A multi-institutional comparison of mitoxantrone, etoposide, and cytarabine vs high-dose cytarabine and mitoxantrone therapy for patients with relapsed or refractory acute myeloid leukemia.

Relapsed or refractory acute myeloid leukemia (R/R AML) has a poor prognosis and is best treated with salvage chemotherapy as a bridge to allogeneic stem cell transplant (alloSCT). However, the optimal salvage therapy remains unknown. Here we compared two salvage regimens; mitoxantrone, etoposide, and cytarabine (MEC) and mitoxantrone and high-dose Ara-C (Ara-C couplets). We analyzed 155 patients treated at three academic institutions between 1998 and 2017; 87 patients received MEC and 68 received Ara-C couplets. The primary endpoint was overall response (OR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of hospitalization, hematologic and nonhematologic toxicities, and success in proceeding to alloSCT. Baseline characteristics of the cohorts were well matched, though patients receiving Ara-C couplets had more co-morbidities (48.5% vs 33%; P = .07). OR was achieved in 43.7% of MEC and 54.4% of Ara-C couplets patients (P = .10). Ara-C couplets patients also trended towards a longer OS and PFS, more frequently proceeded to alloSCT (31% vs 54.4%; P = .003), and experienced less febrile neutropenia (94% vs 72%; P < .001) and grade 3/4 gastrointestinal toxicities (17.2% vs 2.94%; P = .005). No significant differences in other toxicities or median duration of hospitalization were noted. This is the first multi-institutional study directly comparing these regimens in a racially diverse population of R/R AML patients. Although these regimens have equivalent efficacy in terms of achieving OR, Ara-C couplets use is associated with significant reductions in toxicities, suggesting it should be used more frequently in these patients.

Retrospective Evaluation of Anaesthetic Techniques for Caesarean.

OBJECTIVE: This study aimed to evaluate the maternal, foetal and neonatal effects of anaesthetic techniques used in caesarean sections (C/S) retrospectively over 6 years at the Hospital of Medical School of Dokuz Eylül University and to compare the results with the literature from Turkey and developed countries. METHODS: After obtaining approval from the ethics committee, anaesthetic and gestational data from all caesarean operations performed over a 6-year period between 2005 and 2010 was retrospectively obtained from hospital archives. RESULTS: During this period, a total of 10,819 labours was conducted and C/S ratio was 55% with 5953 patients. General anaesthesia was performed in 1479 patients (24.8%) and regional anaesthesia was performed in 4474 patients (75.2%) [Spinal anaesthesia for 1203 patients (26.9%), epidural anaesthesia for 830 patients (18.5%) and combined spinal-epidural anaesthesia for 2441 patients (54.6%)]. In 2010, regional anaesthesia ratio increased to 84.6%, whereas in 2005, it was 63.8%. Regional anaesthesia was used significantly more often in both elective and urgent patients (82% elective and 65.2% emergency). Because of failed regional anaesthesia or surgical complications, anaesthesia was changed to general anaesthesia in 215 patients (4.8%). APGAR scores in 1 and 5 min were significantly higher with regional anaesthesia when compared with general anaesthesia. CONCLUSION: Regional anaesthesia rate for C/S patients in the Hospital of Medical School of Dokuz Eylül University is increased and is higher than Turkey's average; but these figures are still lower than those in the developed countries.