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1.
Presse Med ; 33(7): 474-8, 2004 Apr 10.
Article in English | MEDLINE | ID: mdl-15105770

ABSTRACT

BACKGROUND: After myeloablative treatment and allogeneic stem cell transplantation (ASCT), patients are kept isolated in the hospital to prevent infections during neutropenia. METHODS: So far, 22 patients have been given the choice of being treated at home. Eleven could not be treated at home, and they served as controls. Most of them had haematological malignancies. The donors were 12 HLA-compatible unrelated, 9 HLA-identical siblings and one twin. RESULTS: In the home care group, 3 developed bacteraemia, compared to 9 in the controls (p<0.01). The patient in the home care group had fewer days on total parenteral nutrition (median 3 vs. 24, p<0.001), required fewer erythrocyte transfusions (median 4 vs. 8, p=0.01), fewer days on i.v. antibiotics (median 6 vs. 13 days), and on analgesics (median 0 vs. 15) than the controls (p<0.05). Days with fever, time to engraftment, days with G-CSF and acute GVHD were the same in the two groups. 7/11 patients treated at home were readmitted to the ward for median 3 (0-7) days, due to fever or lack of a caregiver at home. Days to discharge to the out-patient clinic was faster in the group treated at home (median 20 vs 35 days, p<0.01). DISCUSSION: Patients who were treated at home enjoyed being active and taking a walk when they felt like it. This preliminary report suggests that home care after ASCT is not only safe, but better than isolation in the hospital.


Subject(s)
Ambulatory Care , Antineoplastic Agents/adverse effects , Cross Infection/prevention & control , Hematologic Neoplasms/drug therapy , Home Care Services, Hospital-Based/statistics & numerical data , Neutropenia/chemically induced , Opportunistic Infections/prevention & control , Pancytopenia/chemically induced , Stem Cell Transplantation , Adolescent , Adult , Ambulatory Care/statistics & numerical data , Antineoplastic Agents/therapeutic use , Bone Marrow Purging/adverse effects , Bone Marrow Purging/statistics & numerical data , Cross Infection/epidemiology , Female , Fever of Unknown Origin/epidemiology , Fever of Unknown Origin/etiology , Fever of Unknown Origin/prevention & control , Follow-Up Studies , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Neutropenia/complications , Opportunistic Infections/epidemiology , Outcome and Process Assessment, Health Care/statistics & numerical data , Pancytopenia/complications , Patient Isolation/statistics & numerical data , Patient Readmission/statistics & numerical data , Pilot Projects , Risk Factors , Switzerland
2.
Ann Oncol ; 14(5): 758-65, 2003 May.
Article in English | MEDLINE | ID: mdl-12702531

ABSTRACT

BACKGROUND: Little is known about the pharmacokinetics of rituximab in an autologous stem cell transplant (ASCT) setting. PATIENTS AND METHODS: We evaluated serum rituximab levels in 26 patients with follicular or mantle cell lymphoma treated with a combination of ASCT and immunotherapy. Patients received nine infusions of rituximab (375 mg/m(2)): one dose as an 'in vivo purge' prior to stem cell collection, and two 4-week cycles at 8 and 24 weeks following ASCT. Pre- and post-infusion serum rituximab levels were measured during the purging dose, with doses 1 and 4 of both sets of maintenance rituximab cycles, and 12 weeks and 24 weeks following treatment. RESULTS: Rituximab levels were detectable after the first infusion, and peaked at a mean concentration of 463.8 micro g/ml after the final dose. Levels remained detectable 24 weeks after completion of treatment. There was a trend toward higher rituximab levels in patients with follicular lymphoma. Serum concentrations achieved during the maintenance cycles were similar to levels observed in patients with measurable lymphoma treated during 'the pivotal trial'. No correlation was observed between serum rituximab levels achieved in the minimal disease state and the risk of later clinical relapse, nor with the ability to achieve a molecular remission following ASCT. CONCLUSIONS: The finding that patients treated in minimal disease states and at the time of active disease both achieve similar final serum rituximab concentrations after four infusions suggests that the pharmacokinetics are complex, and may not necessarily correlate with disease burden. The precise factors influencing rituximab clearance in patients with lymphoma are unresolved, and this remains an area of active research.


Subject(s)
Antibodies, Monoclonal/pharmacokinetics , Antibodies, Monoclonal/therapeutic use , Bone Marrow Purging/methods , Lymphoma, Follicular/therapy , Lymphoma, Mantle-Cell/therapy , Stem Cell Transplantation/methods , Antibodies, Monoclonal/blood , Antibodies, Monoclonal, Murine-Derived , Bone Marrow Purging/statistics & numerical data , Humans , Immunotherapy/methods , Immunotherapy/statistics & numerical data , Lymphoma, Follicular/blood , Lymphoma, Follicular/immunology , Lymphoma, Mantle-Cell/blood , Lymphoma, Mantle-Cell/immunology , Prospective Studies , Rituximab , Stem Cell Transplantation/statistics & numerical data , Transplantation, Autologous
3.
Haematologica ; 87(1): 17-22, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11801461

ABSTRACT

BACKGROUND AND OBJECTIVES: Autologous stem cell transplantation is a therapeutic option for chronic myeloid leukemia (CML) patients who are not candidates for allogeneic transplant. To reduce the risk of post-autografting disease recurrence, different strategies of stem cell selection have been attempted. The results of using recombinant human granulocyte colony-stimulating factor (rHuG-CSF) for harvesting hematopoietic progenitors in CML patients treated with interferon-a (IFN) are reported. DESIGN AND METHODS: Twenty-one CML patients who received IFN for a median of 21 (8-68) months were mobilized with rHuG-CSF (10 mg/kg/day). Twelve were in complete (CCR) or major (MCR) cytogenetic response. Complete success was considered a sufficient harvest (> 1 x 10(6)/kg CD34(+) cells/kg) without Philadelphia (Ph)+ metaphases in at least one apheresis; a partial success was a sufficient harvest with 1-35% Ph(+) cells. RESULTS: A total of 78 aphereses were performed. No patient had major side-effects. The median number (range) of mononuclear and CD34(+) cells obtained was, respectively, 8.6 x 10(8)/kg (0.9-22.6) and 3.3 x 10(6)/kg (0.4-26.3) per patient. A sufficient cell yield was collected in all but three patients. A complete/partial success was achieved in seven CCR/MCR patients (63%) and in three (33%) with other responses. Four patients underwent successful autografting using the stem cells obtained after rHuG-CSF mobilization. INTERPRETATION AND CONCLUSIONS: Mobilization of IFN-treated patients using rHuG-CSF is safe and provides a significant proportion of Ph-negative progenitors in CML patients in complete or major cytogenetic response.


Subject(s)
Bone Marrow Purging/methods , Granulocyte Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells/cytology , Immunologic Factors/therapeutic use , Interferons/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Blood Cell Count , Blood Component Removal , Bone Marrow Purging/statistics & numerical data , Busulfan/administration & dosage , Busulfan/therapeutic use , Cytarabine/therapeutic use , Feasibility Studies , Female , Filgrastim , Granulocyte Colony-Stimulating Factor/adverse effects , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Humans , Hydroxyurea/administration & dosage , Hydroxyurea/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Leukocytosis/chemically induced , Male , Middle Aged , Neoplastic Cells, Circulating , Pain/chemically induced , Philadelphia Chromosome , Recombinant Proteins , Remission Induction , Safety , Transplantation, Autologous , Treatment Outcome
5.
Oncology (Williston Park) ; 8(9): 19-24; discussion 24, 29-32, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7993723

ABSTRACT

Although the role of hematopoietic stem-cell transplantation (HSCT) in cancer treatment is rapidly expanding, decreasing the side effects of stem-cell infusion is a major challenge. Cancer cells present in the stem-cell collection can cause relapse after autologous transplantation. In allogeneic transplantation. T lymphocytes contribute to graft-versus-host disease. Various methods of purging have been used to remove these unwanted cells, and there is some evidence that such manipulations are clinically useful. Nevertheless, the inability to detect minimal disease makes it difficult to determine whether relapse is caused by incomplete disease eradication in the patient or by the infused cells. This makes it hard to justify the clinical benefit of ex vivo purging. Researchers can focus on this issue by designing studies with minimal variation in other factors that affect the success of stem-cell transplantation.


Subject(s)
Bone Marrow Purging , Hematopoietic Stem Cell Transplantation , Neoplasms/therapy , Bone Marrow Purging/methods , Bone Marrow Purging/statistics & numerical data , Hematopoietic Stem Cell Transplantation/methods , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Humans , Recurrence , Risk
7.
J Hematother ; 2(1): 103-9, 1993.
Article in English | MEDLINE | ID: mdl-7921961

ABSTRACT

Significant amounts of information are currently available within the database generated by the responses to the Bone Marrow Processing Survey. As additional Surveys are returned, the data will continue to be entered into a Lotus spreadsheet, until a more sophisticated database with a programmed interface becomes available. The readership is encouraged to enter or edit the databank by returning a completed or amended Survey to the Society. Copies of the form are available from the Society or can be found in the first issue of the Journal of Hematotherapy.


Subject(s)
Bone Marrow Transplantation/statistics & numerical data , Data Collection , Databases, Factual , Tissue and Organ Procurement/statistics & numerical data , Blood Transfusion, Autologous/statistics & numerical data , Bone Marrow Purging/statistics & numerical data , Bone Marrow Transplantation/methods , Cryopreservation , Forms and Records Control , Global Health , Hematology , Hematopoietic Stem Cell Transplantation , Humans , International Cooperation , Laboratories/statistics & numerical data , Lymphocyte Depletion/statistics & numerical data , Societies, Medical , Tissue Preservation , Tissue and Organ Procurement/methods
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