Results: 252 consecutive allogeneic HSCT admissions were included, 137 before versus 115 after introduction of stewardship SOP. Median age was 57 years (range 17-74) and 61.5% (155/252) were male. Majority of HSCT were performed for AML (46%; 116/252), followed by MDS (16.3%; 41/252) and ALL (10.3%; 26/252). Donor type was most frequently MUD (52%; 131/252), followed by sibling (36.9%; 93/252), haplo-identical (8.7%; 22/252) and mismatched MUD (2.4%; 6/252). Mean duration of hospitalisation and profound neutropenia was 30.1 days and 14.8 days respectively. Both study populations show equal distribution of these characteristics, except for a slight increase in proportion of haplo-identical transplants in the stewardship group.
Conclusions: Mycafungin provides effective prophylaxis against fungal infections in children undergoing HSCT. The incidence of breakthrough infections is low at 13.8% in this cohort of high risk children including those with primary immune deficiency disorders, marrow failure and relapsed leukemia. The children at high risk of breakthrough infections are those undergoing haploidentical HSCT. Strategies implemented to reduce our current mortality of 20.5% due to fungal infections include augmenting the dose of mycafungin from 1 mg/kg/day to 2mg/kg/day or azole prophylaxis in selected children, meticulous follow up of serum galactomannan and beta D glucan and introduction of liposomal amphotericin B, early removal of central lines in candida sepsis and liberal use of HRCT chest to help diagnose invasive aspergillosis.
Introduction To Biostatistics Glover Pdf 56
Conclusions: In the largest single-center experience reported to date, we confirm that allo-HCT, including auto-allo HCT, is a reasonable and relevant treatment option conferring low rates of NRM for select high-risk ALCL patients. Given the introduction of highly active novel agents into modern ALCL treatment algorithms, further work is needed to characterize which patients would most benefit most from the additional graft-versus-lymphoma advantage that allo-HCT offers.
Background: The introduction of tyrosine kinase inhibitors (TKI) for BCR/ABL in patients with chronic phase (CP) chronic myeloid leukemia (CML) resulted in disappearance of the disease, restoration of normal life expectancy and even treatment free remission. In contrast, the outcome of patients with advanced disease is still dismal. HSCT remains the only curative option in advanced phase, but data on outcome and risk factors are scarce, on limited patient numbers and short follow-up. The objective of the study was to investigate the outcome in a large population of patients with advanced disease treated with different generations of TKI and transplanted in only two centers over a follow-up period of up to 15 years. The identification of risk factors in multivariate analysis should help to optimize the outcome of this high-risk patient population. 2ff7e9595c
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