merlusca ◽  
Amandine Charbonnier ◽  
...  
Keyword(s):  
Overall Survival ◽  
De Novo ◽  
Conflicts Of Interest ◽  
Regulation Of Gene Expression ◽  
Complete Response ◽  
Allogeneic Transplantation ◽  
Dna Methyltransferases ◽  
Duration Of Response ◽  
Myeloid Neoplasia ◽  
Refractory Aml

Abstract Abstract 4332 Background: Azacitidine (Aza), inhibitor of DNA methyltransferases, plays an important role in epigenetic regulation of gene expression and tumorogenesis, and is active in myeloid neoplasia such as myelodysplasia (MDS) and de novo acute myeloid leukemia (AML). Efficacy of Aza for relapsed and refractory AML has not been so far reported. Methods: We report in 2 french centers (Amiens, Rouen) retrospective study, the results of Aza for relapsed or refractory patients. All patients received Aza (75 mg/m2 per day over 7 days for 4 weeks cycles), until progression, and at least one cycle. Leukocyte blood count was < 10109/l. The primary endpoint was overall response rate (ORR), according to IWG 2006: complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD), hematological improvement (HI). Secondary endpoints were duration of response and overall survival (OS). Results: 41 patients (26 males and 15 females) with a median age of 59 years (range 28–78) were studied from August, 2007 and November, 2011 (Table): 15 had refractory and 26 relapsed AML. At relapse 11/26 had MDS, defined by blast count <20% and cytological morphology of MDS in bone marrow aspirate, and 15/26 AML. Patients received in average 6 cycles (1–30): 4 (1–7) for refractory; 7 (1–30) for relapsed (11 (3–30) for MDS post AML; 3 (3–5) for relapsed AML). Overall, the ORR was 34% (7 CR, 5 RP, and 9 HI). For patients with MDS post AML OR was 82% (7 CR, 2 RP, 7 HI), 13% (1 RP, 1 HI) for relapsed AML, and 13% (2 PR and 1HI) for refractory AML. The average duration of response was 4 months (0–39) for the 41 patients: 14 months (0–39) for MDS post AML, 0.3 for relapsed AML, and 0.5 for refractory. Overall survival from diagnosis was 29 months (6.9–87): 38.2 (12–57) for MDS post AML, 30.1 (6.9–87) for relapsed AML and 13.3 (6.9–35.5) for refractory (no significant differences). Overall survival from initiation of Aza was 9.4 months (1.1–39.2): 22.6 (4.8–39.2) for MDS post relapsed and 3.9 (0.3–11.3) for relapsed AML and 6.2 (1.1–13.3) for refractory patients. The differences are not statically significant probably due to small effective of our study. Contrarily to the others 2 groups, 6 patients (55%) with MDS post AML are alive in CR at the latest report; moreover three of them underwent an allogeneic transplantation. Conclusion: Aza seems to efficient for relapsed AML patient, especially for MDS post AML, but inappropriate for refractory patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Effectiveness of Eltrombopag at the Different Stages of Aplastic Anemia and Probability of Clonal Expansion

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5108-5108
Author(s):  
Anton V. Luchkin ◽  
Elena A. Mikhaylova ◽  
Zalina T. Fidarova ◽  
Anastasia V. Abramova ◽  
Vera V. Troitskaya ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
De Novo ◽  
Conflicts Of Interest ◽  
Therapeutic Option ◽  
Monosomy 7 ◽  
Single Center Experience ◽  
Hla Dr ◽  
Attractive Option ◽  
Severe Infections ◽  
Pnh Clone

Abstract Background. New insight into pathogenesis of aplastic anemia (AA) in conjunction with effectiveness of Eltrombopag allowes to recommend it for initial treatment of de novo AA. However, eltrombopag was an attractive option for patients at different stages of the therapy. Aim. In our study we present various application points of eltrombopag as a therapeutic option in patients (pts) at different stages of the disease. Materials and patients. We are presenting our single-center experience, that include 11 pts with acquired aplastic anemia (SAA/NSAA = 10/1) on different stages of the disease. All pts were divided into four groups. In the 1st group we included refractory pts after two (n=3) or three (n=2) lines of antithymocyte globulin (ATG) therapy. The 2nd group included two pts who received the second ATG course in combination with eltrombopag, after faild first ATG. In the 3rd group included 2 pts with refractoriness after 1 course of ATG, who couldn't receive the second ATG/CsA because of severe infections. The 4th group included two pts with one lineage thrombocytopenia but transfusion independent. The median time from the start of immunosuppressive therapy (IST) to beginning of eltrombopag was Me(min-max): 56(12-115), 51(8-94), 1(1-1), 69(37-100) months respectively. The daily dose of eltrombopag for pts was 100-150 mg. Results. Hematological response are present in 3 out of 5 pts in the 1st group. Median duration of eltrombopag treatment was 8,5 (3-12) months. It is necessary to note that responding pts were refractory to 2nd (n=1) or 3rd (n=2) ATG and transfusion dependence. All pts in the 2nd group achieve PR (Me duration eltrombopag treatment was 12 months). All pts from 3rd group achieved granulocytic response, that allowed to recover get out from infections and to hold the 2nd ATG. However in 1 pt monosomy 7 was detected by FISH in bone marrow after therapy. It was noted that before eltrombopag administration there were not cytogenetic aberrancies but there were myelodysplastic features by flow cytometry (low index of granularity in granulocytes, low HLA-DR expression of monocytes and high CD56 expression in both granulocytes and monocytes) and PNH-clone. After eltrombopag treatment and monosomy 7 detection we performed a FACS sorting and FISH-study for PNH+ and PNH- granulocytes. Monosomy 7 was found in PNH- but not in PNH+ granulocytes. From the 4th group thrombocytopenia resolved in 1 pt (11 months eltrombopag duration), in over case present threelineage relapse subsequently. Conclusion. Eltrombopag can be used in pts with long-term ineffective IST and as a bridge to the next step of IST. It is necessary to remain cautious about the earlier development of clonal complications, even in patients from the so-called favorable risk group with the PNH clone. Disclosures No relevant conflicts of interest to declare.

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