Subject(s)
Antineoplastic Agents/administration & dosage , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Piperazines/administration & dosage , Pyrimidines/administration & dosage , Benzamides , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Imatinib Mesylate , Treatment OutcomeABSTRACT
We assessed clinical results in 145 patients with chronic myeloid leukaemia in chronic phase who satisfied criteria for interferon-alpha failure and were thus eligible for treatment with imatinib at the Hammersmith Hospital. We used univariate and multivariate analyses to develop a risk score based on features defined after treatment for 3 months. We identified a low neutrophil count and poor cytogenetic response (<35% Ph-negative marrow metaphases) at 3 months as principal independent predictive factors and incorporated them into a three-tier prognostic scoring system for individual patients. For patients in the low-, intermediate- and high-risk groups, the probabilities of survival at 24 months were 100, 82 and 40% (P<0.0001) and progression-free survival 100, 66 and 15% (P<0.0001), respectively. This Hammersmith prognostic scoring system was validated with an independent cohort of patients treated at another UK centre.
Subject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Piperazines/therapeutic use , Pyrimidines/therapeutic use , Salvage Therapy/methods , Adolescent , Adult , Aged , Benzamides , Cytogenetic Analysis , Drug Evaluation , Female , Follow-Up Studies , Humans , Imatinib Mesylate , Interferon-alpha/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality , Male , Middle Aged , Piperazines/administration & dosage , Prognosis , Pyrimidines/administration & dosage , Risk Assessment , Salvage Therapy/mortality , Severity of Illness Index , Survival Analysis , Treatment FailureABSTRACT
Hematopoietic stem cells collected from umbilical cord blood (UCB) are widely considered a potential alternative to bone marrow. Research on UCB has now developed with the establishment of cord blood banks throughout the world. The aim of our study is to improve the efficiency of our bank because of the high cost and the administrative effort involved in its organization, finding a correlation between the terms of UCB units discarding, such as the low volume and for the low cell counts, and the obstetrics causes. This process has been made to cut the cost of the research and to improve the final result of each bank. We obtained, in 15 months, 683 cord blood units by blood withdrawal from the placenta. The units were cryopreserved within 24 h of collection, in a volume of at least 60 ml with a nucleated cells total of more than 800 per 10(6). Specific analyses of the unit blood to exclude bacterial contamination were undertaken. Of the 683 bags collected, 340 (49.75%) were discarded, and 343 were banked. The main reasons for rejecting the UCB units were: low volume; low cell counts; clinical history; bacterial contamination; freezing problems; unit misidentification; and no informed consent. We suggest that regular monitoring of the reasons for the rejection of the UCB units could give a significant effort to the bank organization, and identifying those units that are suitable before the cryopreservation could save precious resources.
