ABSTRACT
⢠Isolated EMR is defined as the presence of clonal blasts in any tissue other than the medullary compartment with a bone marrow evaluation with less than 5% clonal blasts and a full donor chimerism. ⢠Patients with iEMR have shown better survival outcomes when compared to BMR and EMR and in most cases it heralds a systemic relapse. ⢠Risk factors for iEMR include: younger age, history of EMD, poor risk cytogenetics, advanced disease at HSCT, development of GVHD, and non-TBI based conditioning regimens. ⢠Combination therapy, local and systemic, can achieve better remission rates in this subgroup of patients.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Neoplasm Recurrence, Local/therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adult , Graft vs Host Disease/etiology , Graft vs Host Disease/pathology , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Male , Neoplasm Recurrence, Local/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Risk Factors , Transplantation Conditioning/methodsABSTRACT
BACKGROUND: Arterial blood pressure is the most common variable used to assess the response to a fluid challenge in routine clinical practice. The aim of this study was to evaluate the accuracy of the change in the radial artery pulse pressure (rPP) to detect the change in cardiac output after a fluid challenge in patients with septic shock. METHODS: Prospective observational study including 35 patients with septic shock in which rPP and cardiac output were measured before and after a fluid challenge with 400 mL of crystalloid solution. Cardiac output was measured with intermittent thermodilution technique using a pulmonary artery catheter. Patients were divided between responders (increase >15% of cardiac output after fluid challenge) and nonresponders. The area under the receiver operating characteristic curve (AUROC), Pearson correlation coefficient and paired Student t test were used in statistical analysis. RESULTS: Forty-three percent of the patients were fluid responders. The change in rPP could not neither discriminate between responders and nonresponders (AUROC = 0.52; [95% confidence interval: 0.31-0.72] P = .8) nor correlate (r = .21, P = .1) with the change in cardiac output after the fluid challenge. CONCLUSIONS: The change in rPP neither discriminated between fluid responders and nonresponders nor correlated with the change in cardiac output after a fluid challenge. The change in rPP cannot serve as a surrogate of the change in cardiac output to assess the response to a fluid challenge in patients with septic shock.