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Objectives/Hypothesis: Although nume rous investiga tors have reported a bed side percutaneous dilata tional trach eotomy (PDT) complication incidence similar to that of standard oper a tive tracheostomy, other s have proposed a ''learning curve" for PDT r esult ing in incr a ed complications early in individual or institutional experience with this procedure. The obj ctive of this investigation is to char a cterize and qua ntify the propo ed learning curve for PDT. Study Design: Prospective analys is of complication incidence for the first 100 PDT procedures performed in a local community hospital Department of Gen e ral Surgery. Methods: De mographic data, patient disease va riables, and patient anatomic features, a s w ell as pe rioper a tive, postope ra tive, a nd la te complications, wer e recor d d prosp ectively. Patients w ere divided into s quential cohorts of 20 and we r e evaluated for complica tions a t r egular intervals. R esults: P eriopera tive and late complica tion incidence was signifi. cantly high er in the first 20 patients who unde rwent PDT. Howe ver, postope ra tive complication incidence did not s ignificantly vary with operator or institutiona l expe rience. In addition, patients with suboptimal a natomy w er e found to have a significantly increased complication inciden ce, indep ende nt of ope ra tor and institutional expe rie n ce. Conclusions: P er cutaneous dila tional trach eotomy has an identifiable learning curve tha t is most prominent in the first 20 pa tients treated. Early experience with PDT should be obtained unde r controlled circum tances, ideaUy the operating suite. Although most complica-

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Expression of the granulocyte-macrophage colony-stimulating factor (GM-CSF) gene was studied by Northern blot analysis in normal human hematopoietic cells and a series of leukemias. GM-CSF messenger (m)RNA was detected in activated T cells, but not in normal bone marrow cells, monocytes, or nonactivated T cells. In contrast, leukemic cells from 11 of 22 cases of acute myeloblastic leukemia expressed GM-CSF transcripts. Biologically active CSF was detected in supernatant conditioned by 6 of these 11 leukemias. Expression of the GM-CSF gene was not detected in "common" (pre-B cell) acute lymphoblastic leukemia (11 cases tested) or chronic myeloid leukemia (4 cases tested). These results show that the GM-CSF gene is constitutively expressed in a subset of patients with AML, and further suggest that expression of this gene could contribute to the abnormal growth properties characteristic of AML.

Summary:The purpose of the study was to determine the toxicities and effectiveness of a novel preparative regimen of busulfan (Bu) 14 mg/kg, etoposide 50 or 60 mg/kg, and cyclophosphamide (Cy) 120 mg/kg in non-Hodgkin's lymphoma (NHL) and to analyze results using doses based on different body weight parameters and the two different etoposide doses. Three hundred and eightytwo patients aged 16 to 72 underwent first autologous transplantation with mobilized peripheral blood progenitor cells between August 1992 and December 1998 at either of two transplant centers. Mucositis was the most common toxicity. Hepatic toxicity was the most common life-threatening toxicity; severe hepatic VOD occurred in 11 patients (2.9%). Ten patients (2.6%) died from treatment-related toxicity. The 3-year progressionfree survival (PFS) for the entire group was 46.9% (95% CI, 40.5-53.3%). Elevated LDH, resistance to chemotherapy, and intermediate/aggressive histology were significant adverse prognostic factors. For patients in sensitive first relapse PFS was 47.0% (95% CI, 37-57%). Neither etoposide dose nor body weight parameter utilized significantly affected outcome. In conclusion, the novel preparative regimen of Bu, etoposide and Cy results in a low incidence of treatment-related mortality and is effective in the treatment of patients with NHL. Bone Marrow Transplantation (2000) 25, 1243-1248. Keywords: autotransplantation; non-Hodgkin's lymphoma; busulfan High-dose chemotherapy followed by autologous transplantation of hematopoietic progenitor cells is curative in many patients with NHL who fail primary therapy. [1][2][3][4] The superiority of this approach over standard chemotherapy has been proven in patients with chemotherapy-sensitive, relapsed intermediate and high-grade NHL. 5 Autotransplantation is also commonly performed in patients with more advanced