Removal of basiliximab by plasmapheresis.

Basiliximab is a chimeric monoclonal antibody directed against the alpha chain of interleukin-2 (IL-2) receptors. Given its expected volume of distribution (plasma volume), therapeutic plasmapheresis may be expected to lower serum Basiliximab levels. A 20-mg dose of Basiliximab was given before plasmapheresis. Blood and pheresis fluid samples were obtained to monitor Basiliximab levels. A total of three blood samples were drawn: the first was obtained 4 hours before, the second sample immediately before commencement, and the third 2 hours after cessation of plasmapheresis. A fourth sample was obtained from the removed plasma. There was an appreciable reduction in Basiliximab concentration levels after plasmapheresis. From the change in serum concentration after plasmapheresis, approximately 64.6% of circulating Basiliximab was removed. Plasmapheresis removes substantial amounts of Basiliximab. Therefore, supplemental Basiliximab should be given after plasmapheresis to maintain the desired duration of IL-2R saturation.

Characteristics and treatment of patients not reusing dialyzers in reuse units.

Dialyzer reuse is practiced in more than 75% of the patients and dialysis units in the United States. However, reuse is not practiced in a small fraction of patients treated in reuse units (RUUs). This study evaluates both patient and facility characteristics associated with nonreuse in RUUs. The data source is from the Dialysis Mortality and Morbidity Study, Waves 1, 3, and 4, of the US Renal Data System. Only facilities that practiced dialyzer reuse were included in the analysis. A total of 12,094 patients from 1,095 reuse facilities were studied. Patients undergoing hemodialysis as of December 31, 1993, were selected. Of all patients treated in RUUs, 8% did not reuse dialyzers. Nonreuse was significantly (P < 0.02) more common, based on adjusted odds ratios (ORs), among patients who were younger (OR = 1.16 per 10 years younger), had primary glomerulonephritis (OR = 1.26 versus diabetes), had lower serum albumin level (OR = 1.72 per 1 g/dL lower), had more years on dialysis, and had higher level of education. Nonreuse patients were more likely to be treated with low-flux dialyzers (OR = 7.35; P < 0. 0001) and have a lower dialysis dose. No reuse was more likely in larger units and in not-for-profit and hospital-based units. Patient refusal accounted for one fourth of nonreuse in RUUs and was associated with the same factors, as well as with fewer comorbid conditions and non-Hispanic ethnicity. Significant geographic variations (up to eightfold) were documented. Nonreuse patients are treated with smaller, low-flux dialyzers and, on average, receive a lower Kt/V than reuse patients in the same units.

Hodgkin's lymphoma in a pregnant patient with acquired immunodeficiency syndrome.

The occurrence of Hodgkin's lymphoma in pregnancy is unusual; its management poses not only medical but also ethical problems. We report the case history of a pregnant patient with acquired immunodeficiency syndrome and Hodgkin's lymphoma. Combination chemotherapy was given, with a favourable outcome for the foetus. From a review of some of the available literature, the management considerations are discussed.