Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
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Biol. Blood Marrow Transplant. · Jan 2001
Randomized Controlled Trial Clinical TrialRandomized open-label trial of dolasetron for the control of nausea and vomiting associated with high-dose chemotherapy with hematopoietic stem cell transplantation.
A prospective open-label trial was performed to compare the efficacy of dolasetron with that of ondansetron or granisetron (standard therapy) for prevention of nausea and vomiting associated with high-dose chemotherapy with or without total body irradiation followed by hematopoietic stem cell transplantation (HSCT). In a university teaching hospital setting, 62 patients were randomized to receive either dolasetron 100 mg daily or standard doses of ondansetron or granisetron. In addition to objective data such as number of episodes of emesis and quantity of rescue antiemetics required, 100 mm visual analogue scales were used to rate nausea, appetite, and changes in taste. ⋯ Patients in the standard therapy group used fewer rescue antiemetics and also rated more favorably on selected questions of the visual analogue scale. No differences in safety parameters or adverse effects were reported. At doses prescribed in this study, dolasetron was less effective than granisetron or ondansetron in preventing nausea and vomiting associated with high-dose chemotherapy/total body irradiation followed by HSCT.
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Biol. Blood Marrow Transplant. · Jan 2001
Practice Guideline GuidelineGuidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: focus on community respiratory virus infections.
Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant (HSCT) recipients, cosponsored by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, and the American Society for Blood and Marrow Transplantation, were issued in October 2000. The guidelines recommend that to minimize transmission of community respiratory virus (CRV) infection, health care workers and visitors with symptoms of upper respiratory tract infection be restricted from having contact with HSCT recipients and candidates undergoing conditioning therapy. To screen HSCT recipients for CRVs, active clinical surveillance for CRV disease should be conducted on all hospitalized HSCT recipients and candidates undergoing conditioning therapy, including daily monitoring for signs and symptoms of CRV infections. ⋯ If test results are positive, the patient should be treated early and aggressively. Early preemptive therapy with such treatments as aerosolized ribavirin has been proposed, but limited data preclude a recommendation as to the optimal strategy. Lifelong seasonal influenza vaccination is recommended for all HSCT recipients.
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Biol. Blood Marrow Transplant. · Jan 2001
Clinical TrialAllogeneic cell therapy for patients who relapse after autologous stem cell transplantation.
Allogeneic donor leukocytes can be used after nonmyeloablative conditioning to exploit their graft-versus-tumor (GVT) activity in the setting of reduced conditioning-regimen toxicity. This approach may be particularly useful for patients who relapse after autologous stem cell transplantation (SCT). However, GVT activity, toxicity, and ability to establish mixed chimerism may differ in patients who were heavily pretreated prior to SCT compared with patients treated earlier in the course of their disease. ⋯ However, these data show that ACT with either DLI or G-CSF-stimulated blood cells results in direct GVT activity in some patients with Hodgkin's disease, myeloma, and non-Hodgkin's lymphoma, even after relapse from autologous SCT. Most patients developed donor chimerism with minimal conditioning. Alternative prophylactic regimens that control GVHD while maintaining GVT are needed to improve outcomes in these heavily pretreated patients.
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Biol. Blood Marrow Transplant. · Jan 2001
Clinical TrialRespiratory virus infections in stem cell transplant patients: the European experience.
The frequency of and survival from community-acquired respiratory virus (CRV) infections among patients undergoing allogeneic or autologous stem cell transplantation (SCT) were evaluated in a prospective study conducted at 37 medical centers affiliated with the European Group for Blood and Marrow Transplantation. Of the 40 CRV infections diagnosed in 1863 patients (739, allogeneic SCT; 1124, autologous SCT), 20 were attributed to respiratory syncytial virus (RSV), 4 to parainfluenza viruses, and 16 to influenza virus A. ⋯ In an 18-month extension, an additional 53 patients with CRV were identified. Results for the combined data were similar to those from the first phase of the study.
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Biol. Blood Marrow Transplant. · Jan 2001
Successful allogeneic stem cell transplantation with nonmyeloablative conditioning in patients with relapsed hematologic malignancy following autologous stem cell transplantation.
The use of myeloablative preparative therapy and allogeneic stem cell transplantation (alloSCT) as salvage therapy for adult patients with relapsed hematologic malignancy after autologous stem cell transplantation (autoSCT) is generally unsuccessful due to very high treatment-related mortality rates. We evaluated the outcome of HLA-matched related donor alloSCT following nonmyeloablative preparative therapy in 13 patients (median age, 38 years) with relapsed hematologic malignancies (Hodgkin's disease, n = 4; Hodgkin's disease and advanced myelodysplastic syndrome, n = 1; non-Hodgkin's lymphoma, n = 6; multiple myeloma, n = 2) after initial autoSCT. Median time from autoSCT to alloSCT was 12 months (range, 3-24 months); 6 patients had chemotherapy-refractory disease following autoSCT, 6 were in untreated relapse, and 1 had a partial response from salvage chemotherapy. ⋯ The median survival time of the 13 patients is currently 10 months (range, 3-39 months), with an overall survival probability at 2 years of 45% (95% confidence interval [CI], 19%-73%) and a disease-free survival probability at 2 years of 37.5% (95% CI, 12%-65%). Thus, this novel nonmyeloablative alloSCT strategy followed by prophylactic DLI was well tolerated and can result in durable disease-free survival among patients with advanced hematologic malignancies after a failed autoSCT. Further follow-up and evaluation of additional patients are required to conclusively establish the role of this strategy in the treatment of hematologic malignancies after an autologous transplantation.