Neoadjuvant chemoradiation (NACRT) and the prognostic effect of surgical margin (SM) status in pancreatic adenocarcinoma (PAC).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 407-407
Author(s):  
Lora S Wang ◽  
John Parker Hoffman ◽  
Elizabeth Handorf ◽  
Colin T. Murphy ◽  
Harry S. Cooper ◽  
...  
Keyword(s):  
Negative Impact ◽  
Small Sample Size ◽  
Surgical Margin ◽  
Neoadjuvant Chemoradiation ◽  
Small Sample ◽  
R0 Resection ◽  
Palliative Intent ◽  
Prognostic Effect ◽  
Group I ◽  
Group Ii

407 Background: Many studies have associated a R0 resection to have significantly improved survival compared with a R1 resection in PAC. Patients (pts) who undergo NACRT often go to surgery 4-8 weeks after the end of therapy, before the effects of NACRT can be fully manifested. The goal of this study is to evaluate if a positive SM (+SM) after NACRT has the same poor prognosis as a +SM after upfront surgery. Methods: After IRB approval, we retrospectively reviewed all cases of surgically resected PAC at a single institution from Dec 1996 to Jan 2014. Pts were stratified by receipt of NACRT as well as by SM status. We excluded pts treated with palliative intent, metastatic disease at presentation, death within 90 days of surgery, and biliary or ampullary tumors. The primary endpoint was overall survival (OS). We assessed the relationship between pt and tumor variables with treatment/margin combination using Chi-squared tests. OS was examined using Kaplan-Meier curves, and we tested association with treatment/margin using log-rank tests. Results: A total of 213 pts met inclusion criteria; 111 received upfront surgery (group I) with 94 (85%) receiving adjuvant chemotherapy or CRT and 102 received NACRT (group II) with either concurrent 5-fluorouracil (n=18) or gemcitabine (n=84). There were 31 pts with +SM in group I and 29 pts in group II. Pt demographics were balanced. There was more vessel involvement in group II (81%) at diagnosis than group I (11%) (p<0.01) with a trend towards improved OS in group II vs group I (p=0.09). Pathological evaluation revealed more PNI (61% vs 42%, p<0.01) and more lymph node positivity (71% vs 33%, p<0.01) in group I vs group II, respectively. Median OS for group I SM+/SM- and group II SM+/SM- were 15/25 months and 26/32 months respectively. OS is significantly improved with a negative SM (-SM) compared with a +SM (p<0.01). If the SM is positive, pts in group II had improved OS compared with group I (p=0.02). OS was not significantly different for group II +SM vs group I –SM (p=0.34). Conclusions: The negative impact of a +SM on survival is partially mitigated by NACRT. This data further supports the use of NACRT, although it is limited by its retrospective nature and small sample size.

Periodic Evaluation Of The Clone Size Is Mandatory In PNH: Study Of The Spanish Cohort Of The International PNH Registry

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3715-3715
Author(s):  
Ana Villegas ◽  
Ana Gaya ◽  
Emilio Ojeda ◽  
Ataulfo Gonzalez ◽  
Alvaro Urbano ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Small Sample Size ◽  
Small Sample ◽  
Additional Patient ◽  
Clone Size ◽  
Hematopoietic Stem ◽  
Future Analysis ◽  
Group I ◽  
Group Ii ◽  
Pnh Clone

Abstract Background Paroxysmal nocturnal hemoglobinuria (PNH) is a chronic, life threatening hematopoietic stem cell disorder with chronic hemolytic anemia, peripheral blood cytopenias and thrombosis Aims To observe the PNH clone and LDH evolution of the Spanish patients enrolled in the International PNH Registry, the thrombotic events and the role of eculizumab Methods We analyzed the 117 patients enrolled in the Registry until Dec. 31st 2012, classified in 3 groups: Classic/ hemolytic (group I, n 59), PNH with another bone marrow disorder (group II, n 42) and Subclinical (group III, n 14). The variables analyzed were PNH clone size, LDH levels, and incidence of thrombosis. Medians and percentages should be taken with caution due to the relatively small sample size. In addition to data collected in the Registry, additional patient information was obtained from local physicians. Results The median (range) age at presentation was 36.6 yrs. (16-83); 48 patients (41.0%) were women. Median (range) time from disease start to enrollment was 11.3 years in group I (0.1-41.2), 3.5 in II (0.1-33.8) and 3.4 (0.3-20.8) in III. A total of 49 patients (39 in group I) were started on eculizumab, 38 prior to enrollment (31 in group I) and 11 on or after enrollment; 3 were treated prior to enrollment but discontinued for different reasons (pregnancy, ending trial, access problems). Clone evolution (Table 1). In group I the median clone size remained stable during the follow-up period in the Registry; however, 4 patients in group II evolved to group I, with granulocyte clones > 50% and LDH levels >2000 U/L, while 3 initially in group I evolved to group II at 6, 12 and 18 months respectively. At enrollment 64 patients had a clone ≥30% and 31<30%; 7 patients in group II had a clone ≥30% despite hypoplasia, and they were treated with eculizumab. In groups I and II median clone size increased from Diagnosis to Enrollment in line with the physiopathology of the disease. LDH evolution (Table 2). Median LDH levels at diagnosis were higher in group I. In this group the decrease in LDH level between Diagnosis and Enrollment could be attributed to the start of treatment in 31 patients before the enrollment visit, but that hypothesis will need confirmation in future analysis. Thrombotic episodes (Table 3). Twenty six patients (22.6%) presented 52 TEs along the study period, 41 in group I and 11 in group II. Of the 26, fourteen presented 1 TE, six 2, one 3, four 2 and one 5. Twenty five patients presented 51 TEs since the moment of diagnosis while they were not being treated with eculizumab. Only one patient in the treated group presented a TE (CVA), of which he recovered well; after 30 months of the episode continues with the treatment and scores 90 in the Karnofsky index. Fifty eight percent of the patients presenting TEs were male, showing they may be more prone to TE than women. Conclusions These data show the dynamic features of the disease in some patients, which justifies the necessity of regularly monitoring the clone size LDH levels are higher in patients with classical PNH at diagnostic; the effect of the treatment in the whole cohort will require future analysis Thrombosis is highly prevalent in PNH; 22.6% of the patients in this sample had at least 1 episode along their time in the study. Disclosures: No relevant conflicts of interest to declare.

Prevention of chemotherapy-induced delayed nausea and vomiting with aprepitant in patients recieving highly emetogenic-five day cisplatin regimens

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14125-14125 ◽  
Author(s):  
A. J. Joshi ◽  
H. Singh ◽  
S. Chawla
Keyword(s):  
Small Sample Size ◽  
Rescue Therapy ◽  
Small Sample ◽  
P Value ◽  
High Dose ◽  
Delayed Emesis ◽  
End Point ◽  
Group I ◽  
Delayed Nausea ◽  
Group Ii

14125 Background: It has been shown that addition of the NK1 receptor antagonist aprepitant to 5HT3 antagonist plus dexamethasone is more effective than just the 5HT3 antagonist plus dexamethasone for prevention of acute and delayed emesis due to high dose cisplatin and also that this effect lasts for multiple cycles. This study evaluated whether the antiemetic efficacy of aprepitant could be sustained for 5 day cisplatin regimens. Methods: Patients receiving cisplatin 20mg/m2/day for 5 days (PEB and TCF regimens ) were randomized to one of the following two regimens: (1) aprepitant 125 mg 1 hour before cisplatin on day 1 and aprepitant 80 mg on days 2 and 3 (n = 17); (2) placebo before cisplatin on days 2 to 7 (n = 19). All groups received ondansetron 32 mg and dexamethasone 20 mg before cisplatin, and dexamethasone 8 mg on days 2 to 7. The primary end point was complete response (no emesis and no rescue therapy) over 7 days following cisplatin in up to six cycles analyzed by a modified intent-to-treat approach. Secondary end point was evaluated using Functional Living Index-Emesis questionnaire. Treatment comparisons were made using logistic regression models and P value calculated using the chi square test due to small sample size. Results: In the acute period, 83% and 56% of patients were without emesis in groups I and II, respectively (P < .01 for group I v group II). In the delayed period upto day 5, the proportion of patients without emesis in groups I and II, was 59% and 32%, respectively (P < .01 for groups I v group II). In the extended period day 6 and 7 the proportion of patients without emesis in groups I and II was 50% and 38% respectively (P< .01 for groups I v II). The distribution of nausea scores in the delayed period beyond day 5 was lower when comparing group I with group II (P < .05 for days 6 and 7). Two serious adverse events of diarrhea were probably attributed to aprepitant. Conclusions: Once daily oral administration of aprepitant was effective and superior in reducing delayed emesis and nausea after 5 days cisplatinum regimen when added to 5HT3 antagonist plus dexamethasone. This benefit persists upto day 7. Confirming and extending previous results aprepitant should be used in triple combination in patients receiving 5 day cisplatin regimens. No significant financial relationships to disclose.

scholarly journals COVID-19 potentially causes long-term deterioration of lung function: a systematic review and meta-analysis

2021 ◽  
Vol 30 (4) ◽  
pp. 279-89
Author(s):  
Yudha Nur Patria ◽  
Rahmaningsih Mara Sabirin
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Negative Impact ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Recovery Period ◽  
Small Sample ◽  
Lung Function Measurement ◽  
Meta Analyses

BACKGROUND The COVID-19 is an emerging disease that commonly involves respiratory complaints, including acute respiratory distress syndrome. The effect of COVID-19 on pulmonary function is still unclear and only based on sporadic reports with a small sample size. This study aimed to compile evidence on the pulmonary function of patients who have recovered from COVID-19. METHODS Literature searching was conducted in PubMed, Embase, Google Scholar, Scopus, Web of Sciences, and CINAHL. Any types of studies published before June 26, 2020 and reported lung function tests of post-COVID-19 patients were included. Articles reporting data from early hospitalization were excluded. The risk of bias was measured using tools developed by the Joanna Briggs Institute. Meta-analysis was done using a meta statistical package in R and presented in the random effects model. RESULTS 378 recovered COVID-19 patients in 7 studies were included. The lung function measurement periods were varied, ranging from 14 days after hospitalization to 10 weeks after receiving rehabilitation. Meta-analyses found that the pooled mean of diffusion capacity of carbon monoxide in recovered COVID-19 patients was lower than 80% predicted, whereas the other parameters were normal. The forced vital capacity and total lung capacity showing restrictive lung disorders were significantly lower in the severe COVID-19 survivors. CONCLUSIONS COVID-19 has a negative impact on lung function for at least several weeks in the recovery period. Diffusion and restrictive problems could be the main long-term consequences of COVID-19.

scholarly journals Circulating MicroRNAs for Diagnosis of Acute Pulmonary Embolism: Still a Long Way to Go

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
Matteo Sobrero ◽  
Fabrizio Montecucco ◽  
Federico Carbone
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Application ◽  
Acute Pulmonary Embolism ◽  
Clinical Evidence ◽  
Negative Impact ◽  
Small Sample Size ◽  
Cost Benefit ◽  
Small Sample ◽  
Development Organization

Venous thromboembolism (VTE) represents the third most frequent cause of acute cardiovascular syndrome. Among VTE, acute pulmonary embolism (APE) is the most life-threatening complication. Due to the low specificity of symptoms clinical diagnosis of APE may be sometimes very difficult. Accordingly, the latest European guidelines only suggest clinical prediction tests for diagnosis of APE, eventually associated with D-dimer, a biomarker burdened by a very low specificity. A growing body of evidence is highlighting the role of miRNAs in hemostasis and thrombosis. Due to their partial inheritance and susceptibility to the environmental factors, miRNAs are increasingly described as active modifiers of the classical Virchow’s triad. Clinical evidence on deep venous thrombosis reported specific miRNA signatures associated to thrombosis development, organization, recanalization, and resolution. Conversely, data of miRNA profiling as a predictor/diagnostic marker of APE are still preliminary. Here, we have summarized clinical evidence on the potential role of miRNA in diagnosis of APE. Despite some intriguing insight, miRNA assay is still far from any potential clinical application. Especially, the small sample size of cohorts likely represents the major limitation of published studies, so that extensive analysis of miRNA profiles with a machine learning approach are warranted in the next future. In addition, the cost-benefit ratio of miRNA assay still has a negative impact on their clinical application and routinely test.

Impact of Pre-Transplantation, Mobilization and Graft Variables on Transplant Outcome after Autologus Hematopoietic Stem Cell Transplantation in Multiple Myeloma in Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5137-5137
Author(s):  
Mauricette Michallet ◽  
Quoc Hung Le ◽  
Mohamad Sobh ◽  
Nicole Raus ◽  
Melissa Clarck ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Negative Impact ◽  
Disease Status ◽  
Median Number ◽  
Gm Csf ◽  
Group I ◽  
Cd34 Cells ◽  
Significant Negative Impact ◽  
Group Ii ◽  
Length Of Hospitalization

Abstract This analysis studied 197 autologous HSCT performed in 132 patients treated for multiple myeloma (MM) in our center between 2000 and 2007. There were 53 females and 79 males with a median age of 56.8 years (34–72). At diagnosis there were 71 IgG (49κ, 22λ), 26 IgA (15κ,11λ), 2 IgD (1κ, 1λ), 27 light chain (18κ,9λ), 2 plasma cell leukemia, 3 non secretory, 1 non secretory/non excretory. There were 11 stage I (10A and 1B), 12 IIA, 96 III(75A and 21B) and 13 not classified. At diagnosis, 24/98pts had a del(13), and 65/179 had high levels of β2microglobulin. Before 2004, 50% of transplants were done and the median interval between diagnosis and HSCT was 7.8 months (3.5–131). We divided the population into 2 groups (I = 65: double-auto, II = 67 simple auto). The disease status pre-transplant according to the number of apheresis were: 1 apheresis (group I: 3CR, 29PR, 3SD, 1PD; group II: 2CR, 24PR, 3PD), 2 apheresis (group I: 16PR, 1SD, 1PD; group II: 3CR, 9PR, 1PD), 3 apheresis (group I: 1CR, 4PR; group II: 10PR, 1unknown), 4 apheresis (group I: 4PR, 1PD; group II: 1CR, 10PR, 2SD), 6 apheresis (group II: 1PR) and 8 apheresis (group: 1PR). PBSC were mobilized in steady state in 135 cases, 53 after cyclophosphamide alone, 9 cyclophosphamide with other drugs. During mobilization, we used GCSF in 179cases, GM-CSF in 5cases, SCF in 4 cases and associations of GM-CSF+ GCSF in 2(1%) cases and SCF+GCSF in 7(3.5%) cases. The median number of infused cells were: TNC 5×107/kg (1–59), CFU-GM 70.5×104/kg (0–2616) and CD34+cells 3×106/kg (0–27). Of these, 115 (58%) had a number of CD34+cells&lt;4×106/kg and 82 (42%) ≥4×106/kg. As conditioning regimens, all pts received melphalan alone with a median total dose of 304mg [130–440]. After transplantation, 156(79%) have received growth factors [1(0.5%) GM-CSF, 148 (95%) G-CSF and 7 (4.5%) SCF] and 195 pts well engrafted (99%). Concerning red blood cell (RBC) transfusions, 60% of pts did not received any RBC transfusions, 30% received between 1 and 4 transfusions, 7% between 5 and 8 and 3% 10 or more and concerning platelet (Pt) transfusions, 35,5% did not received any Pt transfusions, 53% received between 1 and 3, 9% between 4 and 7 and 2.5% 10 or more. The median number of RBC and Pt transfusions were 0 [0–23] and 1 [0–20] respectively. The median number of days with neutrophils &lt;0.5G/L was 6 (0–33) and with Pt&lt;50G/L 17 (2–104) and the median length of hospitalization for auto transplantation was 18 days (14–54). The probability of 5-year overall and event-free survival (OS and EFS) were 64.3% (56.3–73.4%) and 32.4% (24.9–42.2%) and the median OS was not reached. Among all pts, 25 received an allogeneic HSCT as further treatment. Statistical analysis studied age disease status at transplant infused TNC, CD34+cell and CFU-GM, growth factors during mobilization and after transplantation, mobilization chemotherapy, interval Diag-T and transplantation period in a conditional logistic-regression model to analyze associations between these variables and length of hospitalization, number of RBC and Pt transfusions; a multivariate analysis using Cox model to analyze the impact of these variables on length of aplasia (&lt;0.5G/L neutrophils and &lt;50G/L Pt). We observed no significant impact of all studied variables on length of hospitalization and RBC transfusions and a significant negative impact of long interval diagnosis-T (p=0.05) and of the period &gt; 2004 on Pt transfusion number (p=0.03). We showed a significant positive impact of CFU-GM number [HR=1 (1000–1.002) (p=0.03)] and growth factor use after transplantation [HR=0.55 (0.36–0.85) (p=0.005)] on days &lt;0.5 G/L neutrophils and a significant negative impact of CD34+cell&lt;4 ×106/kg on the number of days &lt;50G/L Pt ([HR=1.65 (1.09–2.50) (p=0.01)]. A more refined analysis of the groups, as well as a medico-economic analysis are ongoing and will be presented. In conclusion, this retrospective analysis showed an interesting long-term overall survival probability for this high risk MM population. We demonstrated no apparent impact of the pre-transplant, mobilization, and graft variables on number of transfusions and the length of hospitalization in this global analysis. However, we did show a significant influence of the diagnosis-T interval on platelet transfusions and of the CD34+ cell number, GCSF post-transplant and CFU-GM number on the length of aplasia.

scholarly journals Oral candidiasis and nutritional deficiencies in elderly hospitalised patients

2004 ◽  
Vol 92 (5) ◽  
pp. 861-867 ◽  
Author(s):  
Elena Paillaud ◽  
Isabelle Merlier ◽  
Catherine Dupeyron ◽  
Elisabeth Scherman ◽  
Joël Poupon ◽  
...  
Keyword(s):  
Vitamin C ◽  
Nutritional Status ◽  
Negative Impact ◽  
Oral Candidiasis ◽  
Protein Energy Malnutrition ◽  
Nutritional Deficiencies ◽  
Vitamin C Deficiency ◽  
Group I ◽  
Hospitalised Patients ◽  
Group Ii

The prevalence of oral candidiasis and its association with malnutrition in terms of protein–energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82·1 (SD 8·6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m2 was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12·5 μmol/l) and vitamin C deficiency (<0·7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

scholarly journals The Impact of Breast Cancer on Female Sexuality: An Integrative Literature Review

2017 ◽  
Vol 9 (5) ◽  
pp. 180 ◽  
Author(s):  
Ana Rita P Castelo ◽  
Mônica Oliveira B Oriá ◽  
Anne Fayma L Chaves ◽  
Karine C Bezerra ◽  
Ana Fátima C Fernandes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Literature Review ◽  
Latin American ◽  
Female Sexuality ◽  
Negative Impact ◽  
Small Sample Size ◽  
Small Sample ◽  
Cochrane Library ◽  
Willingness To Participate ◽  
The Impact

OBJECTIVE: The aim of this study was to conduct an integrative literature review on the impact of breast cancer (CA) on female sexuality.METHODS: The search was performed online in November 2014 using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, PubMed, Latin American and Caribbean Health Sciences (LILACS) and the Cochrane Library. The search results consisted of 13 articles.SYNTHESIS: Most studies have shown that women have less lubrication and a decrease in desire, which directly affect their quality of life. Moreover, 70% of the articles described limitations of the studies, the most cited of which were as follows: small sample size because of the feeling that participants considered the theme to be embarrassing, the altered emotional state decreased willingness to participate in the study, and the non-participation of husbands in the study reduced the impact on marital intimacy.CONCLUSION: It can be concluded that breast cancer has a negative impact on the sexual function of women who are affected by this disease.

scholarly journals Hepatic biomarkers and coprology as indicators of clinical bovine fasciolosis in Chad

2021 ◽  
pp. 1153-1157
Author(s):  
Ibrahim I. Elshahawy ◽  
Sherif Elshanat ◽  
Mayo Mahamat Arab ◽  
Mohamed Nayel ◽  
Akram Salama ◽  
...  
Keyword(s):  
Fasciola Hepatica ◽  
Negative Impact ◽  
Small Sample Size ◽  
Close Association ◽  
Food Additives ◽  
Small Sample ◽  
Health Conditions ◽  
Economic Losses ◽  
Main Complaint ◽  
Prophylactic Measures

Background and Aim: Fasciolosis is a cosmopolitan parasitic disease of food-producing animals and is typically caused by digenetic trematodes, Fasciola gigantica and Fasciola hepatica. It has a direct negative impact on the liver and consequently affects liver metabolism. It has indirect effects, including lowered milk production and effects on quality and general health conditions leading to extensive economic losses. This study aimed to focus on the link between clinical fasciolosis and some biochemical analysis of the hepatic profile of cattle in Chad. Materials and Methods: This study was initiated in response to emerging complaints from dairy cattle owners detecting a bitter milk cream and butter taste. Furthermore, those animals had shown poor health conditions by presenting with diarrhea. Preliminary surveillance for possible causes was performed, including fecal and serum biochemical analyses and clinical observation to diagnose the possible disease. Results: The results obtained, including the finding of parasite stages during the coprological examination, confirmed the role of fasciolosis. The independent sample t-test indicated highly significantly altered values of all biochemical liver indicators in the infected animals. All animals were treated with two doses of rafoxanide (3 mg/kg b.w.) S/C, at 21 days intervals, with vitamin supplements, mineral mixtures, and food additives. Surprisingly, the main complaint was restored after treatment. This is another evident clue of fasciolosis. To the best of our knowledge, this is the first recent study that diagnosed fasciolosis in Chad. Conclusion: This study emphasized the importance of fasciolosis, its negative impact on milk taste, and the necessity for veterinary advice regarding routine examination and prophylactic measures, especially before autumn, to minimize economic losses. However, regardless of the small sample size, this study could serve as a cornerstone for future studies on evaluating the accurate epidemiological status of fasciolosis in Chad. This study reported a close association between the alteration of liver enzymes and total protein levels in fasciolosis and the bitter milk cream taste, which could be used as a diagnostic tool for fasciolosis.

The efficacy of preventive methods and their combinations in the preterm birth prevention

2021 ◽  
Vol 42 (2) ◽  
pp. 18-21
Author(s):  
O. V. Grishchenko ◽  
◽  
S. V. Korovai ◽  
I. V. Lakhno ◽  
◽  
...  
Keyword(s):  
Premature Birth ◽  
Small Sample Size ◽  
Cervical Length ◽  
Small Sample ◽  
Short Cervix ◽  
Group Iii ◽  
Placental Angiogenesis ◽  
Vaginal Progesterone ◽  
Group I ◽  
Prediction And Prevention

Prediction and prevention of premature birth is a significant problem of modern obstetrics. The use of ultrasound cervicometry and the index of placental angiogenesis for the prediction of premature birth is promising. The aim of the study was to investigate the effectiveness of cerclage, pessary, intravaginal progesterone or their combinations in the prevention of premature birth. A total of 292 pregnant women were examined. They were divided into several groups according to the results of the detection of cervical length and the level of the ratio between placental growth factor (PlGF) and fms-like tyrosine kinase (sFlt-1). Group I included women with a negative screening’ resuls. Other groups included women with a «short» cervix and disturbed placental angiogenesis. In group II, women with cervical cerlage were observed. In group III — used a pessary; Group IV — vaginal progesterone; V — cobined use of cerclage and pessary; and in VI — use of cerclage and vaginal progesterone. The pregnancy was completed at term in 159 patients, and 133 women had preterm delivery. Among patients who had positive miscarriage screening results, the use of preventive measures or combinations resulted in fairly equal results. However, the use of progesterone and cervical cerclage has shown the best efficacy. Some limitations in this study were the small sample size and the lack of information on the use of anticoagulants, disaggregants and tocolytics in the examined women.

Factors Influencing Relapse after Allogeneic Hematopoietic Cell Transplantation (HCT) Following Reduced Intensity Conditioning (RIC) in Patients with AML and MDS.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1654-1654
Author(s):  
Haifa K. Al-Ali ◽  
Claudia Nehring ◽  
Rainer Krahl ◽  
Cornelia Becker ◽  
Sabine Leiblein ◽  
...  
Keyword(s):  
High Risk ◽  
Hematopoietic Cell Transplantation ◽  
Bone Marrow Cells ◽  
Negative Impact ◽  
Chronic Gvhd ◽  
Therapeutic Interventions ◽  
Entire Cohort ◽  
Factors Influencing ◽  
Group I ◽  
Group Ii

Abstract Relapse (RI) after HCT especially after RIC remains the major risk factor affecting outcome. Factors influencing relapse in patients (pts) with AML/MDS undergoing HCT after RIC were analysed. Patients and methods: From July, 1998- December, 2006, 156 consecutive pts [86 m/70 f; median age 61 (range 21–75) years (y)] with AML, n=138 (88%) and high-risk MDS, n=18 (12%) treated within the OSHO studies received HCT after RIC [2Gy TBI ± fludarabine 30 mg/m2/day on 3 days] followed by immunosuppression with mycophenolate mofetil and cyclosporine. Donors were MRD in 40 (26%) and MUD in 116 (74%) pts. Stage of disease was CR1, n= 99 (63%), CR2, n=18 (12%), and &gt;CR2, n=39 (25%). Cytog. was intermediate-, and high-risk in 100 (64%), and 49 (31%) respectively. DCC in unsorted and flow-sorted T (CD3+)-, and CD34+-bone marrow cells at days (d) 28, 56, 84, and at 3 months interval thereafter was monitored by FISH for the XY chromosome in gender mismatched or PCR for polymorphic micro satellite regions in gender matched HCT. Results: 141 (90%) pts engrafted. OS, DFS, RI, and NRM at 5 y were 38%, 36%, 47%, and 30% respectively. In multivariate analysis, RI for pts in CR1 was significantly lower compared to pts transplanted beyond CR1 (p=0.005). For the entire cohort, type of donor had no influence on RI but for pts in CR1, RI with MUD and MRD was 29% and 60% respectively (p=0.008). NRM did not correlate with the type of donor. Interestingly, high-risk cytog. had no negative impact on outcome. OS, DFS, and RI for pts with high-risk cytog. transplanted in CR1 were 43%, 48%, and 38% respectively compared to 38%, 43%, and 45% for pts with intermediate-risk cytog. (p=0.65). Incidence of acute (grade I-IV) and chronic (limited and extensive) GvHD was 55%, and 58% respectively. GvHD correlated with an improved OS (p=0.0003) and DFS (p=0.003) but was not associated with a higher NRM (p=0.1) compared to pts with no GvHD. Also, RI was markedly influenced by GvHD (p=0.002). RI in pts with no GvHD (n=42), acute GvHD only (n=34), limited chronic GvHD (n=33), and extensive chronic GvHD (n=30) was 63%, 41%, 29%, and 18% respectively. In pts with chronic GvHD, RI was significantly lower compared to pts with no GvHD (p&lt;0.0001). Further, CD34+ DCC ≥90% at d 28 strongly correlated with outcome at 5 y. OS and DFS in pts with CD34+ DCC ≥90% at d 28 (group I) were 50%, and 47% respectively compared to pts with CD34+ DCC &lt;90% at d 28 (group II) (OS 20%, DFS 15%) (p&lt;0.0001). CD34+ DCC ≥90% at d 28 was highly predictive of early (≤100 d) and late (&gt;100 d) haematological relapse. Probability of RI in group I was 29% compared to 76% in group II (p&lt;0.0001). On the other hand, DCC in unsorted- and CD3+-cells at d 28 did not correlate with OS, DFS nor predict relapse. Conclusions: HCT after RIC offers long-term OS and DFS in AML/MDS pts. RI was lowest in pts transplanted from MUD in CR1. High-risk cytog. had no negative impact on RI. GvHD correlated with an improved outcome. CD34+ DCC ≥90% at d 28 was highly predictive of relapse after HCT. Careful monitoring of CD34+ DCC could identify pts at risk of relapse and might allow therapeutic interventions as tapering of immunosuppression.

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