bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myelodysplasia after Autologous Stem Cell Transplantation for Multiple Myeloma.
Authors: Franz Gregory , McClune Brian , Buadi Francis , Walsh William , White Frank , Przepiorka Donna 
Published: October 2019

Abstract
Autologous stem cell transplantation (ASCT) increases the overall survival of patients with newly diagnosed multiple myeloma (MM), and it has become standard of care in this setting. Long-term survivors of ASCT transplanted for lymphoma or Hodgkin’s disease are known to have a high risk of developing myelodysplasia (MDS), but the risk of MDS is not clear for patients transplanted for MM. From 1996 through 2005, 82 patients underwent ASCT for MM at our center, survived at least 6 months and have adequate documentation of follow-up for review. The group included 47 males and 35 females of median age 56 years (range, 37–74 yrs). Median time from diagnosis to ASCT was 8.2 mos (range, 2.6–86.1 mos). Prior to coming to transplantation, 28% had received melphalan (MEL), 98% received some form of chemotherapy, and 34% received radiation. This prior therapy included 1 or 2 regimens for 48% of the patients, and more than 2 regimens for 52% of patients. Mobilization was effected using CYC plus growth factor for 79% of the patients, CAD or VAD plus growth factor for 17%, and growth factor alone for 4%. The median mobilization rate was 28.7 × 106 CD34/L blood processed (range, 2.0–250.1 × 106 CD34/L blood processed). A single ASCT was provided for 68%, and 32% underwent ASCT more than once. High-dose MEL alone was used as the preparative regimen for 83%, and the remainder received at least one ASCT with a more intensive preparative regimen. The median CD34 dose for the first ASCT was 5.1 × 106/kg (range, 0.4–113.0 × 106/kg). Nine patients developed MDS. The 5-yr actuarial risk was 26% (95% CI, 8–43%). On multivariate analysis, there was a trend for an increased risk of developing MDS with a CD34 cell dose <3 × 106/kg (HR 3.0, 95% CI 1.0–16.2, p=0.059), but there were otherwise no significant prognostic factors. Eight of the 9 patients with MDS had a PR or better as the best response to ASCT for MM. Five of the MDS patients had relapse of MM as well. Median survival after the diagnosis of MDS was 18.1 mos. Five patients with MDS have died, two from recurrent myeloma, two from AML, and one from sepsis and MDS. The median survival for all patients was 51.7 mos from ASCT and 69.1 mos from diagnosis, and there were no differences in survivals between those with or without MDS. We conclude that there is a relatively high risk of MDS after ASCT for MM, but development of MDS does not appear to worsen overall survival.
Results of CCG-5941: Intensified Multiagent Chemotherapy and Non-Cross Resistant Maintenance Therapy for Advanced Lymphoblastic Lymphoma in Children and Adolescents.
Authors: Abromowitch Minnie , Sposto Richard , Perkins Sherrie , Finlay Jonathan , Cairo Mitchell S. 
Published: October 2019

Abstract
The treatment of advanced (Stage III/IV) pediatric lymphoblastic lymphoma (LL) has recently utilized treatment strategies similar to childhood acute lymphoblastic leukemia (ALL) with prolonged maintenance chemotherapy for up to two years (Burkhardt et al JCO, 2006) compared to older treatment strategies of less intense lymphoma type therapy (Anderson et al NEJM, 1983). The CCG previously piloted a “NY regimen” for “lymphomatous” ALL with a new intensive induction/intensive conditioning and alternating non-cross resistant combination maintenance therapy (Steinherz et al JCO, 1986). We modified the NY regimen for lymphomatous ALL in children with advanced (Stage III/IV) lymphoblastic lymphoma with ≤25% BM lymphoblasts. Between July 1994 and June 1997, 85 eligible LL patients with advanced disease (Stage III/IV) were enrolled in a pilot study CCG-5941 to estimate toxicity, feasibility and efficacy of a short (12 month) aggressive multiagent chemotherapy regimen. Patients were staged according to the St. Jude staging system. Induction (3wks) consisted of VCR, Pred, Daunomycin, Cyclophosphamide, L-ASP and IT MTX/ARA-C. Consolidation (3wks) consisted of VCR, ARA-C, VP-16, HD MTX and IT MTX. There were six maintenance courses each consisting of 4 pulses: A (Cylcophosphamide, 6TG), B (VCR, Pred, Dauno), C (VCR, HD MTX, L-ASP) and D (ARA-C, VP-16). CNS positive pts received 1800 cGy-cranial and 600 cGy spinal at completion of chemotherapy (approximately 1 yr). Central pathology review (84%) and immunophenotyping were preformed with CD3, CD5, CD45RO, TDT, CD 79 and CD20. Neupogen (G-CSF) was given after each cycle to maintain dose intensity. Median age 10 yrs (1–18 yrs), 64% male, median f/u 7.2 yrs, 91% T-cell, 7% B-cell, 2% mixed lineage, 27% LDH ≥2nL, 12 % M2 BM, 5% CNS positive. Among the 85 patients there were four deaths unrelated to disease progression (4.7%), three due to infectious complications and one due to venoclusive disease of the liver. Two second malignant neoplasms (AML) have occurred. Hematopoietic (grade III/IV) toxicity occurred in approximately 80% of patients, resulting in delays in chemotherapy. The 5yr event free survival (EFS) is 78±4.5% and 3 yr overall survival (OS) is 85±3.9%. Analysis of EFS by age, sex, induction responses, marrow status at diagnosis (M2 vs M1), presence of CNS disease, LDH ≥2nL and presence of mediastinal mass was not significant. The prognosis in patients with progressive/relapsed disease was dismal with a 2 yr OS of 33±14%. These pilot results suggest that this experimental approach in children and adolescents with advanced LL is safe and feasible and results in similar long term efficacy as compared to more prolonged maintenance ALL type chemotherapy regimens.
Reduced-Intensity Bone Marrow Transplantation for Heavily Transfused Patients with Severe Aplastic Anemia - Japanese Single Center Experience.
Authors: Kozuka Teruhiko , Tanimoto Kazushi , Nakase Koichi , Nawa Yuichiro , Hara Masamichi 
Published: October 2019

Abstract
Background: Bone marrow transplantation (BMT) is a curative therapy for severe aplastic anemia (SAA). Outcome of BMT can be negatively affected when there is organ damage such as heart failure, liver dysfunction and diabetes mellitus after multiple transfusions in patients with long-standing SAA. Multiple transfusions also sensitize SAA patients with alloantigens and place them at high risk of graft rejection; it is an important problem after BMT for patients with multiply transfused SAA. We investigated the use of the combination of fludarabine monophosphate (FLU), cyclophosphamide (CY) and anti-thymocyte globulin (ATG) as the conditioning regimen in heavily transfused SAA patients.
Methods: Four patients with heavily transfused SAA were treated with allogeneic BMT from unrelated and sibling donor. They were treated with a reduced-intensity conditioning regimen that included FLU (120 mg/m2), CY (1,200 mg/m2) and ATG (horse 40 mg/kg, rabbit 15 mg/kg).
Results: The regimen was well tolerated, and engraftment rapidly occurred with some therapy-related toxicity encountered. Chimerism analysis on day 30 after transplant showed reconstitution with 100% donor cells in three patients. Among these three patients, two patients showed late graft rejection. At this time of reporting, only one patient is alive with complete donor chimerism.
Conclusion: The combination of FLU/CY/ATG was well tolerated also in heavily transfused SAA patients: problems such as graft rejection remain.
Comparison of Cord Blood Transplant Outcome between U.S. Versus Non-U.S. Transplant Centers for Cord Blood from a Single Source.
Authors: Wang Brian , Tseng Peggy , Wu Tina , Rosenthal Joseph , Jaing Tang-Her , Chan Lee Lee , Tan Ah Moy , Tan Poh-Lin , Lin Hai-Peng , Lin Allen , Yang Steven , Chow Tiffany , Gjertson David , Petz Lawrence , Tan Patrick , Chow Robert 
Published: October 2019

Abstract
Background: Cord blood transplantations (CBT) are performed in transplant centers (TC) worldwide; however, conditions for TC located around the world may be quite different, in particular, few studies have focused on CBT outcome in Asian TC. Factors such as patient populations, experiences, disease indications, available resources, and protocols may affect outcome as some have suggested.
Methods: In an effort to compare CBT performed by U.S. (n=129) and non-U.S. TC (n=63), a retrospective audited analysis was performed for all 192 patients with available engraftment and/or survival data using cord blood units (CBU) from a single source to minimize potential differences in quality.
Results: Kaplan-Meier estimates of engraftment for ANC500, platelet 20K and 50K were 91±3%, 80±5% and 74±5% for U.S. respectively, and 81±5%, 85±6%, and 81±7% for non-U.S. TC respectively. The relapse rate for the U.S. and non-U.S. TC were 26±5% and 17±5% respectively. TRM were 31±4% for U.S. TC and 22±5% for non-U.S. TC. The 3-year OS and DFS were 51±5% and 41±7% for U.S. and 68±6% and 61±7% for non-U.S. centers respectively. Factors including recipient age, CD34+ cell dose, #HLA matches, malignancy and wash status of the CBU were taken into consideration in a multivariate analysis which will be presented. In this study, non-U.S. TC were more likely to forego post-thaw wash of CB and perform CBT for benign indications, which appeared to affect outcome. Upon closer inspection of the individual TC, it appeared that there may be more heterogeneity in the TC results overseas, and that centers in the U.S. produced more consistent outcome. While it is possible that, due to many complex reasons, outcome at some non-U.S. TC may be somewhat uneven, many including several in Asia, produced outstanding results that rival the best TC anywhere.
Conclusion: It appears that many factors, including available resources, post-thaw wash, and CBT experience affect outcome, and outstanding outcome can be achieved, regardless of TC location.
Autologous Stem Cell Transplant (ASCT) in HIV-1 Positive (HIV+) Hodgkin Lymphoma (HL) Patients in the HAART Era: Are Clinical Results Comparable to Those in HIV-1 Negative (HIV−) HL Patients?.
Authors: Balsalobre Pascual , Serrano David , Carrion Rafael , Anguita Javier , Miralles Pilar , Berenguer Juan , Buño Ismael , Gomez-Pineda Alfonso , Varela Rosario , Loscertales Javier , Escoda Lourdes , Ribera Josep-Maria , Diez-Martin Jose L. 
Published: October 2019

Abstract
ASCT has been reported as a feasible, safe and effective treatment in HIV associated lymphoma patients (pts) receiving Highly Active Antiretroviral Therapy (HAART). Nevertheless comparative studies with HIV− lymphoma population have not yet been performed. We present a retrospective matched analysis comparing clinical outcomes in both HIV+ and HIV− auto-transplanted HL pts.
Patients and Methods: 6 HIV+ HL pts who underwent ASCT since June 2000 were included. Twelve transplanted HIV− HL auto-transplanted pts were selected as controls. Both groups (HIV+ vs HIV−) were comparable for the most relevant clinical features (Mann-Whitney or chi-square tests p value > 0.05): median age (40 vs 36), Ann Arbor advanced stage (50% vs 25%), status at ASCT (CR>1 or PR, 83% vs 75%), all 18 pts received 2 lines of chemotherapy before ASCT. BEAM was used as conditioning regimen in all 18 pts. In the HIV+ group HAART was maintained during mobilization and ASCT, except during the conditioning in 1 Pt, in which it was needed to be resumed due to an increase in viral load. The median number of infused CD34+ cells/kg was 3,65×106 in HIV+ pts and 4,75×106 CD34+ in HIV− pts (p: NS). G-CSF was used in all HIV+ pt until engraftment starting at a median of 5 days (d) after ASCT.
Results: All 18 pts engrafted, at a median of 13,5 (9–29) d after ASCT in HIV+ pts and 14 (11–18) d in HIV- pts. The incidence of acute infectious and toxic events was not different in both groups. All pts developed neutropenic fever. Documented infections were (HIV+ vs HIV−): Gram+ bacteraemia (2 vs 3), Gram− bacteraemia (1 vs 0), CMV antigenemia (2 vs 1). Pneumonia was documented in one pt from each group. One HIV+ pt showed grade II liver toxicity and grade II renal toxicity occurred in 1 HIV− pt. All events were succesfully resolved. In 4 out of 6 HIV+ pts, HAART was withdrawn due to gastrointestinal toxicity. The median follow-up time was 36,5 mo in HIV+ pts and 37,5 mo in HIV− pts. Two pts relapsed in each group. Within the HIV+ group 1 pt died, due to disease progression. Within the HIV− group 3 pts died, 2 of disease progression and 1 due to post-ASCT secondary acute leukaemia. The OS at 36 mo was 83% for HIV+ pts and 80% for HIV− pts (p=NS). EFS at 36 mo was 55% in HIV+ pts and 70% in HIV− pt (p=NS).
Conclusions: Our results show that clinical outcomes are comparable in HIV+ and HIV− HL pts undergoing ASCT. Engraftment, complication events and survival were not different. ASCT may be applied with guarantees in HIV associated HL on HAART pts in a similar way that in the HIV− setting.
Genetic Polymorphisms in the Homocysteine Metabolism Pathway and Thrombosis in Thai Children: A Case Control Study.
Authors: Sirachainan Nongnuch , Tapanapruksakul Pornsri , Sasanakul Werasak , Visudtibhan Anannit , Charoenkwan Pimlak , Kadegasem Praguywan , Udomtrupayakul Umaporn , Chuansumrit Ampaiwan 
Published: October 2019

Abstract
Hyperhomocysteinemia is a known risk factor for thrombosis in both adults and children. Mutations of genes encoding the enzymes in homocysteine metabolism are predicted to cause elevation of homocysteine and increase the risk of thrombosis. Therefore, this study objectives are to determine the prevalence of methylenetetrahydrofolate reductase (MTHFR) 677C->T, 1298A->C; methionine synthase (MS) 2756A->G, and cystathione β-synthase (CBS) 884ins68 in Thai ethnic patients, aged ≤18 years, and their relationship to thrombosis. The population consisted of 91 patients, from 2 medical institutes in Thailand, first diagnosed with thrombosis. The control group was 169 healthy, Thai children matched for age (mean ± SD in cases/controls = 9.4 ± 5.7 / 9.3 ± 5.7 years, p = 0.9) and sex (male/female in cases/controls = 57.1%/42.9%/53.8%/46.2%, p = 0.7). Genotyping was performed using standard PCR/restriction enzyme assays. The prevalence and allele frequency of the genes are shown in Table 1. The polymorphisms of individual genes and the combinations between the genotype did not affect plasma homocysteine level. The details are shown in Table 2. Conclusion, the prevalence of MTHFR 677C->T, 1298A->C, MS 2756A->G, and CBS 884ins68 in Thai population was lower than Caucasian population; and did not cause the increase risk for thrombosis in Thai children.
Table 1. Frequency of genetic polymorphisms between patients and controls. MTHFR 677A CC (%) CT (%) TT (%) T frequency (%) Controls 71.8 27 1.2 14.7 Patients 73.5 25.3 1.2 - p-value - 0.91 0.96 - MTHFR 1298 AA (%) AC (%) CC (%) C frequency (%) Controls 50.0 42.1 7.9 24.4 Patients 54.3 42.0 3.7 - p-value - 0.76 0.26 - MS 2756 AA (%) AG (%) GG (%) G frequency (%) Controls 78.9 21.1 0 10.5 Patients 75.9 24.1 0 - p-value - 0.63 - - CBS 884ins68 NN (%) NI (%) II (%) G frequency (%) Controls 98.7 0.6 0.6 1 Patients 98.7 1.3 0 - p-value - 0.55 - - Table 2. Homocysteine value and genetic polymorphisms. Genetic polymorphism (number) Plasma Hcy (μmol/L) p value MTHFR 677 CC (n=105) 7.4 ± 2.9 0.11 CT (n=29) 8.3 ± 2.7 MTHFR 1298 AA (n=64) 7.4 ± 2.4 > 0.05 AC (n=59) 7.5 ± 2.8 > 0.05 CC (n=12) 8.7 ± 5 MS 2756 AA (n=110) 7.8 ± 3 AG (n=25) 6.7 ± 1.9 0.055 CBS 884 ins 68 DD (n=137) 7.5 ± 2.8 ID (n=2) 10.3 ± 8.7 0.72 MTHFR 677 / MTHFR 1298 CT/AC (n=16) 8.7 ± 2.5 0.07 MTHFR 1298 / MS 2765 AC/AG (n=6)6.8 ± 1.6 6.8 ± 1.6 0.38 MTHFR 1298 / CBS884ins68 AC/IN (n=9) 6.8 ± 2.1 0.34
The Association of Delta Neutrophil with Severity of Sepsis.
Authors: Lee Jongwook , Song Kyung-Soon , Lee Kyungwon , Song Jaewoo , Choi Jong-Rak , Lim Jong-Baeck 
Published: October 2019

Abstract
Background: The entrance of microbes into blood stream results in rapid spreading of infection through circulation system progressing to sepsis with accompanying fever, leukocytosis and circulatory collapse necessitating prompt recognition and treatment. We calculated the difference between white blood cell counts measured in myeloperoxidase and basophil channel, designated as “delta neutrophil”, and found that the value correlates the progression of sepsis.
Methods: We categorized patients who were referred for automatic blood cell analysis according to the calculated value of delta neutrophil and analyzed positive rate of blood culture, mortality and laboratory data including hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrinogen degradation product, D-dimer, ESR, CRP. Delta neutrophil values were calculated as above mentioned from measured values from automatic blood cell analyzer, ADVIA® 120 automated Hematology System (Bayer Diagnostics, New York, USA). Among 1781 patients selected, those with delta neutrophil value less then 5 were categorized as group I, 5 to 10 as group II, 10 to 20 group III, 20 to 30 group IV, 30 to 40 group V, 40 to 50 group VI and greater than 50 as group VII, arbitrarily. Patients with hematologic malignancy or with Gynecologic malignancy were excluded in this study.
Results: The mortality and blood culture rate in group VII were 75.0% and 57.1% and in group VI 76% and 46.7%, group V 46.2% and 37.9%, respectively. On the contrary for group I the mortality and isolation rate were 3.3% and 17.1%. (The means of hemoglobin concentration for group I and II were 13.2 g/dL and 12.1 g/dL compared with 10.5 g/dL and 10.2 g/dL in group VI and VII.) With regard to consumptive coagulopathy, the means of platelet count were 263,700/mL and 259,200/mL in group I and II while those for group VI and VII were 107,200/mL and 112,600/mL. Antithrombin activities were 5.20 % and 7.98% in group VII and VI in contrast to 66.6% and 75.8% for group I and II.
Conclusion: The categorization by delta neutrophil value correlated with the isolation rate of bacteria from blood culture and mortality. The delta neutrophil value is expected to provide useful information for following up progression of sepsis.
Laparoscopic Splenectomy for Hematologic Disorders: A Safe Procedure.
Authors: Ghys Christophe , Capelluto Elie , Baize A. , Meuleman Nathalie , Bennani Jalil , Libertalis Marc , Cadiere Guy Bernard , Bron Dominique 
Published: October 2019

Abstract
Background : Splenectomy for hematological diseases remains controversial in many circumstances due to a high morbidity and mortality after a classical surgery. Laparoscopic surgery becoming more popular, spleen removal by this approach was more widely used and we retrospectively reviewed the outcome of 33 patients who underwent laparoscopic splenectomy in our institution.
Population : Between 1998 and 2006, laparoscopic splenectomy was performed in 33 patients (F=6, M=27) by an anterior approach. Median age was 62 (40–90) y.o. Indications for splenectomy was hemolytic anemia or discomfort in malignant hemopathies (CML, MF, NHL, CLL, HD) and autoimmune cytopenia or peripheral cytopenia in non malignant hemopathies (AIHA, ITP,.). Spleen weights ranged from 100g to 5000g. All the patients received anti-pneumococcal vaccination 2 weeks before surgery. After surgery, all patients were covered by penicillin and LMWH until discharge from the hospital.
Results : Perioperative mortality was 0% and major postoperative complications were observed in 3 patients (Pulmonary Embolism, DVT, Hemorrhage). Conversion was required in one patient. One patient died 4 years after splenectomy from extended deep portal thrombosis.
Improvement in hematological parameters and/or performans status was observed in 95% of the patients. Mean duration of hospital stay was 5 days.
Conclusion : Anterior laparoscopic splenectomy for splenomegaly is a safe and minimally invasive procedure in the hands of experienced surgeons. Howerer, a closed monitoring of the platelets count should be performed, even on an ambulatory basis, because of the risk of thrombotic complications.
Methyl-Green-Pyronin as a Differential Nucleic Acid Stain for Peripheral Blood Smears
Authors: PERRY SEYMOUR , REYNOLDS JOHN , BAKER MARY 
Published: October 2019

Abstract
A differential nucleic acid stain for peripheral blood and marrow smears using methyl-green and pyronin Y and Carnoy’s solution as a fixative is described. Characteristics of the various blood cells are quite distinct so that identification is readily accomplished.
If pyroninophilia is assumed to be a measure of RNA, morphologically identical and mature leukocytes are found to vary in the quantity of cytoplasmic RNA. Since cellular immaturity is associated with increased RNA, this must be an indication of the varying "age" of white blood cells in the peripheral blood. With the use of this stain a much more dynamic picture of white cell physiology is obtained than with other more conventional stains.
The quantity of cytoplasmic RNA in peripheral blood leukocytes, as measured by a scoring technic, was found to be increased as compared to normal in most infections, leukemias, pernicious anemia in relapse, and a variety of other conditions. With treatment, the score fell to normal levels in pernicious anemia and infections.
Roles of Flow Cytometry in Bone Marrow Staging of B-Cell Non-Hodgkin Lymphoma.
Authors: Nakorn Thanyaphong Na , Polprasert Chantana , Srisakham Jirawan , Assanasen Thamatorn 
Published: October 2019

Abstract
Background Bone marrow staging is important in determining the extent of disease and for making therapeutic decision in B-cell non-Hodgkin lymphoma (B-NHL). Flow cytometry has been widely used in this setting but its value has not been clearly demonstrated.
Objectives To determine the usefulness of bone marrow flow cytometry in staging of B-NHL.
Materials and Methods We compare the results of bone marrow studies using bone marrow aspirate (BMA), bone marrow biopsy (BMB) and three-color flow cytometry (FCM), in non-leukemic B-NHL patients performed during May 2003 to December 2006 at our institution and determine the concordant rate among these three methods in detecting bone marrow involvement by B-NHL.
Results Two hundred and sixty-eight bone marrow samples were analyzed in this study. Diffuse large B-cell lymphoma (DLBCL) was the most common histologic subtype (60.8%). Bone marrow (BM) involvement as confirmed by immunohistochemistry of BMB was observed in 66 samples (24.6%). Prevalence of BM involvement was slightly higher in indolent B-NHL (32.2%) as compared to aggressive B-NHL (20.8%). Agreement among all three methods was observed in 163 samples (60.8%). BMA had the sensitivity of 77.3% and specificity of 73.8%. FCM alone had the sensitivity of 63.6% and specificity of 89.6%. FCM failed to demonstrate clonal B-cells mainly in patients with focal involvement pattern. When FCM was combined with BMA, the sensitivity was increased to 87.9% but the specificity was decreased to 67.8%. They did not perform significantly better than using morphological criteria in BMB alone, which showed sensitivity of 80.3% and specificity of 94.5%.
Conclusion Based on these data, we conclude that flow cytometry may not be necessary in bone marrow staging of B-NHL in patients with non-leukemic presentation.