Myeloma patients who are able to receive HDM plus ABMT following conventional chemotherapy achieve a high proportion of CRs, which may be associated with prolonged survival.

Summary. High-dose chemotherapy (melphalan) with autologous marrow stem cell support (AMSCS) results in high response rates in multiple myeloma (MM), with up to 50% of patients achieving complete remission. However, these remissions are generally not durable. As the cytokine interferon alpha has been shown to prolong partial response following conventional chemotherapy, this trial was conducted to evaluate its role following high-dose chemotherapy. 85 patients were randomly assigned to maintenance treatment with interferon alpha, 3 × 10 6 units/m 2 subcutaneously three times weekly until relapse or no further treatment following recovery from high-dose chemotherapy (melphalan 140-200 mg/m 2 or busulphan 16 mg/kg) combined with AMSCS. At 5·8 years following the accrual of the last patient in this trial, 38 patients had died, 17 in the interferon arm and 21 in the control arm. The median progression-free survival (PFS) in the 42 patients randomized to interferon alpha was 46 months versus 27 months in the controls. Both overall survival and PFS, which were highly significant at median follow-up of 52 months, have now ceased to be significant, because most patients have ultimately succumbed to their disease. Interferon was tolerated by the majority of patients with very good compliance. Toxicity consisted mainly of flu-like symptoms and malaise which were usually self-limiting. The results of such a pilot study should be carefully interpreted and the benefits of interferon should be confirmed in larger multicentre studies in the setting of minimal residual disease following autologous transplantation.

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Summary Eighteen patients with advanced cancer have been treated intravenously with human recombinant tumour necrosis factor (rhTNF). The drug produced febrile reactions at all doses although these were preventable by steroids and indomethacin. Doses at or above 9 x 105 units (400 pg)m-2 were associated with hypotension, abnormal liver enzymes, leucopenia and mild renal impairment in a substantial proportion of patients. RhTNF was cleared from plasma with a half life of -20 minutes but non-linear pharmacokinetics were seen with decreased clearance at higher doses. In 3 patients, all with lymphoma, improvements in their tumours were recorded.RhTNF was noted to produce rapid increases in serum C-reactive protein concentrations. Endogenous TNF levels were not found to be elevated in 72 cancer patients.TNF deserves further therapeutic evaluation and these observations support its biological importance as an endogenous pyrogen, mediator of acute phase protein responses, and a mediator of endotoxic shock.

ObjectiveThe aim of this study was to investigate the views of young people (YP) with gender dysphoria and their parents concerning fertility preservation and reproductive and life priorities.DesignA cross-sectional questionnaire-based study assessed knowledge of potential effects of treatments for gender dysphoria on fertility, current and future life priorities and preferences regarding future fertility/parenting options among YP and parents.ResultsA total of 79 YP (81% assigned female at birth [AFAB], 19% assigned male at birth [AMAB], aged 12–18 years, 68% between ages 16 years and 18 years) and 73 parents participated. The top current life priority for YP among eight options was being in good health; the least important priority was having children. Anticipated life priorities 10 years from now were ranked similarly. Parents’ rankings paralleled the YP responses; however, parents ranked having children as a significantly higher priority for AFAB compared with AMAB YP in 10 years. The majority of YP (66% AFAB, 67% AMAB) want to be a parent in the future. However, most do not envision having a biological child. A large majority (72% AFAB, 80% AMAB) were open to adoption. None of the YP surveyed pursued fertility preservation.ConclusionFertility is a low current and future life priority for transgender YP. The majority of YP wish to become parents but are open to alternative strategies for building a family. These data may explain in part the reported low rates of fertility preservation among this population. Further studies are needed to assess if life priorities change over time.

Summary:OS yet to reach a median at 8 years and a PFS of 44 months, significantly better than non IFN high-dose A single centre series of 195 consecutive newly diagpatients (P Ͻ 0.0036). However, although we showed nosed untreated myeloma patients under 70 years, seen benefit for selected patients in studies and trials between September 1986 and March 1994, were ana-(particularly with IFN) during the 8-year period of the lysed to assess the impact of current intensive treatment series, this did not translate into overall PFS benefit in methods upon remission rate, response rate and subour study for unselected cohorts of patients for 1986-sequent outcome. They were predominantly an unselec-1988 (64 patients) 1989-1992 (100 patients) and 1992-ted population based group of patients (other than by 1994 (31 patients) in spite of progressive increases in age) that could be used by purchasers of health care the proportion of patients receiving IFN (respectively 6, as a model for outcome assessment. All patients were 35 and 58%). This is likely to be due to the dilution scheduled to receive a care plan which included a of benefit to specific patients by the overall number of sequential package of treatment consisting initially of patients involved. Outcome data from unselected courses of infusional chemotherapy using vincristine, patients are now expected by purchasers and presented adriamycin and methyl prednisolone (VAMP) and 90 of in this way, help qualify the activity impact of advances these also received cyclophosphamide (C-VAMP).made from research trials for the treatment of popuThirty-eight patients received verapamil in addition to lation-based cancer problems. C-VAMP(V-C-VAMP). After VAMP all patients wereKeywords: myeloma; induction; autologous transplanplanned to receive high-dose treatment with melphalan tation; interferon; outcome assessment; population based and an autograft (marrow or blood) and 112 received this treatment; a further 29 patients received modified high-dose treatment with melphalan alone (23) or busulfan (6) and 54 (28%) did not proceed to high-dose treatSince 1980, three important and entirely different treatment because of refusal, resistant disease, poor performments for myeloma have been developed in phase II studies ance or treatment-related death. The patients who and then been shown in controlled trials to markedly received melphalan or busulfan alone instead of highimprove outcome for selected patients with myeloma; dose melphalan/autografts did so because of increasing namely infusional induction chemotherapy, 1-3 high-dose age (P = 0.001) and a raised creatinine (P = 0.05). The consolidation chemotherapy 4,5 with autologous bone marcomplete remission rate was 53% for the whole group row rescue, 6,7 and maintenance interferon. 8,9 However, the and 74% for those receiving high-dose melphalan and nature of controlled trials, with strict entry criteria, usually an autograft. From July 1988, the sequential therapy requires that patients are selected, and further selection package in...

Single-agent HDM without autologous bone marrow transplantation is a feasible therapeutic option in myeloma, and is associated with a high objective response rate, relatively long remission durations, and good symptom control.

Background: Mindfulness-Based Interventions (MBIs) can improve mental health and well-being in adolescents with chronic illnesses. However, there are many barriers such as reduced mobility and distance which compromise accessibility to MBIs. Objective: The aim of this study was to determine the effectiveness of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program in youth with chronic illnesses delivered in person or via eHealth. Method: In this mixed method randomized controlled trial, participants received weekly 90- minute long MARS-A sessions for 8 weeks, either in person or via a secure eHealth audiovisual platform allowing group interactions in real time. Data was collected at baseline, immediately after and two months post-MBI through saliva analyses, electronic participant logs and validated questionnaires assessing mindfulness skills and mental health outcomes. Results: Seven participants per group completed the intervention (total n=14, completion rate 77.8%). Paired t-test analyses revealed a significant reduction in depression/anxiety scores immediately post-intervention (p=0.048, Cohen’s d=0.934) and a significant reduction in pre-post mindfulness cortisol levels at week 8 (p=0.022, Cohen’s d=0.534) in the eHealth group. Frequency and duration of weekly individual home practice (eHealth: 6.5 times; 28.8 minutes; in-person: 6.0 times; 30.6 minutes) were similar in both groups and maintained at follow-up. Conclusion: This is the first study comparing in-person and eHealth delivery of an 8-week MBI for adolescents with chronic illnesses. Although the study was limited by the small size of the sample, our results suggest that eHealth delivery of MBIs may represent a promising avenue for increasing availability in this population.