ABSTRACT
The role of unrelated donor bone marrow transplantation (UD-BMT) in the management of patients with acute myeloid leukaemia (AML) is uncertain. We describe 18 patients with a median age of 13 years (range 4-31) who received an ex vivo T-cell-depleted UD-BMT for AML (13 in second complete remission (CR2) and five in first complete remission (CR1) with high-risk features). Nine donor recipient pairs were fully matched; eight of these donor-recipient pairs had a single class I HLA mismatch; one patient had both single class I and class II HLA mismatches. Grade II GVHD of the skin occurred in four patients (22%) and limited chronic GVHD in two patients (11%). There have been four deaths: one from relapse and three from infection. With a median follow-up of 27 months, 14 patients survive and the actuarial event-free survival at 2 years is 70 +/- 20% (95% confidence interval). We conclude that unrelated donor BMT can result in prolonged disease-free survival in children and young adults with AML.
Subject(s)
Bone Marrow Transplantation/methods , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , Adult , Child , Child, Preschool , Disease-Free Survival , Female , Graft vs Host Disease/etiology , Humans , Lymphocyte Depletion , Male , Opportunistic Infections/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Recurrence , Survival Analysis , Survival Rate , T-Lymphocytes , Transplantation, Homologous , Virus Diseases/complicationsABSTRACT
Juvenile chronic myeloid leukaemia (JCML) is a rare haematological condition of childhood curable only by bone marrow transplantation (BMT). We report our experience using matched and mismatched unrelated donor BMT for JCML in five patients. Although the procedure is hazardous in terms of toxicity and relapse, two patients are alive and disease-free 28 and 49 months post BMT.
Subject(s)
Bone Marrow Transplantation/methods , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Child , Child, Preschool , Female , Graft Rejection , Graft Survival , Graft vs Host Disease/etiology , Humans , Infant , Male , Recurrence , Treatment OutcomeSubject(s)
Bone Marrow Transplantation/adverse effects , Hemolytic-Uremic Syndrome/therapy , Plasma Exchange , Purpura, Thrombotic Thrombocytopenic/therapy , Adult , Child , Child, Preschool , Female , Hemolytic-Uremic Syndrome/etiology , Humans , Male , Purpura, Thrombotic Thrombocytopenic/etiologyABSTRACT
Ten patients with newly diagnosed haematological malignancy were given ofloxacin, 400 mg daily orally, for antibacterial prophylaxis during neutropenia. Before cytotoxic chemotherapy was given, and on three occasions between days 2-3, 5-7 and 8-10 afterwards, blood samples were taken before and 1, 2, 3, 4, 6 and 10 h after administration of ofloxacin. Serum ofloxacin concentrations were measured by HPLC. Mean (range) pharmacokinetic parameters before chemotherapy were: Cmax, 6.1 (2.7-9.1) mg/L; AUC0-2, 7.5 (1.9-11.6) mg.h/L. On days 2-3 post-chemotherapy the values were reduced to: Cmax, 5.0 (3.6-7.3) mg/L; AUC0-2, 5.8 (1.9-7.8) mg.h/L. On days 5-7 the values were: Cmax, 6.1 (4.0-10.4) mg/L; AUC0-2, 8.5 (0.8-16.8) mg.h/L, and by days 8-10 the values were: Cmax, 6.4 (3.3-12.5) mg/L; AUC0-2, 8.6 (0.8-23.1) mg.h/L. There was a statistically significant difference between Cmax pre- and Cmax two to three days post-chemotherapy (paired t-test, P = 0.05). These changes are similar to those previously reported with ciprofloxacin but less marked.
Subject(s)
Antineoplastic Agents/therapeutic use , Intestinal Absorption/drug effects , Ofloxacin/pharmacokinetics , Adolescent , Adult , Aged , Antineoplastic Agents/adverse effects , Chromatography, High Pressure Liquid , Humans , Leukemia/complications , Leukemia/drug therapy , Leukemia/metabolism , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/metabolism , Male , Middle Aged , Neutropenia/microbiology , Neutropenia/prevention & control , Ofloxacin/blood , Ofloxacin/urineABSTRACT
Acremonium species (previously Cephalosporium) are saprophytic moulds of low pathogenicity commonly found in the environment. We report a case of repeated acremonium fungaemia in a neutropenic patient, probably associated with a Hickman line. Fungaemia was accompanied by fever and a papular skin rash, both of which appeared to resolve when the neutrophil count recovered without antifungal chemotherapy, only to return when the patient next became neutropenic.
