Annals of hematology
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Annals of hematology · Apr 2008
Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates.
Infectious complications are a major cause of morbidity and mortality in immunosuppressed patients. Febrile patients with hematologic malignancies and pulmonary infiltrates have high mortality rates, especially if mechanical ventilation is required. The diagnostic value of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in these patients is controversial. ⋯ Three nonlethal complications (bleeding, arrhythmia) occurred that required early termination of FOB. In 94 (38.2%) patient episodes, antibiotic treatment was modified as a result of microbiological findings in BAL samples. Our results show that FOB with BAL is a valuable diagnostic tool with low complication rates in high-risk febrile patients with hematologic malignancies and pulmonary infiltrates, contributing crucial results for the individual case, and also improving epidemiologic knowledge.
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Annals of hematology · Apr 2008
The sepsis-related Organ Failure Assessment (SOFA) score is predictive for survival of patients admitted to the intensive care unit following allogeneic blood stem cell transplantation.
Intensive care unit (ICU) support following allogeneic peripheral blood stem cell transplantation (PBSCT) is controversial due to the limited prognosis of these patients in case of secondary critical illness. In this retrospective single centre study, we looked for factors predicting survival in patients who needed ICU support after myeloablative (MAC) or non-myeloablative conditioning (non-MAC) therapy and allogeneic PBSCT. Between 1999 and 2006, 64 out of 319 patients following allogeneic PBSCT were admitted to the ICU (24 female and 40 male patients, median age 47 years, range 17-65 years; MAC 49 patients, non-MAC 15 patients). ⋯ Nineteen of 49 patients who had received MAC therapy survived the ICU stay for a median time of 9 months (range 2-29 months) and three of 15 patients who had received non-MAC therapy could be discharged from the ICU with a survival time of 4, 5 and 12 months. After univariate and multivariate analysis the SOFA score discriminated survivors and non-survivors of the ICU stay. We conclude that the SOFA score is predictive for survival when applied on the day of ICU admission.
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Annals of hematology · Feb 2008
Kinetics and apoptotic profile of circulating endothelial cells as prognostic factors for induction treatment failure in newly diagnosed acute myeloid leukemia patients.
The circulating endothelial cells (CEC) are proposed to be a noninvasive marker of angiogenesis. Recent data suggest that endothelial cells may enhance the survival and proliferation of leukemic blasts and mediate chemotherapy resistance in acute myeloid leukemia (AML). We analyzed CEC count by the four-color flow cytometry in AML and healthy subjects. ⋯ In refractory AML, the aCEC, rCEC, CEPC, and CEC(AnnV+) counts assessed before and after induction chemotherapy did not differ significantly, and a significant decrease in CEC count and increase in CEC(AnnV+) number were noted only after the last dose of chemotherapy. The number of CEC is significantly higher in AML patients than in healthy subjects and correlates with response to treatment. The evaluation of CEC kinetics and apoptotic profile may be a promising tool to select AML patients with poor response to chemotherapy who may benefit from antiangiogenic therapies.
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Annals of hematology · Sep 2007
Pure red-cell aplasia following major and bi-directional ABO-incompatible allogeneic stem-cell transplantation: recovery of donor-derived erythropoiesis after long-term treatment using different therapeutic strategies.
Blood group incompatibility between donor and recipient of allogeneic stem cell transplants may be associated with post-transplant erythroid aplasia. A total of 548 patients (pts) received allogeneic transplant for malignant and non-malignant hematologic disorders. In a retrospective analysis, the prevalence and outcome of pure red-cell aplasia (PRCA) in 44 pts with major and bi-directional ABO-mismatch were investigated. ⋯ Major ABO mismatch may lead to delayed donor erythroid engraftment. It results in long-term transfusion dependence and, therefore, the risk of iron overload. The therapy is long lasting, but usually effective in majority of patients.
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Annals of hematology · Aug 2007
Comparative StudyIfosfamide, epirubicin, and etoposide (IEV) mobilize peripheral blood stem cells more efficiently than cyclophosphamide/etoposide.
High-dose chemotherapy with autologous stem cell support is an effective treatment in advanced multiple myeloma. In this study, we compare chemotherapy with ifosfamide, epirubicin, and etoposide (IEV) or cyclophosphamide and etoposide (CE) in 47 patients with multiple myeloma with regard to stem cell mobilization, toxicity, and tumor response. The proportion of patients reaching the threshold of >6 x 10(6) CD34+ cells/kg body weight was significantly higher in the IEV group (97% vs 71%), and more CD34+ cells (10 x 10(6) vs 3.5 x 10(6) cells/kg; p = 0.002) could be collected by the first leukapheresis associated with less leukaphereses needed. ⋯ However, the overall response rate (complete response and partial tumor response) after mobilization and tandem high-dose chemotherapy was 75% after IEV and 78% after CE and, thus, independent of the mobilization. In summary, both treatment protocols can readily be used for the mobilization of peripheral blood stem cells with comparable major toxicities and similar tumor response rates. However, the efficiency of the stem cell mobilization was significantly higher after IEV treatment.