Summary:Umbilical cord blood (CB) is a useful stem cell source for patients without matched family donors. CB banking is expensive, however, because only a small percentage of the cord units stored are used for transplantation. In this study, we determined whether maternal factors, such as race, age, and smoking status have an effect on laboratory parameters of hematopoietic potential, such as viability, cell counts, CD34+ cell counts, and CFU-GM. We studied the effect of neonatal characteristics such as birth order, birth weight, gestational age, and sex of the baby on the same laboratory parameters. Race and maternal age had no effect on these laboratory parameters. In multivariate analysis, babies of longer gestational age had higher cell counts, but lower CD34 + cell counts and CFU-GM. Bigger babies had higher cell counts, more CD34 + cells, and more CFU-GM. Women with fewer previous live births also produced cord units with higher cell counts, CFU-GM, and CD34 + cell counts. Specifically, each 500 g increase in birth weight contributed to a 28% increase in CD34 + cell counts, each week of gestation contributed to a 9% decrease in CD34 + cell counts, and each previous birth contributed to a 17% decrease in CD34+ cell counts (all P Ͻ 0.05). These data may be used to select the optimal cord blood donors and allow CB banks efficient resource allocation. Bone Marrow Transplantation (2001) 27, 7-14.

Summary:use of intensive chemotherapy, the incidence of therapyrelated MDS is rising. [4][5][6][7] There are also recent reports of therapy-related MDS occurring after autologous transplants Therapy-related myelodysplasia (MDS) is a fatal marrow disorder distinct from primary MDS. We examined for lymphoma and breast cancer. 8-10The prognosis for patients with therapy-related MDS is the efficacy of bone marrow transplantation (BMT) as a treatment for patients with therapy-related MDS.poor. The median survival is 4 months, with deaths due to infection, bleeding, or progression to acute leukemia. 5,7,11Eighteen patients with therapy-related MDS and twenty-five patients with primary MDS received an alloThe prognosis for primary MDS is better, with a median survival of 15 months. 2 However, the outcome is variable geneic, syngeneic, or unrelated donor BMT. Graft-versus-host disease prophylaxis included methotrexate, and the prognosis depends on blast percentage, cytogenetic abnormalities, platelet count and on stage of disease as methotrexate plus cyclosporine, FK-506, or T cell depletion. Conditioning regimens consisted of described by French-American-British (FAB) classification. 12,13cyclophosphamide/total body irradiation, with and without cytosine arabinoside, busulfan/cyclophosTreatment for therapy-related MDS has included intensive induction therapy similar to the regimens used for phamide, and cyclophosphamide/etoposide/carmustine. For patients with therapy-related MDS, the median age acute myelogenous leukemia. These regimens have induced a remission in 60% of patients but the remission duration is was 32 years and the actuarial disease-free survival was 24% (95% confidence interval 6, 42%) with a median only a few months and the overall survival is poor. 14-16 Other approaches have included retinoids, 5-azacytidine, cytosine follow-up of 3 years. For patients with primary MDS, the median age was 36 years and the actuarial diseasearabinoside, growth factors, and hormonal agents, all with no improvement in survival. 17-22free survival at 3 years was 43% (95% confidence interval 22, 64%). Four of the therapy-related patients and Bone marrow transplantation (BMT) is effective therapy for selected patients with primary MDS. [23][24][25][26] The value of two of the primary patients have relapsed. Three patients experienced graft failure; all three had received BMT in patients with therapy-related MDS has been difficult to assess because the number of reported cases is small. T cell-depleted marrow and two had marrow fibrosis. Our results suggest that patients with therapy-relatedIn addition, data for therapy-related MDS have been shown together with primary MDS, making the relative utility of MDS can be successfully transplanted. Transplantation should be considered early in the disease, since longtransplantation for the two diseases difficult to determine. [26][27][28][29][30] In this study, we examine the long-term outcome term disease-free survival is achievable. Keywords: myelodysplasia; bone marrow transplan...

Summary:The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients Xthe age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients o60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher b 2 -microglobulin level at diagnosis (P ¼ 0.016) and fewer had lytic lesions (P ¼ 0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients o60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients X60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT 412 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.

Hemorrhagic cystitis is a major cause of morbidity after bone marrow transplantation. Traditional methods of prevention have included mesna (2-mercaptoethane sodium sulfonate) and bladder irrigation. We report the use of hyperhydration as an alternative to these prophylactic measures. One hundred consecutive patients who underwent autologous or allogeneic bone marrow transplantation received high dose cyclophosphamide with hyperhydration using 5% dextrose normal saline at the rate of 250 ml/h and furosemide to maintain a urine output of >150 ml/h. Seventy-one of these patients also received high dose cyclophosphamide as mobilization chemotherapy. There were no episodes of hemorrhagic cystitis following mobilization chemotherapy. The incidence of hemorrhagic cystitis after transplant conditioning was 7% with 2 patients developing clinically significant hemorrhagic cystitis; one was a severe episode. The cost of hyperhydration was US$ 20 per course as opposed to US$ 1,500 per course for mesna, based on acquisition costs at our institution. We conclude that hyperhydration is a safe, inexpensive means of preventing hemorrhagic cystitis associated with high dose cyclophosphamide in bone marrow transplant recipients.

Acute graft-versus-host disease (GVHD) that is resistant to therapy is a highly lethal complication of marrow transplantation. Inflammatory cytokines such as interleukin-1 (IL-1) may be critical mediators of this process. If so, specific inhibition of IL-1 activity with recombinant human IL-1 receptor antagonist (IL-1Ra), a naturally occurring competitive inhibitor of IL-1, may ameliorate acute GVHD. We performed an open-label, phase I/II trial to evaluate the safety and efficacy of IL-1Ra in 17 patients with steroid-resistant GVHD. The IL- 1Ra was administered as a 24-hour continuous infusion over 7 days. The dose was escalated in cohorts of patients from 400 to 3,200 mg/d. Acute GVHD was evaluated in each affected organ and as an overall grade. Stage-specific improvement of acute GVHD occurred in the skin (8 of 14, 57%), gut (9 of 11, 82%), and liver (2 of 11, 18%). Overall, acute GVHD improved by at least one grade in 10 of 16 (63%) patients. Response to therapy was associated with a reduction of tumor necrosis factor-alpha (TNF-alpha) mRNA levels in blood mononuclear cells (P = .001). The only toxicity attributable to IL-1Ra was reversible transaminase elevation in two patients. Inhibition of IL-1 activity with IL-1Ra is safe and has demonstrable efficacy in acute GVHD that failed to respond to conventional treatment. These data provide further evidence that IL-1 is a mediator of GVHD.

Summary:We describe a successful autologous bone marrow transplant without the use of any blood products. The prognosis for patients with relapsed large cell lymphoma is poor, and high-dose chemotherapy followed by autologous stem cell transplantation is the treatment of choice for young, healthy patients. 1 The risks of high-dose chemotherapy include life threatening bleeding from thrombocytopenia and profound anemia. 2 Autologous stem cell transplantation is usually associated with the transfusion of 5 to 20 units of red blood cell or platelets, with the potential side-effects of infectious disease transmission, transfusion reactions, and iron overload. 3 This report describes a successful autologous stem cell transplant without the use of any blood transfusions in a patient with relapsed lymphoma. Case reportA 34-year-old man presented with a mediastinal mass and superior vena cava syndrome in September 1996. He was diagnosed with large cell lymphoma, stage IIB and was treated with cytoxan/adriamycin/vincristine/prednisone (CHOP) followed by mediastinal irradiation. He was well

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