Subject(s)
Antilymphocyte Serum/therapeutic use , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation , Histocompatibility , Immunosuppressive Agents/therapeutic use , Sirolimus/therapeutic use , Tacrolimus/therapeutic use , Adult , Aged , Female , Graft Survival , Humans , Male , Middle Aged , Retrospective Studies , T-Lymphocytes/immunology , Young AdultABSTRACT
High-dose melphalan at 200 mg/m(2) can be administered in 1 day or over 2 consecutive days before autologous hematopoietic cell transplantation (HCT) for multiple myeloma (MM). Limited data exist on the comparison of the two dosing schedules. A retrospective study of 278 consecutive MM patients receiving high-dose melphalan from January 2010 to December 2012 was conducted. Objectives were to compare the length of hospitalization, toxicity profile, response rates, PFS and OS. One hundred and eighty five patients received 2-day dosing and 93 received 1-day dosing. The two end points of the 95% confidence interval (CI) for the difference did not exceed the preselected margin, therefore the length of hospitalization was considered equivalent. No significant differences were found for response rates, PFS and OS. The toxicity profile was similar with the exception of more frequent ⩾grade 3 oral mucositis in the 2-day group (13.5% vs 5.4%; odds ratio 3.07 (95% CI:1.11-8.48); P=0.03). High-dose melphalan, given either in 1 day or over 2 days, produced comparable treatment outcomes except for increased grade 3/4 mucositis in the 2-day regimen. One-day dosing could shorten the hospital stay by 1 day and may allow better resource utilization.
Subject(s)
Hematopoietic Stem Cell Transplantation , Melphalan/administration & dosage , Multiple Myeloma/drug therapy , Multiple Myeloma/therapy , Myeloablative Agonists/administration & dosage , Adult , Aged , Autografts , Combined Modality Therapy , Disease-Free Survival , Drug Administration Schedule , Female , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Melphalan/adverse effects , Middle Aged , Myeloablative Agonists/adverse effects , Retrospective Studies , Transplantation Conditioning/adverse effects , Transplantation Conditioning/methods , Treatment OutcomeSubject(s)
Motion Pictures , Nuclear Warfare , Culture , History, 20th Century , Humans , Japan , Motion Pictures/history , Radiation Injuries/history , United StatesABSTRACT
A health care worker (HCW) was infected via needlestick with human immunodeficiency virus (HIV) type 1 from a subject with AIDS who harbored a zidovudine-resistant, syncytium-inducing (SI) HIV strain. The phenotypic characteristics of the HIV-1 isolates obtained from the HCW and markers of virus load were followed for 20 months. Although the HCW was initially infected with an SI strain, within 75 days of infection the isolate became non-SI and remained so for > or = 635 days. Even though the AIDS patient had a zidovudine-resistant virus, the HCW was infected with a zidovudine-sensitive virus. Plasma RNA levels peaked 20 days after infection, declined rapidly within 2 weeks, and remained stable for the duration of follow-up. Similarly, the HCW's CD4 lymphocyte count remained stable throughout the study. Thus, selection for non-SI and zidovudine-sensitive virus occurred in the HCW, who, after initial symptomatic infection associated with high levels of plasma HIV-1 RNA, developed low plasma RNA copy numbers and stable CD4 lymphocyte counts.
Subject(s)
Acquired Immunodeficiency Syndrome/transmission , HIV Infections/transmission , HIV-1 , Health Personnel , Infectious Disease Transmission, Patient-to-Professional , Needlestick Injuries , Zidovudine/therapeutic use , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/drug therapy , Catheterization, Central Venous , Follow-Up Studies , HIV Antibodies/blood , HIV Core Protein p24/blood , HIV Infections/blood , HIV Infections/drug therapy , HIV-1/drug effects , HIV-1/isolation & purification , Humans , Phenotype , RNA, Viral/blood , Time Factors , Zidovudine/pharmacologyABSTRACT
The hypothesis that catheter-related sepsis (CRS) may be preceded by contamination of the catheter hub was tested in neonates with central venous catheters. Cultures of the catheter hub were obtained three times per week. One hundred thirteen catheters were placed in 88 patients. Of 35 episodes of sepsis, 28 were catheter-related, for a catheter sepsis rate of 1.03/100 catheter-days. CRS occurred in 26 (23%) of 113 catheters. In 10 of 28 episodes, the infecting microorganism was cultured from the hub before its culture from blood obtained at the time of clinical sepsis. In an additional 5 cases, a culture of the catheter hub at the time of clinical sepsis yielded the same isolate as the blood culture. Thus, 54% of episodes of CRS were preceded by or coincided with contamination of the hub. The catheter hub may be a major portal of entry for microorganisms causing sepsis in a neonatal intensive care unit.
