Cost analysis of hematopoietic stem cell transplantation in adult patients with acute myeloid leukemia at King Chulalongkorn Memorial Hospital.

The purpose of the study was to analyze the first-year cost ofhematopoietic stem cell transplantation (HSCT) program for the treatment of adult patients with acute myeloid leukemia (AML) at King Chulalongkorn Memorial Hospital (KCMH). The present retrospective study was carried out on 67 AML patients treated with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) at KCMH during the period of 1994 to 2005. The actual total one-year cost from the provider perspective were determined by the reviewing medical records for medical care costs (MCCs) and by adjusting data from the reports of annual cost analysis of KCMH for routine services costs (RSCs). All costs were converted to 2006 values using the Thai consumer price indices. It was found that the full cost of allogeneic HSCT (allo-HSCT) and autologous HSCT (auto-HSCT) in the first year of the program was $22,592.85 and $24,171.25 per case respectively. Cost-effective appraisal, comparing with chemotherapy, need to be studied further.

Thrombophilia profile in Thai patients with arterial thrombotic disorders.

BACKGROUND: Arterial thrombosis is attributed mainly to atherosclerosis and the roles of hypercoagulability remain unclear In addition, there are ethnic variations in thrombophilia profiles. OBJECTIVE: The authors performed a survey of the thrombophilia profile in Thai patients with arterial thrombosis MATERIAL AND METHOD: The authors analyzed 103 consecutive cases of proven arterial thrombosis and requested thrombophilia profile in Chulalongkorn Hospital during 2003-2004. The mean age was 42.5 years. The proportions of stroke, peripheral arteries, and other sites were 70.9%, 22.3% and 6.8%, respectively. RESULTS: Abnormal profile was found in 35.0% with the prevalence of hyperhomocysteinemia, low protein S, antiphospholipid antibody and low protein C was 15.5%, 12.6%, 9.7%, and 5.8%, respectively. There was no difference in clinical characteristics between cases with or without detectable abnormalities. However, the authors found significant associations of low protein S with poor outcome and HIV seropositivity with antiphospholipid. CONCLUSION: The present study found that the defective protein C pathway may be the most common thrombophilia found in Thais with arterial thrombosis. Future study is required to prove the cause-effect relationship and its clinical significance.

Hospital-acquired anemia.

OBJECTIVE: The incidence and etiologies of hospital-acquired anemia has not been well defined A prospective study was conducted to determine the incidence and etiologies of hospital-acquired anemia developed in patients admitted in the medical ward of a tertiary care university hospital. MATERIAL AND METHOD: All non-anemic (hemoglobin (Hb) > or = 13 g/dl in male, > or = 12 g/dl in female) patients who were admitted to the general medical wards for at least 1 week, between March 2001 to October 2001, were included in the present study. Outcome of interest was anemia developed during hospital stay. The total volume of blood collected for investigations were recorded. RESULTS: Of the 98 evaluable patients, 64 (65.3%) developed anemia. Thirty-five percent of the patients had mild anemia (Hb > 10.0 g/dl) and 7% had severe anemia (Hb < or = 8.0 g/dl). Anemia of chronic disease was the most common cause found in 57.4% of anemic patients. Mean total volume of blood collected for investigation was higher in the anemic compared with the non-anemic group (147.0 ml vs. 52.0 ml, p < 0.05). Total volume of investigational blood also correlated significantly with degree of anemia (r = 0.638, p < 0.05). CONCLUSION: Anemia was a common complication occurring in almost two-thirds of patients admitted to the hospital. Even though anemia of chronic disease was the leading cause, investigational blood loss was also an important contributing factor.

Von Willebrand factor (vWF) antigen levels and function in healthy Thais.

Type I von Willebrand disease (vWD) is very common in caucasians. Its genetic basis is possibly heterogenous, lying both within and out of the vWF gene locus. We sought to investigate vWF levels in the Thai population, to compare with those of western countries. The vWF antigen and activity were measured using ELISA and Collagen Binding Assay (CBA), respectively, in 311 healthy Thai volunteers. The mean age was 32.3, ranging from 18 to 75 years. Fifty-four percent were female. Low vWF antigen and activity (below 50 U/dl) were found in 3.5% and 10.2%, respectively. Around 75% and 20% of these cases had O and A blood groups, respectively. Three (0.96%) had definitely low levels of vWF (vWF antigen level below 35 U/dl), suggesting the diagnosis of vWD. Similar to previous studies, vWF levels were lowest in subjects with group O blood. We found that subjects with blood group A had higher vWF levels than group O subjects, but significantly lower vWF levels than those with group B. The average ratio between the vWF activity and antigen was 0.96, ranging from 0.66 to 1.66. These ratios were inversely correlated with age (p=0.047), suggesting a decline in vWF activity per vWF protein with advancing age. Low levels of vWF are common in healthy Thais. Clinicians should be aware of vWD in bleeding patients and beware low levels of vWF in therapeutic plasma products, especially from blood groups O and A.

Mantle cell lymphoma in Thai patients.

Mantle cell lymphoma (MCL) is a disease entity recently introduced into the new lymphoma classification, therefore, the clinical features as well as therapeutic outcomes in Thai patients with MCL has never been described The authors herein retrospectively analysed 21 newly diagnosed patients with MCL at King Chulalongkorn Memorial Hospital from January 1997 to December 2002. The median age of the patients was 54 years (range, 38-79). Male:female was 4:1. Generalized lymphadenopathy (67%) was the most common presenting feature. The majority of patients (85%) had advanced disease (stage III, IV, Ann Arbor system). Fifty-six percent of the patients were classified as the high- and high-intermediate risk group by the international prognostic index. Most patients were treated with CHOP (vincristine, cyclophosphamide, doxorubicin, prednisolone) or CVP (vincristine, cyclophosphamide, prednisolone) regimen. The overall complete remission rate was 59%. With a median follow-up of 13 months (range, 1-62 months), the rates of overall, progression-free and disease-free survivals were 32%, 9% and 20%, respectively. Sixty-seven percent of the patients had relapse/progressive disease after follow-up. In conclusion, the clinical features as well as the outcomes of Thai patients with MCL were comparable to patients in Western countries. Newly diagnosed patients should be treated with novel modalities other than conventional CHOP chemotherapy in order to improve the outcomes.