Non-cryopreserved unmanipulated hematopoietic peripheral blood stem cell autotransplant program: long-term results.

BACKGROUND: Methods to simplify bone marrow transplantation procedures are needed mainly in developing countries. METHODS: Between May 1993 and February 1999 in a private-practice setting, we performed 29 autotransplants in 28 patients using non-cryopreserved and unmanipulated peripheral blood stem cells mobilized from the bone marrow to the peripheral blood by means of hematopoietic growth factors. The autografting procedure was performed entirely on an outpatient basis in 19 cases (65%). The median age of the patients was 30 years, with a range of 9-67. There were 15 patients with acute leukemia (9 with acute myelogenous leukemia), 3 with chronic myelogenous leukemia, 2 with multiple myeloma, 3 with Hodgkin's disease, 2 with non-Hodgkin's lymphoma, and 4 with metastatic breast carcinoma. RESULTS: The median time to achieve > 0.5 x 10(9)/L granulocytes was 14 days (range 7-42), whereas the median time to achieve > 20 x 10(9)/L platelets was 20 days (range 5-49). The 64-month post-transplant survival was 38%, whereas the median post-transplant survival was 18 months. The transplant-related mortality was 3.4%. The approximate cost of this simplified procedure was 10.8% for in-hospital procedures and for outpatient autografts, substantially lower than figures reported from the U.S. for autotransplants. CONCLUSIONS: This simplified method for autografting patients, avoiding in-hospital stays, purging procedures and cryopreservation of the cells is feasible and results in a substantial decrease of the cost of autologous hematopoietic stem cell transplantation methods.

Tuberculosis-associated fatal hemophagocytic syndrome in a patient with lymphoma treated with fludarabine.

A patient with a stage IV high-grade non-Hodgkin's lymphoma who developed a fatal hemophagocytic syndrome is presented: When the patient had achieved complete remission and receiving fludarabine and chlorambucil/prednisone, she developed miliary tuberculosis, the CD4+ T-cell count then being 50/microL; the hemophagocytic syndrome ensuing at this point was fatal. Speculations about the predisposing factors that could have led to this complication are discussed focusing on the severe cellular immunosuppression which developed probably related to the use of fludafabine: it could be useful in the future to use anti-tuberculous prophylaxis in selected patients treated with this purine nucleoside analog.

[A case of Brunner's gland hamartoma as a cause of digestive tract hemorrhage]. / Un caso de hamartoma de glándulas de Brunner como causa de hemorragia de tubo digestivo.

A twenty six year old woman was admitted suffering an anemia syndrome, postprandial vomiting and intermittent melena of six months evolution. The hemoglobin was 3.5 g/dL: an endoscopy detected a large tumor in the duodenum with a 90% obstruction of the lumen. A biopsy reported an erosive, acute and chronic duodenitis. Subsequently a surgical exploration with duodenotomy showed a large nodular polyp attached to a stalk that was removed: a hamartomatous polyp of Brunner's glands was reported. It coursed with gastrointestinal bleeding and symptoms of duodenal obstruction, which are two of the most common symptoms of this rare tumor.

[Surgical risk and complications after major surgery in patients with cirrhosis]. / Riesgo quirúrgico y complicaciones después de cirugía mayor en pacientes con cirrosis.

In this study we report the morbidity and the mortality observed in 55 patients with cirrhosis who had a major surgical procedure between October 1986 and June 1988, as well as its relation with different variables. The overall mortality was 34.5% and it was due to multiple organ failure or bleeding because of coagulopathy in 18 of 19 patients. The preoperative variables associated with major mortality were: emergency surgery, classification 3 or 4 of the American Society of Anesthesiology (ASA) and poor hepatic reserve evaluated with the Child Turcotte classification (the mortality for A group was 16%, B 62%, and C 100%). The transoperative hypotension increased the mortality 4.5 times. In the postoperative period an elevated APACHE (Acute Physiologic and Chronic Health Evaluation) II score (mortality of 100% in those with greater than 20 points), multiple organic failure (100% died with 2 or more organ failures) or surgical reintervention in the patients with Child A increased significatively the mortality. The 24 patients who survived without complications were discharged on the 19th day (+/- 9 S.D.), while those with complications stayed during 46 days (+/- 18 S.D.).