scholarly journals Six Months Later by N. Richards

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Kelsi McGillivray
Keyword(s):  
International School ◽  
School Librarian ◽  
Study Group ◽  
Sat Scores ◽  
Realistic Fiction ◽  
Big Dreams ◽  
Circle Of Friends ◽  
Waking Up ◽  
Grade 3 ◽  
Authentic Voice

Richards, Natalie D. Six Months Later. Naperville, Ill: Sourcebooks Fire, 2013. Print.Sixteen-year-old Chloe goes to sleep in study group one May and wakes up six months later with everything she could have wanted: unbelievable SAT scores, popularity, and the boyfriend of her dreams. What she doesn't have is any memory about how she got there. As her memories return, the answers only become more clouded and more chilling. Set in current day southern USA, this story explores the ethics of consent and foreshadows the outcomes of living in a medicated society.Chloe has big dreams but only a small chance of reaching them. Her circle of friends is equally minuscule, but when that circle includes Maggie, it’s all she needs. Waking up to find that she has achieved everything she could have dreamed of rings hollow when she realizes it’s also been at the expense of their friendship. And why is she strangely repulsed by her godlike boyfriend, Blake, while just a glance from bad boy Adam Reed is enough to send her spinny? Chloe struggles to determine what has happened to her while the only person she feels she can trust isn't talking to her anymore. The battle becomes more desperate when Chloe begins to believe that her fate is inextricably linked with a former classmate who has disappeared.The story is written with an authentic voice, and realistically depicts the complicated relationships between Chloe, her parents, and her friends. Although the plot is somewhat predictable and at times leaves the reader questioning the characters’ motivations, it engages the reader through the anticipation of Chloe’s gradually-revealed memories. This psychological thriller is the debut work of author Natalie Richards and was a winner of the 2013 YALSA Teen’s Top Ten Award.This book would likely appeal most to young adults who enjoy contemporary realistic fiction, have an interest in psychology or enjoy suspenseful novels.Recommended: 3 out of 4 starsReviewer: Kelsi McGillivrayKelsi McGillivray teaches grade 3 at an international school in Kathmandu, Nepal. She is currently working on her Masters of Education in teacher-librarianship and aspires to become the school librarian in the future. She enjoys reading, hiking, and adventures.

scholarly journals The Rithmatist by B. Sanderson

2015 ◽  
Vol 4 (4) ◽  
Author(s):  
Kelsi McGillivray
Keyword(s):  
New York ◽  
International School ◽  
Harry Potter ◽  
School Librarian ◽  
Writing Style ◽  
Alternate History ◽  
The World ◽  
American Author ◽  
Grade 3

Sanderson, Brandon. The Rithmatist. Illus. Ben Sweeney. New York: Tom Doherty Associates, 2013. Print.What if the survival of humanity depended on the geometry skills of a few elite youths? But it does.Winner of the YALSA 2014 Teen’s Top Ten Award, this book asks readers to envisage an alternate history for Earth. The Asian nation of JunSeo has overtaken much of the globe, and technology relies on elaborate systems of springs and gears. Society relies on the skills of Rithmatists, who use geometric shapes and angles to wage war against a rogue force of chalklings – two-dimensional chalk drawings with a penchant for blood.All Joel has ever wanted to be is a Rithmatist, but he has not been chosen by the Master. In spite of this, he spends all his time exploring Rithmatic principles. Joel’s dreams are realized when the disgraced Professor Fitch begins to tutor him along with remedial Rithmatics student Molly. When the far-off war against chalklings in Nebrask becomes more real and Rithmatic students begin to be targeted close at home, Joel’s suspicions are fixated on the new Rithmatics professor, Nalizar.In the misdt of this fantasy novel, American author Brandon Sanderson has embedded a number of intriguing questions. What would the world be like if a power other than Great Britain had achieved world dominance? What does the idea of predestination mean for those who are not chosen? What if different technologies had taken hold?Although there are literary and symbolic elements that posit this story as a thriller, the author has included enough humor that it still maintains a playful and adventurous tone. A sense of anticipation is maintained throughout, as the principles of Rithmatics and the plot are gradually revealed. Though Sanderson’s writing style at times impedes the immersive quality of the story, the reader is kept deliciously in suspense until the end. Ben Sweeney’s illustrations at the end of every chapter masterfully enhance the reader’s understanding of Rithmatic principles.The first in a series, this book would appeal to readers who enjoy fantasy, such as the Harry Potter series or The Golden Compass.  It is recommended for children in grades 7-12 and is a good example of “hi-lo” fiction. The accessible language will engage reluctant readers. A reading and activity guide is included at the end of the book, suitable for discussion and exploration in a classroom setting.Highly Recommended: 4 out of 4 starsReviewer: Kelsi McGillivrayKelsi McGillivray teaches grade 3 at an international school in Kathmandu, Nepal. She is currently working on her Masters of Education in teacher-librarianship and aspires to become the school librarian in the future. She enjoys reading, hiking, and adventures.

Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction?

2017 ◽  
Vol 46 (4) ◽  
pp. 832-838 ◽  
Author(s):  
Heath P. Melugin ◽  
Nick R. Johnson ◽  
Isabella T. Wu ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Control Group ◽  
Study Group ◽  
Activity Levels ◽  
Segond Fracture ◽  
Acl Tear ◽  
Significant Difference ◽  
Ikdc Score ◽  
Grade 3

Background: There is a paucity of clinical information to guide the treatment of a combined anterior cruciate ligament (ACL) tear and Segond fracture. Purpose: To compare clinical outcomes, graft failure rates, and activity levels between patients undergoing ACL reconstruction (ACLR) with and without an untreated Segond fracture at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients with a combined ACL tear/untreated Segond fracture that was matched based on age, sex, body mass index, and graft type to a control group of patients with an ACL tear and no Segond fracture. All patients were treated with ACLR alone between the years of 2000 and 2015. The diagnosis of a Segond fracture, or bony avulsion of the anterolateral complex, was made by radiographic analysis. Data regarding the initial injury, surgical intervention, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination results, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity levels. Results: Twenty patients (16 male, 4 female) with a combined ACL tear/untreated Segond fracture with a mean age of 26.3 years (range, 13-44 years) were matched to a control group of 40 patients (32 male, 8 female) with an ACL tear and no Segond fracture with a mean age of 26.4 years (range, 13-47 years). The study group was followed for a mean of 59.1 months (range, 24-180 months) and the control group for a mean of 55.5 months (range, 24-120 months). The mean IKDC score was 86.5 (range, 54-100) for the study group compared with 93.0 (range, 54-100) for the control group ( P = .03). The graft rupture rate was 10% for both groups ( P = .97). The mean time to rupture was 33.0 months (range, 21-45 months) in the study group and 63.5 months (range, 39-88 months) in the control group ( P = .24). Patients in the study group had significantly more anteroposterior instability by preoperative Lachman testing than those in the control group (control group: 0 normal, 3 grade 1+, 37 grade 2+, 0 grade 3+; study group: 0 normal, 1 grade 1+, 10 grade 2+, 9 grade 3+; P = .0001). There was no significant difference between the 2 groups in regard to postoperative Lachman testing (control group: 35 normal, 3 grade 1+, 2 grade 2+, 0 grade 3+; study group: 17 normal, 3 grade 1+, 0 grade 2+, 0 grade 3+; P = .31). Patients in the study group had significantly more instability by preoperative pivot-shift testing than those in the control group (control group: 0 normal, 7 grade 1+, 33 grade 2+, 0 grade 3+; study group: 1 normal, 1 grade 1+, 11 grade 2+, 7 grade 3+; P = .0003). No significant difference was found between the 2 groups for postoperative pivot-shift testing (control group: 36 normal, 2 grade 1+, 2 grade 2+, 0 grade 3+; study group: 18 normal, 1 grade 1+, 1 grade 2+, 0 grade 3+; P = .61) or final Tegner activity level (median, 6). Conclusion: At midterm follow-up, patients undergoing ACLR with and without a Segond fracture had similar pivot-shift test results, graft failure rates, and activity levels. The IKDC score was statistically worse in the patients with a combined ACL tear/untreated Segond fracture, but the difference was less than the minimal clinically important difference for the IKDC score. These findings suggest that patients with a combined ACL tear/untreated Segond fracture can have comparable outcomes to patients with an ACL tear and no Segond fracture when treated with ACLR alone.

Lingual Tonsil Hypertrophy in Patients With Allergic Rhinitis

2019 ◽  
Vol 34 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Kübra Çoban ◽  
Alper Köycü ◽  
Erdinc Aydın
Keyword(s):  
Allergic Rhinitis ◽  
Healthy Volunteers ◽  
Laryngopharyngeal Reflux ◽  
Control Group ◽  
Study Group ◽  
Positive Skin ◽  
Lingual Tonsil ◽  
Immunglobulin E ◽  
Skin Prick Tests ◽  
Grade 3

Background Lingual tonsils, part of the Waldeyers’ Ring, are located in base of the tongue. They are commonly observed in childhood, due to increased immunological activity. Several factors such as laryngopharyngeal reflux, younger age, smoking, and obesity are associated with hypertrophy of lingual tonsils (LTH) in adulthood. However, the relation between allergic rhinitis and LTH is not clearly highlightened in the literature so far. Objective To investigate the role of allergic rhinitis in the development of LTH. Methods Adult patients who were diagnosed with allergic rhinitis were included in the study group. The control group consisted of age- and sex-match healthy volunteers. Complete otorhinolaryngology examination including fiberoptic endoscopic evaluation was performed to both groups. Blood samples were obtained for total immunglobulin E levels, and skin prick tests were performed to both groups. Patients with allergy complaints and positive skin prick tests were included in the study group, while healthy volunteers with negative skin prick tests were enrolled in the control group. The grading for LTH was achieved by a physician who was blind to the study. Results The incidence of LTH was significantly higher in the study group when compared to the control group ( P = .001). Similarly, the incidence of grade 3 LTH was significantly higher in the study group compared to the controls ( P = .002). Conclusion According to our results, LTH is more frequently observed in patients with allergic rhinitis. Grade 3 representing larger LTH is more commonly seen in patients with allergic rhinitis.

Clofarabine Is Active in Myelodysplastic Syndrome (MDS).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2660-2660 ◽  
Author(s):  
Stefan Faderl ◽  
Varsha Gandhi ◽  
Susan O’Brien ◽  
Francis Giles ◽  
Jorge Cortes ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Study Group ◽  
Eligibility Criteria ◽  
Lymphoid Leukemia ◽  
Safety And Efficacy ◽  
Prior Therapy ◽  
Grade 3 ◽  
Febrile Episodes ◽  
To Receive ◽  
Acute Myeloid

Background. Clofarabine, an adenosine nucleoside analog, is active in acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL). Its anti-MDS activity is not well defined. Study Aims. To evaluate the safety and efficacy of clofarabine in MDS in two studies, one with intravenous administration and one with oral, using lower doses than those for leukemia (40–52 mg/m2 IV daily x 5). Study Group and Results. The first study randomized patients in a Bayesian design to receive clofarabine 15 or 30 mg/m2 IV daily x 5 every 4–6 weeks. The second study used clofarabine 40 mg/m2 orally daily x 5 every 4–6 weeks (assuming oral bioavailability about 50%). Standard eligibility criteria for MDS were used; only high risk MDS patients (IPSS intermediate or high) were eligible. So far, 16 patients have been treated, 10 on IV clofarabine and 6 on oral clofarabine. Age ≥60 yr in 13 (81%); prior therapy with decitabine/azacitidine 11 (69%); cytogenetic abnormalities 12 (75%). Responses were graded according to International Working Group criteria (IWG). Results are shown in the table below. Myelosuppression was significant resulting in febrile episodes and hospitalization in 4/6 patients on oral clofarabine and in 4/10 patients on IV clofarabine. Rash grade 3 was noted in 1 patient on oral clofarabine. Summary. Clofarabine is active in MDS. The oral dose of 40 mg/m2 daily x 5 may be too high for MDS; lower dose of oral clofarabine 30 mg/m2 orally daily x 5 will be tested with PK studies. The 2 IV schedules (15 vs. 30 mg/m2) are ongoing. Oral Clofarabine IV Clofarabine • Treated/evaluable to date 6/3 10/6 • Response - CR 2 (67%) 3 (50%) - Other IWG response -- 1 (17%)

Bendamustine in Combination with Rituximab (BR) for Patients with Relapsed Chronic Lymphocytic Leukemia (CLL): A Multicentre Phase II Trial of the German CLL Study Group (GCLLSG)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 330-330 ◽  
Author(s):  
Kirsten Fischer ◽  
Stephan Stilgenbauer ◽  
Carmen D Schweighofer ◽  
Raymonde Busch ◽  
Jasmin Renschler ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Overall Response Rate ◽  
Response Rate ◽  
Phase Ii Trial ◽  
Lymphocytic Leukemia ◽  
Study Group ◽  
Overall Response ◽  
Grade 3

Abstract Introduction: Bendamustine, an alkylating agent with additional properties of a purine analogue, has shown considerable activity in monotherapy for solid and lymphoid malignancies including chronic lymphocytic leukemia (CLL). In vitro studies have demonstrated synergistic pro-apoptotic effects of bendamustine and the CD20 antibody rituximab (BR) in primary CLL cells. Encouraging clinical results have been obtained using BR combination treatment in relapsed/refractory and previously untreated Non-Hodgkin’s lymphoma. This phase II trial represents the first study evaluating the efficacy and toxicity of bendamustine in combination with rituximab in patients (pts) with relapsed or refractory CLL. Patients and Methods: 81 pts with a median number of 2 (1–3) pretreatments were enrolled between March 2006 and June 2007. Patients received 70 mg/m² bendamustine on day 1 and 2 combined with 375mg/m² rituximab for the first cycle and 500 mg/m² for the second and subsequent cycles. BR treatment was administered every 28 days for up to 6 courses. Blood samples were taken for molecular cytogenetics by fluorescence in situ hybridization (FISH) and analysis of the immunoglobulin heavy chain (IgVH) mutational status prior to the first treatment course. Assessment for minimal residual disease (MRD) was performed by four-colour flow cytometry of peripheral blood and bone marrow. Primary endpoint of the trial was the overall response rate (ORR). Secondary endpoints included toxicity, duration of response, event-free survival, MRD response rate and overall response rate in biological defined risk groups. Results: 81 pts (mean age 66.7 years) received a total of 328 treatment cycles. A mean number of 4.5 courses was administered. In total 123 CTC grade 3/4/5 adverse events were reported, most frequently on myelosuppression and infections: grade 3/4 anemia occurred in 6.1%, grade 3/4 leukopenia/neutropenia and thrombocytopenia in 11.9% and 9.1% of all given courses, respectively. 16 episodes (4.9%) of CTC grade ≥3 infections were documented, most of them could be successfully managed. However, treatment related mortality occurred in 3.7% of pts: three pts died due to severe infections associated with treatment related neutropenia including 1 fatal pneumonia, one sepsis after diagnosis of Richter’s syndrome and 1 urosepsis. In 62 pts data for response assessment were available: 19 pts were not evaluable for response due to withdrawal or missing of consent, violation of enrolment criteria or early discontinuation of therapy. The overall response was 77.4% with complete remissions (CR) in 14.5% (9 pts) and a partial response (PR) in 62.9% of pts (39 pts). An MRD level below 10E-4 was measured after completion of therapy in 2 of 30 evaluable pts in peripheral blood, while none of the pts achieved MRD negativity in bone marrow. Stable disease (SD) was achieved in 17.7% (11 pts) whereas 3 pts (4.8%) had progressive CLL (PD). Differences in response were observed among genetic subgroups: 12 of 13 pts with 11q- achieved a remission with 11 PR and 1 CR (ORR: 92.3%). Accordingly, 8 of 8 patients with +12 responded (7 PR, 1 CR). In the high-risk group with 17p-, four of nine pts showed a partial remission (ORR: 44,4%). 29 of 39 pts (ORR: 74.4%) with unmutated IgVH status were responsive to BR. Conclusion: Bendamustine plus rituximab is an effective treatment regimen for pts with relapsed and/or refractory CLL and has notable activity in high-risk CLL disease. Major but tolerable treatment toxicities were myelosuppression and infections. Ongoing trial follow-up analysis will define response duration and long-term safety. In a forthcoming trial the German CLL Study group will investigate the efficacy of BR in comparison to fludarabine-based immunochemotherapy (FCR) for first-line treatment of CLL.

Bendamustine Combined with Rituximab (BR) in First-Line Therapy of Advanced CLL: A Multicenter Phase II Trial of the German CLL Study Group (GCLLSG).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 205-205 ◽  
Author(s):  
Kirsten Fischer ◽  
Paula Cramer ◽  
Stephan Stilgenbauer ◽  
Raymonde Busch ◽  
Leopold Balleisen ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Phase Ii ◽  
Research Funding ◽  
Phase Ii Trial ◽  
Study Group ◽  
First Line ◽  
Advisory Committees ◽  
Multicenter Phase ◽  
Grade 3 ◽  
First Line Treatment

Abstract Abstract 205 Introduction: Bendamustine has shown considerable activity in monotherapy for lymphoid malignancies including chronic lymphocytic leukemia (CLL). In vitro studies have demonstrated synergistic pro-apoptotic effects of bendamustine and the CD20 antibody rituximab (BR) in primary CLL cells. Encouraging results have also been obtained using the BR combination treatment in previously treated CLL. This multicenter phase II trial (CLL2M) is the first study assessing the efficacy and toxicity of bendamustine in combination with rituximab in previously untreated CLL patients (pts). Patients and Methods: Between March 2007 and September 2008 117 pts with untreated CLL requiring therapy were enrolled into the protocol. Bendamustine was given at a dose of 90 mg/m2 on day 1 and 2, combined with 375 mg/m2 rituximab for the first cycle and 500 mg/m2 for subsequent cycles. BR treatment was administered every 28 days for up to 6 courses. Blood samples were taken for analysis by fluorescence in situ hybridization (FISH), the IgVH mutational status and expression of ZAP70/CD38. Minimal residual disease (MRD) was evaluated in peripheral blood and bone marrow by 4-color flow cytometry. Results: Data on the entire study population of 117 pts (median age 64 years) with a total of 583 treatment cycles are available. As of June 2009 the median observation time was 15.4 months (mo). 11.1% of the pts presented with stage Binet A, 41.0% with Binet B and 47.9% with Binet C disease. A mean number of 5.0 courses were delivered. 114 pts were evaluable for toxicity, 110 for response and 113 for progression free survival (PFS). The most frequent adverse events based on 583 treatment cycles were myelosuppression and infections: grade 3/4 anemia occurred in 4.9%, grade 3/4 leukopenia in 14.6%, grade 3/4 neutropenia and thrombocytopenia in 6.5% and 6.1% of all given courses, respectively. 29 episodes of CTC grade >3 infections were documented (5.1% of all courses). Treatment related mortality occurred in 2.6% of the pts: one liver failure after attempt of suicide with antihistamines, one fatal pneumonia and one sepsis in neutropenia. The overall response rate was 90.9% with 32.7% (36 pts) clinical complete remissions (CR). A nodular partial remission (nPR) was achieved in 2.7% (3 pts) and a partial response (PR) in 55.5% of the pts (61 pts), respectively. 9.1% of the pts (10 pts) had stable disease (SD) whereas none of the pts was progressive (PD). After 18 mo 75.8% of the pts were still in remission, median PFS has not been reached. An MRD level below 10E-4 was observed after completion of therapy in 29 of 50 evaluable pts in peripheral blood, while 7 of 25 pts achieved MRD negativity in bone marrow. Differences in response were observed among the genetic subgroups: 19 of 21 pts with 11q- achieved a remission with 10 PR and 9 CR (ORR: 90.5%). Accordingly, 17 of 19 patients with +12 responded (14 PR, 3 CR, ORR: 89.5%). In the high-risk group with 17p-, 3 of 7 pts showed a partial response (ORR: 42.9%). 56 of 63 pts (ORR: 88.9%) with unmutated IgVH status responded to BR. Conclusion: Bendamustine plus rituximab (BR) is effective and safe in the first-line treatment of CLL. Major side effects (myelosuppression and infections) were infrequent. Based on these encouraging phase II data the German CLL Study group is presently investigating the efficacy of BR in comparison to fludarabine-based immunochemotherapy (FCR) in the first-line treatment of CLL within a randomized phase III trial (CLL10 protocol). Disclosures: Fischer: Roche: travel expenses. Cramer:Roche: travel grants. Stilgenbauer:Bayer: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria, Research Funding. Fink:Roche: . Boettcher:Roche: Research Funding. Ritgen:Roche: Research Funding. Kneba:Roche: Consultancy, Research Funding; Novartis: Consultancy, Research Funding. Döhner:Roche: Research Funding. Eichhorst:Roche: Honoraria, Research Funding; Mundipharma: Research Funding; Hospira: Honoraria. Hallek:Roche: Consultancy, Honoraria, Research Funding. Wendtner:Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer Schering: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

THE SEVERITY OF DEPRESSION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN COMBINATION WITH ESSENTIAL HYPERTENSION

2020 ◽  
pp. 36-41
Author(s):  
Kochetova E.V.
Keyword(s):  
Quality Of Life ◽  
Essential Hypertension ◽  
Severe Depression ◽  
Chronic Obstructive ◽  
Study Group ◽  
Hypertensive Disease ◽  
Obstructive Pulmonary Disease ◽  
Severity Of Depression ◽  
Grade 3

The purpose of this study was to assess the severity of depression in patients with chronic obstructive pulmonary disease (COPD) with hypertensive disease. Research methods: patients with COPD in combination with hypertensive disease (n = 41) were studied. The study group consisted of patients with COPD with a long history of smoking. The study group was dominated by men (78.05%). The av-erage age of the patients was 64.51 ± 8.66 years. Research of function of external breath was studied with multimodular installation of type «Master-Lab/Jaeger». Exercise tolerance (6MWD, m), degree of dyspnea (MRC scale) were studied. The CAT test (COPD Assessment Test) was used to assess the state of health. Patients were asked to complete a Beck Depression Inventory. Results: Patients with grade 2 COPD accounted for 43.9%, with grade 3 COPD - 39.02%, with grade 4 COPD - 17.08%. Severe depression was diagnosed in 16.67% of patients with grade 2 COPD, in 37.50% of patients with grade 3 COPD and in 42.86% of patients with grade 4 COPD. Very Severe depression was noted in 28.57% of patients with grade 4 COPD. In 50% of patients with severe and very severe depression, a serious effect of COPD on the quality of life (21– 30 CAT points) was re-vealed, a very serious effect of COPD on the quality of life (31– 40 CAT points) was noted in 35.71% of patients. In general, in the group of COPD patients with essential hypertension, severe depression according to the Beck scale was found in 29.27%. Very severe depression was noted in 4.88% of pa-tients with COPD with essential hypertension.

Alternative Schedule of Filgrastim after Autologous Transplantation: Less Dosing, Same Efficacy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4334-4334
Author(s):  
Aida B. Sousa ◽  
Fatima Costa ◽  
Gilda Ferreira
Keyword(s):  
Pilot Study ◽  
Median Time ◽  
Autologous Transplantation ◽  
Standard Of Care ◽  
Control Group ◽  
Study Group ◽  
Current Standard ◽  
Transfusion Requirements ◽  
Clinical Instability ◽  
Grade 3

Abstract Administration of colony-stimulating factors (CSF) after autologous peripheral-blood progenitor cell transplantation is the current standard of care, and G-CSF is usually given from day +5 or +7 until engraftment. Recent preliminary data in a non-transplant setting suggest that 2 doses of G-CSF may be equivalent to the standard schedule. In this pilot study, we evaluated the safety and efficacy of giving only 2 doses of filgrastim post-transplant (days +7 and +9) in non-myeloma pts; exclusion criteria were re-transplants and clinical instability at day +7. From July 07 to June 08, 19 consecutive pts were included (16 lymphomas, 3 acute leukaemias) and their outcome was compared to a historical control group of 42 similar pts transplanted from Jan 06 to Jun 07, who received filgrastim from d+7 until 1000 neutrophils/ul (4–18 days, median 9). There were no significant differences in primary endpoints: median time to neutrophil engraftment (500/ul reached on day +12 vs +11) rate of documented infections (with bacteremia in 23% of transplants in the study group vs 36% in the control group) and median length of hospitalisation (both 22 days). Median duration of intravenous antibiotics (11 vs 12 days) median time to platelet engraftment (20,000/ul reached on day +13 vs +14) incidence of grade 3/4 mucositis and transfusion requirements were also similar. There were no deaths at day +30 in the study group. In 2 of the 19 pts a secondary prescription of filgrastim was made (for 2 and 4 days). In this pilot study, reducing filgrastim administration to 2 doses seems possible without undue risks. If confirmed in a randomized trial, these findings could have a significant impact on the cost of transplantation.

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