We performed a prospective, randomized, open, blinded end point (PROBE) study to assess the efficiency of transfusing high doses of platelets in patients with thrombocytopenia, either acute leukemia (AL) or those undergoing autologous hematopoietic stem cell transplantation (AT). Patients were randomly assigned to receive transfusions with a target dose of 0.5 ؋ 10 11 /10 kg (arm A) or 1 ؋ 10 11 /10 kg (arm B). A total of 101 patients were included, of whom 96 were given at least one transfusion. The median time between the first transfusion and when the platelet count reached at least 20 ؋ 10 9 /L increased from 63 hours to 95 hours in the arm B group (P ؍ .001), and the median number of transfusions was lower in this group (2; P ؍ .037). The total number of transfused platelets did not differ between groups (14.9 ؋ 10 11 for arm A versus 18.5 ؋ 10 11 for arm B; P ؍ .156). In such patients, a prophylactic strategy of high doses of platelets could improve platelet transfusion efficiency. IntroductionIn hematologic patients with thrombocytopenia, platelet transfusions remain vital in supportive care. If the dose of 0.5 ϫ 10 11 /10 kg 1 remains the standard, 2-5 the optimal dose for prophylactic treatment is debatable. Results of 2 studies comparing different doses of platelets showed an increased platelet count and time between 2 transfusions according to the dose. 6,7 Both were crossover studies; however, transfusion efficiency may be associated with the number of previous transfusions and dose. To assess the overall efficiency of transfusing a high dose of platelets, we performed a prospective randomized study to compare the effect of a single dose (0.5 ϫ 10 11 /10 kg) versus a double dose (1 ϫ 10 11 /10 kg) of platelets on repeat transfusion in hematologic patients with thrombocytopenia. Study design PatientsPatients who had not undergone transfusion who had acute leukemia (AL; AML3 excluded) undergoing first-line treatment or autologous hematopoietic stem cell transplantation (AT) without criteria impairing platelet efficiency were enrolled. Setting and ethical approvalThe study protocol was approved by the institutional review board of Brest, France, and written informed consent of patients was obtained. Four regional blood banks in France (Etablissement Français du Sang [EFS]) and hematology departments from university hospitals in Angers, Besançon, Brest, and Tours, France, participated. Trial designThe design was multicenter, randomized, parallel group. Physicians and patients were not blinded to the randomization arm. The main outcome parameter was platelet count and the laboratory was blinded to the dose of platelets received, thus defining the study as a prospective, randomized, open, blinded end point (PROBE) study. 8 Randomization was based on the center and type of pathology. Platelet transfusion protocolBlood cells were counted daily between 7:00 and 8:00 AM, and transfusions were given when the platelet count was less than 20 ϫ 10 9 /L. To avoid interference with criteria known to impair re...
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy with mixed hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) histological features. It is almost impossible to obtain an accurate, preoperative noninvasive diagnosis of cHCC-CC with tumor markers or crosssectional abdominal imaging due to the mixed histological features. Despite these difficulties, accurate cHCC-CC diagnosis remains an important goal with prognostic significance. In our study, we retrospectively reviewed the tumor markers: AFP and CA 19-9, and cross-sectional liver imaging, in light of liver explant findings, to identify and characterize cHCC-CC features followed by liver transplantation (LT) outcome analysis. The results from this 12 patient cohort failed to identify characteristic features for cHCC-CC. None of the imaging features helped to identify the cHCC-CC tumor and they mimicked either HCC or CC, depending on the degree of glandular differentiation expressed histologically. In our cHCC-CC LT recipients, the 1-, 3-and 5-year cumulative survival probabilities were 79%, 66% and 16%, respectively with a 5-year survival comparable to or better than LT for intrahepatic CC but poorer than LT for HCC following the Milan criteria. Conceivably explained by its cholangiocarcinoma component the LT outcome for this rare and hard to diagnose tumor appears poor.
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