Bone marrow transplantation
-
Bone Marrow Transplant. · Jan 2010
Reduced-intensity conditioning using fludarabine with either antithymocyte globulin and BU, or low-dose TBI allowing allogeneic hematopoietic SCT.
In a single-center study, we analyzed the outcomes of 66 patients with advanced hematological malignancies receiving two reduced-intensity conditioning regimens for allogeneic transplantation: fludarabine and low-dose TBI (flu/TBI, n=25), or fludarabine, antithymocyte globulin and BU (flu/ATG/BU, n=41). The selection criteria were based on the hypothesis that flu/TBI patients were expected to achieve autologous recovery in the event of non-engraftment. Sixty-three patients (95%) engrafted. ⋯ By contrast to our hypothesis, patients receiving flu/TBI who subsequently failed engraftment did not achieve autologous recovery. Yet, rapid attainment of full donor chimerism after flu/TBI is associated with greater survival than after flu/ATG/BU. Further, larger prospective randomized studies are required to define the advantage of one regimen over the other.
-
Bone Marrow Transplant. · Jan 2010
Multicenter StudyA multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT.
Acute kidney injury (AKI) is a common early complication in patients with hematopoietic SCT (HSCT). However, there are limited data about the incidence and risk factors of AKI in patients with nonmyeloablative HSCT. We conducted a multicenter, retrospective cohort study of 62 patients from three institutions who were treated with similar protocols for nonmyeloablative HSCT. ⋯ Complications such as acute GVHD, veno-occlusive disease of liver and sepsis were also associated with the development of AKI (OR 12.1; 95% CI 2.4-62.4). AKI was significantly associated with mortality (OR=4.7; 95% CI 1.9-11.5). We concluded that AKI is a very common complication in patients with nonmyeloablative HSCT, which is associated with incomplete HLA-matched transplant and complications, and has an important impact on the patients' first year of survival.
-
Bone Marrow Transplant. · Jan 2010
Comparison of general vs regional anaesthesia for BM harvesting: a retrospective study of anaesthesia-related complications.
This retrospective study was conducted to evaluate the safety and complications profile of general anaesthesia (GA) compared with that of regional anaesthesia (RA) for BM harvesting (BMH). The study included 281 donations carried out between 1992 and 1999. Of these, 204 (73%) were allogeneic donations, and GA was carried out in 69% (140 of 204) and RA in 31% (64 of 204) of cases. ⋯ However, the incidence of postoperative events was higher in the allogeneic group compared with that in the autologous group (25 vs 10%, P<0.01) and in female donors compared with male donors (29 vs 14%, P=0.002). In conclusion, both GA and RA are comparable with regard to BMH. Nevertheless, non-severe intra- and postoperative events were frequent.