scholarly journals Reduction of infection-related mortality after allogeneic PBSCT from HLA-identical siblings: longitudinal analysis from 1994 to 2008 at a single institution

2010 ◽  
Vol 46 (5) ◽  
pp. 690-701 ◽  
Author(s):  
R Martino ◽  
A Kerguelen ◽  
D Valcárcel ◽  
A Sureda ◽  
L Fachini ◽  
...  
Keyword(s):  
Longitudinal Analysis ◽  
Single Institution ◽  
Allogeneic Pbsct ◽  
Related Mortality

Response of 864 Patients to Steroids as Primary Therapy for Acute Gvhd at a Single Institution: Day 28 Response Is the Best Endpoint to Predict Transplant-Related Mortality.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1134-1134
Author(s):  
Margaret L. MacMillan ◽  
Todd E. DeFor ◽  
Daniel J Weisdorf
Keyword(s):  
Regression Analysis ◽  
Partial Response ◽  
Multiple Regression Analysis ◽  
Acute Gvhd ◽  
Initial Therapy ◽  
P Value ◽  
Single Institution ◽  
Factors Associated ◽  
Matched Sibling ◽  
Related Mortality

Abstract Abstract 1134 Poster Board I-156 The optimal primary endpoint for acute GVHD treatment trials has not been established. In a retrospective analysis, we examined the response of 864 patients who received prednisone 60 mg/m2 for 14 days, followed by an 8 week taper, as initial therapy for acute GVHD from 1990-2007 at a single institution. Complete response (CR), partial response (PR), very good partial response (VGPR), and no response (NR) were scored at day 14, day 28 and day 56 after initiation of steroids. To determine the best endpoint, an index of concordance, the c-statistic (C), was performed to estimate the probability that patients with the better GVHD response will have lower transplant related mortality (TRM) than patients with a worse response. Median patient age was 32 (range, 0.2-69) years; 35% were <18 years old. Patients received grafts of HLA-matched sibling bone marrow (BM) or peripheral blood (PB, n=315), partially matched sibling BM or PB (n=24), unrelated donor (URD) BM or PB (n=313), single umbilical cord blood (sUCB, n=89) or double UCB (dUCB, n=123). Prior to initiation of steroid therapy, initial GVHD grades were grade I in 230 (27%), grade II in 504 (58%), grade III in 119 (14%), and grade IV in 11 (1%). Initial GVHD organ involvement was skin only (57%), gut only (17%), liver only (1%) or multiorgan (25%). Day 28 responses were similar to day 56 responses (p=0.14) and better than day 14 responses (p=0.03) in predicting TRM. In multiple regression analysis, patients with NR at day 28 were 2.77 times more likely to have TRM than patients with CR, VGPR or PR while any response favored lower TRM (table). Factors associated with significantly worse 2 year TRM in patients with acute GVHD include: NR to steroids, partially matched BM/PB, high risk disease, older age and skin only GVHD. Factors not associated with TRM include CMV serostatus, conditioning therapy, GVHD prophylaxis, days to steroid treatment, and initial grade of GVHD. Table: Factors associated with 2 year TRM: multiple regression analysis Factor Relative Risk P value Overall P Value Day 28 Response (% patients) . . <0.001     CR (53%) 1.0 .     VGPR (7%) 0.63 0.13     PR (4%) 1.22 0.45     NR (31%) 2.77 <0.001 Donor Type . . <0.01     MSD BM/PBSC 1.0 .     URD well matched BM/PBSC 1.35 0.17     URD partial matched BM/PBSC 1.54 0.03     URD or sibling MM BM/PBSC 1.77 <0.001     Single UCB 1.06 0.83     Double UCB 0.79 0.36 Disease Risk . . 0.02     Standard 1.0 .     High 1.35 0.02 Age 1.0 0.02 0.02     <18 years 1.40     318 years Affected Organs (skin only) . . 0.05     Yes 1.0 .     No 1.36 0.05 Grade at Start of Steroid Therapy . . 0.11     I 1.0 .     II 1.08 0.60     III-IV 1.51 0.10 These data suggest that responses at day 28 or 56 are equally effective endpoints for acute GVHD trials. Day 14 responses cannot as accurately predict TRM. As patients with NR require further therapy in a timely manner, early progression or response by day 28 is the best endpoint to assess efficacy of initial therapy for acute GVHD. Prospective trials are still required to determine the best therapy for different subgroups of patients with acute GVHD, especially those identified to have predictably poor responses and high TRM. Disclosures No relevant conflicts of interest to declare.

Air Conditioning and Heat-Related Mortality in U.S. and Japan: A Longitudinal Analysis

2018 ◽  
Vol 2018 (1) ◽  
Author(s):  
Francesco Sera ◽  
Ana Maria Vicedo-Cabrera ◽  
Masahiro Hashizume ◽  
Yasushi Honda ◽  
Joel D. Schwartz ◽  
...  
Keyword(s):  
Longitudinal Analysis ◽  
Air Conditioning ◽  
Related Mortality

scholarly journals Gastrostomy Tube Outcomes Among Surgical and Non-Surgical Services: A Retrospective Review

2021 ◽  
pp. 000313482110471
Author(s):  
Joshua Herb ◽  
Nidia Rodriguez-Ormaza ◽  
Clark Cunningham ◽  
Neal Bartl ◽  
Jihane Jadi ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Gastrostomy Tube ◽  
Complication Rates ◽  
Single Institution ◽  
Surgical Services ◽  
Service Placement ◽  
Multivariable Analyses ◽  
Baseline Characteristics ◽  
Complications And Mortality ◽  
Related Mortality

Background Our objective was to evaluate differences in baseline characteristics, complications, and mortality among patients receiving a gastrostomy tube (GT) by surgical or non-surgical services. Methods We performed a retrospective analysis of adult patients who underwent GT placement from 2014 to 2017 at a single institution. Using bivariate and multivariable analyses, we compared baseline characteristics, complications, and overall 30-day mortality of patients undergoing GT placement with surgical or non-surgical services. Results Of the 1339 adults who underwent GT placement, surgical and non-surgical services performed 45% (n = 609) and 55% (n = 730) procedures, respectively. Gastrostomy tube-related complications were similar (29.6% surgical vs 28.8% non-surgical, P = .76). Thirty-day mortality was higher among non-surgical services (23.7% vs 16.5%, P = .004). On multivariable analysis, this was not significant (OR 1.21, 95% CI 0.83; 1.77). Conclusion Surgical and non-surgical service placement of GTs had equivalent GT-related mortality and complication rates.

scholarly journals Umbilical cord blood transplantation: a maturing technology

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 215-222 ◽  
Author(s):  
Betul Oran ◽  
Elizabeth Shpall
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Survival Rates ◽  
Single Institution ◽  
Reduced Intensity Conditioning ◽  
Blood Transplantation ◽  
Dose Limitation ◽  
Related Mortality

Abstract The use of umbilical cord blood (CB) as a source of hematopoietic progenitor cells for patients with high-risk hematologic disorders receiving allogeneic hematopoietic cell transplantations (HCTs) has increased significantly. Single-institution and registry studies have shown a decreased relapse rate and an increased transplantation-related mortality rate with similar overall survival rates after allogeneic HCT with CB compared with other donor sources. The transplantation of double CB units has overcome the dose limitation inherent in a single CB unit and thus has markedly extended the use of CB to larger children and adults. Similarly, the use of reduced intensity conditioning in the CB transplantation setting has allowed the treatment of older patients who would be unable to tolerate the myeloablative regimens used in the original CB transplantation protocols.

scholarly journals CLINICAL FEATURES AND OUTCOME IN CHILDREN WITH LANGERHANS CELL HISTIOCYTOSIS. A SINGLE INSTITUTION EXPERIENCE FROM PAKISTAN

2022 ◽  
Vol 71 (6) ◽  
pp. 2194-2201
Author(s):  
Nida Noor ◽  
Rabia Muhammad Wali ◽  
Annis -Ur- Rehman ◽  
Muhammad Abu Bakar
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Clinical Manifestations ◽  
Langerhans Cell ◽  
Single System ◽  
Single Institution ◽  
Multisystem Disease ◽  
Disease Mortality ◽  
Multisystem Involvement ◽  
Related Mortality

Objective: To find out the clinical manifestations, treatment given and outcome of children with diagnosis of Langerhans cell histiocytosis. Study Design: Retrospective observational study. Place and Duration of Study: Shaukat Khanum Cancer Hospital, Lahore Pakistan, from Jan 2005 to Dec 2015. Methodology: Medical charts were reviewed in detail along with the available imaging for the patients. The data included age at the time of diagnosis, extent of the disease, involvement of risk organs, treatment given, response at 6th week of chemotherapy and at the end of the treatment, and outcome in terms of disease progression during the treatment, relapse of disease on follow up and cause of death either due to treatment related mortality or disease complications. Results: There were 29 patients, 12 patients (41%) had single system and 17 (58%) had multisystem involvement. 7 patients (41%) had risk organ involvement in the multisystem group. All the patients of multisystem and 6 patients of single system were treated according to the Langerhans cell histiocytosis III protocol. Commonest sites of involvement were bone in 22 (75%), followed by lymph nodes in 18 (62%) patients. Disease relapse was seen in 6 patients and all of them had multisystem disease. Mortality was observed only in multisystem Langerhans cell histiocytosis patients and more than 50% were risk organ positive. Conclusion: Langerhans cell histiocytosis is a highly heterogeneous disease. Some forms are curable without chemotherapy, while the multisystem disease requires aggressive treatment. However, despite intensive treatment, the multisystem disease and risk organs involved have poor...........

Surgical management of gastrointestinal stromal tumors: A single institution 31 — Year experience

2001 ◽  
Vol 120 (5) ◽  
pp. A401-A401 ◽  
Author(s):  
D EFRON ◽  
K LILLEMOE ◽  
J CAMERON ◽  
S TIERNEY ◽  
S ABRAHAM ◽  
...  
Keyword(s):  
Surgical Management ◽  
Gastrointestinal Stromal Tumors ◽  
Single Institution ◽  
Stromal Tumors
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