Retrospective Study of Childhood Ganglioneuroma

2008 ◽  
Vol 26 (10) ◽  
pp. 1710-1716 ◽  
Author(s):  
Bruno De Bernardi ◽  
Claudio Gambini ◽  
Riccardo Haupt ◽  
Claudio Granata ◽  
Antonino Rizzo ◽  
...  
Keyword(s):  
Homovanillic Acid ◽  
Tumor Resection ◽  
Significant Risk ◽  
Complication Rates ◽  
Surgical Results ◽  
Related Complication ◽  
Historical Cohort ◽  
Neuroblastic Tumor ◽  
Aggressive Surgical Approach ◽  
Metaiodobenzylguanidine Scintigraphy

Purpose To review a historical cohort of childhood ganglioneuroma (GN), the benign representative of the peripheral neuroblastic tumor (PNT) family. Patients and Methods Of 2,286 PNTs enrolled between 1979 and 2005, 146 (6.4%) were registered as GN. Histological revision was carried out on 76 tumors. Diagnosis was confirmed in 45, while 27 were reclassified as ganglioneuroblastoma intermixed (GNBI) and four were reclassified as other PNT subtypes. Results GNs differed from other PNTs for sex, age, tumor site, stage, tumor markers, and scintigraphic results. Characteristics of 76 reviewed and 70 nonreviewed patients were comparable. Reviewed GN and GNBI patients were comparable except for homovanillic acid excretion, metaiodobenzylguanidine scintigraphy, and DNA content. Seven patients were only biopsied and 139 underwent surgery. Twenty-two patients suffered surgery-related complications, of which two were fatal and seven were severe. Radical tumor resection and surgery-related complication rates were comparable for GN, GNBI, and nonreviewed instances. Six patients developed tumor progression but survived. Two patients developed a late malignancy but survived. None of the 146 patients received chemotherapy. Of 146 patients, two died of surgery-related complications and 144 survived. Conclusion Diagnosis was changed to GNBI for approximately one third of 76 reviewed tumors. Patients with confirmed GN, reclassified as GNBI, and nonreviewed histology presented with comparable clinical, biochemical, and biologic features. Surgical results, complication rate, number of progressions, and outcome were similar for the three groups. Surgery was associated with significant risk of complications. Survival was not influenced by extent of tumor resection. Aggressive surgical approach should not be recommended for childhood GN and GNBI.

scholarly journals Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

2021 ◽  
pp. neurintsurg-2021-017641
Author(s):  
Kemal Alpay ◽  
Tero Hinkka ◽  
Antti E Lindgren ◽  
Juha-Matti Isokangas ◽  
Rahul Raj ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Flow Diverter ◽  
Supporting Evidence ◽  
Complication Rates ◽  
Related Complication ◽  
Anterior Circulation ◽  
Clinical And Radiological Results ◽  
Ruptured Intracranial Aneurysms

BackgroundFlow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.MethodsThis is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.Results110 patients (64 females; mean age 55.7 years; range 12–82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0–2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).ConclusionsFD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

scholarly journals Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongyuan Ren ◽  
Binni Cai ◽  
Songyun Wang ◽  
Peng Jia ◽  
Yang Chen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Effective Means ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Related Complication ◽  
Aged Patients ◽  
Fluoroscopic Time ◽  
Symptomatic Bradycardia

Background: Left bundle branch pacing (LBBP) has been shown to be a safe and effective means to achieve physiological pacing. However, elderly patients have increased risks from invasive procedures and the risk of LBBP in elderly patients is not known. We aimed to investigate the safety and efficacy of LBBP in elderly patients >80 years of age.Methods: From December 2017 to June 2019, 346 consecutive patients with symptomatic bradycardia, 184 patients under 80 years of age and 162 over 80 years, were included and underwent LBBP. The safety and prognosis of LBBP were comparatively evaluated by measured pacing parameters, periprocedural complications, and follow-up clinical events.Results: Compared with the younger, the elderly group had worse baseline cardiac and renal function. LBBP was achieved successfully in both groups with comparable fluoroscopic time and paced QRS duration (110.0 [102.0, 118.0] ms for the young vs. 110.0 [100.0, 120.0] ms for the elderly, P = 0.874). Through a follow-up of 20.0 ± 6.1 months, pacing parameters were stable while higher threshold and impedance were observed in the elderly group. In the evaluation of safety, overall procedure-related complication rates were comparable (4.4 vs. 3.8%, young vs. elderly). For prognosis, similar rates of major adverse cardiocerebrovascular events (7.1 vs. 11.9%, young vs. elderly) were observed.Conclusions: Compared to younger patients, LBBP could achieve physiological pacing in patients over 80 with comparable midterm safety and prognosis. Long-term safety and benefits of LBBP, however, necessitate further evaluation.

Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

2021 ◽  
pp. 1-11
Author(s):  
Daphne Li ◽  
Vijay M. Ravindra ◽  
Sandi K. Lam
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Statistical Significance ◽  
Flexible Endoscopy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Related Complication ◽  
Rigid Endoscopy ◽  
Pediatric Hydrocephalus ◽  
Significant Difference

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

Retrospective Analysis of Complication Rates Associated With Auricular Reconstruction After Skin Cancer Surgery

2019 ◽  
Vol 24 (2) ◽  
pp. 137-143
Author(s):  
Diana Crișan ◽  
Horațiu Alexandru Colosi ◽  
Avram Manea ◽  
Sabine Kastler ◽  
Anna Lipke ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Infection ◽  
Tumor Resection ◽  
Case Series ◽  
Skin Tumor ◽  
Complication Rates ◽  
Ear Reconstruction ◽  
Retrospective Case ◽  
Auricular Reconstruction ◽  
Early Postoperative Complications

Background There is limited data regarding postoperative complications after microtia surgery or tympanoplasty; however, complication rates after pinna reconstruction following tumor resection and comorbidities associated with suboptimal outcomes have not been investigated so far. Objective To examine the incidence of postoperative complications after auricular reconstruction surgery following tumor resection and determine the association between postoperative complications and defect size, patients’ comorbidities, and reconstruction type. Methods and Materials In a retrospective case series ( n = 146, January 2014 to October 2018), we examined the surgical outcome and amount of postoperative complications following auricular surgery as well as the association with different comorbidities. SPSS 16.0 was used for statistical analyses. Results The following early postoperative complications were identified: pain (29.5%), hematoma (4.1%), flap congestion (4.8%), infection (3.4%), and flap/graft necrosis (2.7%). Late complications including cartilage step-offs, helical rim sulcus alteration, granulomas, or ear deformities occurred only in 3.6% of subjects. Reconstructions of large defects (>1 cm2) were associated with a higher incidence of early postoperative complications compared to small defects (<1 cm2) ( P < .001). Neither the presence of smoking or diabetes nor immunosuppression was significantly linked to an increased incidence of early complications. Immunosuppression, however, was associated with a higher incidence of postoperative infection ( P < .001) Conclusion The incidence of early and late postoperative complications after skin tumor resection and external ear reconstruction is low. The occurrence of postoperative infection was not linked with smoking or the presence of diabetes, but strongly associated with a state of immunosuppression, which is why a perioperative antibiotic prophylaxis in immune-compromised patients may be considered.

scholarly journals 30-day outcome after orthopaedic surgery in patients assessed as negative for COVID-19 at the time of surgery during the peak of the pandemic

2020 ◽  
Vol 1 (8) ◽  
pp. 474-480
Author(s):  
Andrew Price ◽  
Alexander D. Shearman ◽  
Thomas W. Hamilton ◽  
Abtin Alvand ◽  
Ben Kendrick ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Orthopaedic Surgery ◽  
Assessment Tool ◽  
Significant Risk ◽  
Risk Groups ◽  
Morbidity And Mortality ◽  
Nasopharyngeal Swab ◽  
Related Complication ◽  
Time Of Surgery ◽  
Medium Risk

Introduction The aim of this study is to report the 30 day COVID-19 related morbidity and mortality of patients assessed as SARS-CoV-2 negative who underwent emergency or urgent orthopaedic surgery in the NHS during the peak of the COVID-19 pandemic. Method A retrospective, single centre, observational cohort study of all patients undergoing surgery between 17 March 2020 and 3May 2020 was performed. Outcomes were stratified by British Orthopaedic Association COVID-19 Patient Risk Assessment Tool. Patients who were SARS-CoV-2 positive at the time of surgery were excluded. Results Overall, 96 patients assessed as negative for SARS-CoV-2 at the time of surgery underwent 100 emergency or urgent orthopaedic procedures during the study period. Within 30 days of surgery 9.4% of patients (n = 9) were found to be SARS-CoV-2 positive by nasopharyngeal swab. The overall 30 day mortality rate across the whole cohort of patients during this period was 3% (n = 3). Of those testing positive for SARS-CoV-2 66% (n = 6) developed significant COVID-19 related complications and there was a 33% 30-day mortality rate (n = 3). Overall, the 30-day mortality in patients classified as BOA low or medium risk (n = 69) was 0%, whereas in those classified as high or very high risk (n = 27) it was 11.1%. Conclusion Orthopaedic surgery in SARS-CoV-2 negative patients who transition to positive within 30 days of surgery carries a significant risk of morbidity and mortality. In lower risk groups, the overall risk of becoming SARS-CoV-2 positive, and subsequently developing a significant postoperative related complication, was low even during the peak of the pandemic. In addition to ensuring patients are SARS-CoV-2 negative at the time of surgery it is important that the risk of acquiring SARS-CoV-2 is minimized through their recovery. Cite this article: Bone Joint Open 2020;1-8:474–480.

scholarly journals Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

2019 ◽  
pp. 014556131988278
Author(s):  
Carlos Miguel Chiesa-Estomba ◽  
Jon Alexander Sistiaga-Suarez ◽  
Jose Angel González-García ◽  
Ekhiñe Larruscain ◽  
Xabier Altuna-Mariezcurrena
Keyword(s):  
Intraoperative Complications ◽  
Tumor Resection ◽  
Major Complication ◽  
Preoperative Assessment ◽  
Oncologic Outcomes ◽  
Anatomical Location ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Prospective Data ◽  
Single Center Study

Introduction: Despite good outcomes of CO2 laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident. Materials and Methods: An observational, prospective, nonrandomized study. Results: One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors ( P = .001). We do not found difference in complications according to severity (minor vs major complication). Conclusion: Previous studies reported good oncologic outcomes and low complication rates with CO2 transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO2 TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

scholarly journals The Role of Primary Tumor Resection in Colorectal Cancer Patients with Asymptomatic, Synchronous, Unresectable Metastasis: A Multicenter Randomized Controlled Trial

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2306
Author(s):  
Eun Jung Park ◽  
Jeong-Heum Baek ◽  
Gyu-Seog Choi ◽  
Won Cheol Park ◽  
Chang Sik Yu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Complication Rate ◽  
Primary Tumor ◽  
Controlled Trial ◽  
Tumor Resection ◽  
Related Complication ◽  
Cancer Specific Survival ◽  
Randomized Controlled ◽  
Unresectable Metastases

We aimed to assess the survival benefits of primary tumor resection (PTR) followed by chemotherapy in patients with asymptomatic stage IV colorectal cancer with asymptomatic, synchronous, unresectable metastases compared to those of upfront chemotherapy alone. This was an open-label, prospective, randomized controlled trial (ClnicalTrials.gov Identifier: NCT01978249). From May 2013 to April 2016, 48 patients (PTR, n = 26; upfront chemotherapy, n = 22) diagnosed with asymptomatic colorectal cancer with unresectable metastases in 12 tertiary hospitals were randomized (1:1). The primary endpoint was two-year overall survival. The secondary endpoints were primary tumor-related complications, PTR-related complications, and rate of conversion to resectable status. The two-year cancer-specific survival was significantly higher in the PTR group than in the upfront chemotherapy group (72.3% vs. 47.1%; p = 0.049). However, the two-year overall survival rate was not significantly different between the PTR and upfront chemotherapy groups (69.5% vs. 44.8%, p = 0.058). The primary tumor-related complication rate was 22.7%. The PTR-related complication rate was 19.2%, with a major complication rate of 3.8%. The rates of conversion to resectable status were 15.3% and 18.2% in the PTR and upfront chemotherapy groups. While PTR followed by chemotherapy resulted in better two-year cancer-specific survival than upfront chemotherapy, the improvement in the two-year overall survival was not significant.

Short-Term Complications following Single-Session versus Staged Bilateral Tibial Plateau Levelling Osteotomies Stabilized with Locking Plates for Treatment of Bilateral Cranial Cruciate Ligament Disease: A Retrospective Study

2019 ◽  
Vol 32 (06) ◽  
pp. 460-466 ◽  
Author(s):  
Kelsey K. Cappelle ◽  
Matthew D. Barnhart
Keyword(s):  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Significant Risk ◽  
Study Groups ◽  
Complication Rates ◽  
Locking Plates ◽  
Single Session ◽  
Cranial Cruciate Ligament ◽  
Major Complications ◽  
Cranial Cruciate Ligament Disease

Objective The aim of this study was to compare complications between dogs with bilateral cranial cruciate ligament disease treated with single-session bilateral tibial plateau levelling osteotomies (BSSTPLO) versus staged bilateral TPLO (STPLO) procedures stabilized with locking plates. Study Design Medical records of client-owned dogs treated with BSSTPLO or STPLO stabilized with locking plates between March 2017 and July 2018 at two associated institutions were reviewed. Patient data and complications from 37 dogs with BSSTPLO and 18 with STPLO were compared between groups. Major complications were defined as any complication that required further surgical or medical treatment whereas minor complications did not. Results Incidence for major complications for BSSTPLO and STPLO was 7/37 and 6/18 respectively. Incidence for minor complications for BSSTPLO and STPLO was 3/37 and 2/18 respectively. No significant differences in minor or major complication rates existed between study groups (p = 0.2). Mean body weight was significantly higher in the STPLO group (p = 0.001); however, no correlation between weight or BCS and complication rate existed within either group. Increasing age was the only significant risk factor for major complications (p = 0.01) in either group. Conclusion Our findings support the claim that BSSTPLO and STPLO performed with locking implants have similar complication rates. The decision to perform BSSTPLO or STPLO in dogs with bilateral cranial cruciate ligament disease should be based on other considerations rather than just complication rates.

Thromboembolism in Children with Sarcoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4109-4109
Author(s):  
Uma H. Athale ◽  
Stephanie Cox ◽  
Sabrina Siciliano ◽  
Anthony K.C. Chan
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Adverse Outcome ◽  
Significant Risk ◽  
Central Venous Line ◽  
Right Atrial ◽  
Central Venous ◽  
Related Complication ◽  
Exact Test ◽  
Common Causes

Abstract Background: Thromboembolism (TE) is one of the common causes of death in adults with cancer. Cancer is a major risk factor in children with TE and over 40% of children with central venous line (CVL)-related deep venous thrombosis (DVT) had underlying cancer. However, the epidemiology of TE in children with cancer, especially in association with childhood solid tumors is still unknown. Objective: To define the prevalence and epidemiology of TE in association with sarcoma in children. Methods: Hospital records of children ≤18 years of age with sarcoma diagnosed and treated at McMaster Children’s Hospital during January 1990 to September 2004 were reviewed for demographic details, details of diagnosis and therapy for sarcoma, and details of diagnosis and management of TE. Statistical analysis was performed using Fisher’s exact test. Results: Seven of 63 (11.11%) patients with sarcoma developed TE (Table). Six patients had DVT and one patient had right atrial thrombosis. All, but one, patients had central venous line (CVL); three patients had CVL-associated DVT. Four of 28 girls (14.29%; 95% CI 5.7, 31.49) developed TE. Six of 36 patients ≥ 12 years of age developed TE (16.67%; 95% CI 7.87, 31.89) compared to 1 out of 27 (3.7%; 95% CI 0.66, 18.28) patients &lt;12 years of age (p =0.222). Three out of 16 patients with metastatic disease at diagnosis developed TE (18.75%; 95% CI 6.59, 43.01) compared to 4 out of 47 (8.51%; 95% CI 3.36,19.93) (p=0.356) patients with localized disease. Six patients received anticoagulant therapy; one of these six patients required thrombectomy. Four patients received secondary thromboprophylaxis. One patient had recurrence of TE while being off of anticoagulant. Although none of the patients died because of TE or TE-related complication, patients with TE were at high risk for adverse outcome. Four out of 7 (57.1%) patients with TE have died compared to 22 of 56 (39.3%) patients without TE. Conclusions: TE is a significant complication in children with sarcoma and may increase the risk of overall adverse outcome. Older patients and patients with Ewing’s sarcoma seem to be at are at higher, albeit statistically non-significant, risk of TE compared to younger patients and those with other types of sarcoma. Prospective studies of larger patient-populations are needed to define the epidemiology of TE in association with childhood sarcoma. Type of Sarcoma N Patients with TE % TE (95% CI) * Comparison of Ewing’s sarcoma versus rest of patients, p = 0.184 Osteosarcoma 23 1/23 4.35 (0.77, 20.99) Ewing’s sarcoma 19 4/19 21.05 (8.51, 43.33) Rhabdomyosarcoma 14 1/14 7.14 (1.27, 31.47) Other 7 1/7 14.29 (2.57, 51.31) Overall 63 7/63 11.11 (5.99, 21.20)

Efficacy, Complication Rates, and Cost Effectiveness of Chemotherapy Plus Granulocyte Colony Stimulating Factor Conditioned Mobilisation of Peripheral Blood Haematopoietic Stem Cells in Over 150 Patients with Haematological Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2378-2378 ◽  
Author(s):  
Ian H Gabriel ◽  
Juliet Sharon ◽  
Eduardo Olavarria ◽  
Amin Rahemtulla ◽  
Edward Kanfer ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Peripheral Blood ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Organ Damage ◽  
Complication Rates ◽  
Median Cost ◽  
The Cost

Abstract Autologous stem cell transplantation (ASCT) remains the standard consolidation therapy for patients with multiple myeloma (MM) and chemosensitive relapsed lymphoma (r-Ly). Peripheral blood as a source of stem cells (PBSC) has largely replaced marrow and has the advantage of improved engraftment rates. PBSC are routinely collected following administration of chemotherapy in combination with GCSF. However, the resultant pancytopenia poses a significant risk to patients and additional chemotherapy prior to ASCT may lead to increased end organ damage potentially precluding future therapies (including ASCT). Novel agents can achieve PBSC mobilisation without the use of cytotoxics. In the advent of such drugs, we reviewed the efficacy of, and complications experienced by patients during PBSC mobilisation. We also analysed the cost implications of adverse events. Of 151 consecutive attempts, 13.2% of patients failed to reach our criteria in order to attempt pheresis (1 × 104 CD34 cells/ml). Of those achieving target and undergoing pheresis, 6% did not achieve an adequate cell dose for future ASCT (2 × 106CD34+cells/kg) giving an overall failure rate of 19.2%. Furthermore 17.9% failed to harvest our ideal of 4 × 106/kg (permitting &gt;1 ASCT procedure). Factors contributing to failure in achieving target CD34+ve PB count on univariate analysis were; &gt;2 lines of previous chemotherapy and occurrence of neutropenic sepsis (NS (p=0.002, and 0.005 respectively). These factors remained significant on multivariate analysis (RR: 4.4 and 6.2). These same factors also affected CD34+ cell yield on both univariate and multivariate analysis (RR: 3.3 and 4.6). No differences were seen between MM and r-Ly. Overall, the complication rate was 34.4%, with 24.1% of patients suffering NS requiring admission. The mortality rate was 1.3% (NS and intra-cranial bleed). Of those developing NS, only 52% eventually harvested sufficient cells, but with a median delay of 3 days. The median cost of PBSC collection was $17,381.46 ($1,978.97–$39,355.73). NS significantly increased the cost of mobilisation at a median cost of $25,532.95 vs $16,4921) (p=&lt;0.0001). Conclusion: Our results suggest that patients who are potential candidates for ASCT should be harvested as soon as they achieve remission to prevent failure following additional therapy upon relapse. One fifth of patients will fail. The risks associated with current mobilisation protocols are substantial, and also impact greatly on cost, particularly relevant in the current climate of economic probity. Therefore these data suggests that transplant centres should consider the use of non-myelosuppressive agents either in place of, or as a dose reduction strategy for autologous stem cell procurement.

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