Excellent Mobilization Research Articles

Analysis of the Relationship of Domestic Sea Transportation to the Gross Regional Domestic Product of the Real Estate Sector in Indonesia

The economic slowdown due to the pandemic has negatively affected various sectors in Indonesia, including the real estate sector. Meanwhile, Java Island is still the center of the economy in Indonesia. This contrasts the conditions of regions outside Java, which are still experiencing development gaps. Despite being a minor contributor to GDP, areas outside Java, such as Maluku and Papua, have experienced rapid economic growth. This proves that, outside Java, there is still significant potential for growth and investment, although it is inevitable that it will face unique challenges and obstacles in the future. Some of the factors that cause this to happen are the lack of supporting infrastructure such as roads, limited skilled human resources, and connectivity and transportation mobilization in the area. Excellent and appropriate connectivity and mobilization are needed to support economic growth in an area. One option for mobilization tools for archipelagic countries like Indonesia is sea transportation. In meeting the needs of the property and real estate sector, sea transportation is one of the options of choice. Excellent and proper connectivity and mobilization can be a factor that supports economic growth as well as the real estate sector outside Java. In the real estate sector, maritime transportation is essential in the timely distribution of quality building materials and construction equipment to development sites. There is undoubtedly a link between marine transportation and property/real estate in Indonesia. The research method used in this study is a significant correlation analysis, namely Pearson Product Moment, to determine the relationship between two variables, namely Domestic Sea Transportation and Real Estate Sector GRDP. The results of the correlation data test in this study show that the Domestic Sea Transportation variable is positively correlated with the Real Estate GRDP variable. Indicated by the correlation coefficient value for each sea transportation variable of domestic ship visits (units) = 0.331, domestic ship visits (GT) = 0.504, the flow of Non-Crate and Container goods (unloading) = 0.251, the flow of Non-Crate and Container goods (loading) = 0.447. It can be interpreted that there is a positive relationship between the four sea transportation variables and Real Estate GRDP.

Cytarabine Plus Etoposideis+Peg-Rhg-CSF Is More Effective Than Cyclophosphamide + G-CSF As a Stem Cell Mobilization Regimen in Poorly Mobilized MM and Lymphoma

There are several methods for hematopoietic stem cell (HSC) mobilization in lymphoma and multiple myeloma (MM)，of which Cyclophosphamide(Cy) plus granulocyte-colony stimulating factor(G-CSF)is a commonly used HSC mobilization regimen,but this regimen often fails to collect a sufficient number of stem cells, especially for poorly mobilized patients.However,previous studies have shown that the mobilization effect of cytarabine plus etoposide and G-CSF seems to have a higher mobilization efficacy. The purpose of this study is to retrospectively compare the mobilization effects of using cytarabine ，etoposide plus polyethylene glycol recombinant human granulocyte stimulating factor(PEG-rhG-CSF)(EAP) and Cy+G-CSF in proven poor mobilizer or predicted poor mobilizer of MM or lymphoma. A total of 43 patients were mobilized by EAP regimen and the 44 patients by Cy+G-CSF, including 56 patients with MM and 31 patients with lymphoma.Both groups were comparable. The target yield of 2× 10 6 CD34 + cells/kg was achieved in 90.7% (EAP) and 70.7% (Cy) of patients(P=0.003) by 1.3 and 1.6 apheresis (means).By single apheresis in 76.7% (EAP) and 29.5% (Cy) of patients achieve the ideal yield of 5× 10 6 CD34 + cells/kg .EAP mobilization resulted in higher peak concentration of CD34+ cells in blood in the first apheresis (median 59.4 vs 9.5/µL, p＜0.001)and second apheresis(median 23.2 vs 8.5/µL, p=0.001)compared to Cy mobilization. The median time of antibiotic administration in EAP mobilization was shorter than that in Cy mobilization (median 1.2 vs 3.1/d, p=0.041). The toxicity is different,the median time of agranulocytosis (median 1.2 vs 3.1/d, p=0 .003) after EAP mobilization were shorter than those after Cy，however, the median time for thrombocytopenia gr.4 (median 0.5 vs 0.2/d, p=0.001) was longer in the EAP group. In view of these results, we conclude that mobilization with EAP is excellent mobilization regimen with acceptable toxicity and could be considered in MM and lymphoma patients with factors of poor mobilization.

The Efficacy of Residual Plerixafor of Second-Day Stem Cell Mobilization in Multiple Myeloma Patients

Background Granulocyte colony-stimulating factor (G-CSF) plus plerixafor have been shown to improve the efficacy of peripheral blood stem cell (PBSC) mobilization, however, due to its high price, the use of plerixafor in China are limited. Study Design and Methods In this single-center retrospective study, 69 multiple myeloma (MM) patients received G-CSF + plerixafor to mobilize PBSCs, which were collected from 28 patients only for one day and 41 patients for two days. Some of the patients received the residual plerixafor who collected PBSCs on the second day. The yield of CD34+ cells in MM patients was the endpoint of this study, which was divided into 3 levels. The yield of CD34+ cells at ＜2×106 cells/kg, ≥2×106 cells/kg but＜5×106 cells/kg, and ≥5×106 cells/kg was defined as poor, good and excellent mobilization, respectively. CD34+ cells ≥2×106 cells/kg was regarded as the minimum goal of successful mobilization. Collected and analyzed the data of characteristics, different dose of plerixafor and efficacy of PBSC mobilization. Results There was no statistically significant difference in the success rate of CD34+ PBSC mobilization with the different dose of plerixafor on the first day, but the higher residual plerixafor dose resulted in better success rates on the second day (P＜0.001). The mean doses of residual plerixafor in the successful mobilization group and the poor mobilization group on the second day were 155.6 μg/kg and 72.2 μg/kg respectively, which indicated a statistically significant difference (P＜0.001, Figure 1A). Among the patients who collected PBSCs for two days, the level of the CD34+ cell yield of 24 patients (58.5%) changed better, 11 (26.8%) in which from poor to good, and 13 (31.7%) in which from good to excellent. The mean doses of residual plerixafor in the changed group of the total yield of CD34+ cells and unchanged group were 132.3 μg/kg and 61.0 μg/kg respectively, which was significantly correlated with the dose of residual plerixafor on the second day (P=0.001, Figure 1B). Discussion These results suggested that the administration of residual plerixafor to mobilize stem cells on the second day is an economical, efficient and clinically feasible method. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Gemcitabine, Cisplatin, and Dexamethasone as a Salvage and Mobilization Chemotherapy Before Autologous Stem Cell Transplantation is Effective and Safe Outpatient Regimen in Relapsed and Refractory Hodgkin Lymphoma Patients

BackgroundSecond line salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the current standard treatment for eligible patients with relapsed and refractory (R/R) Hodgkin lymphoma (HL). Several salvage regimens have been used before ASCT. However the optimal salvage regimen is still unclear. We report outcome of patients with R/R HL treated with gemcitabine, cisplatin, and dexamethasone (GDP) regimen before ASCT in this retrospective study aiming at evaluating efficacy, stem cell mobilization activity and safety of GDP in a real-life setting. Patients and MethodsForty-five patients with R/R HL who were treated with GDP as salvage and mobilization regimen before ASCT were analyzed retrospectively. Peripheral blood stem cells (PBSC) were collected after GDP. All patients underwent ASCT after 2 cycles of GDP. ResultsThirty-six (80%) patients achieved overall response including 24 (53.3%) complete response (CR). PBSC collections were adequate in all patients with a median number of 11.01 × 106/kg CD34+ cells. The most common grade 3/4 hematological adverse events were thrombocytopenia (31.1%) and neutropenia (22.2%). There were no febrile neutropenic episodes. Grade 3 or 4 renal, hepatic, or cardiac toxicity was not observed. The 4 year progression-free survival and overall survival for patients receiving GDP followed by ASCT were 72% and 92%, respectively. ConclusionOur results suggest that GDP is a viable therapeutic option before ASCT with high response rate, favorable toxicity profile and excellent mobilization potential. Applicability of GDP on an outpatient setting also provides advantage over other effective salvage regimens.

Taking “Trans-ano-rectal” out of ASTRA: An anterior sagittal approach without splitting the rectum

The anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage. We demonstrate a modified technique to the ASTRA without dividing the anterior anal sphincter and rectal wall, with achievement of comparable exposure and excellent vaginal mobilization and length.

Functional results of percutaneous fixation of displaced tibial plateau fractures assisted by arthroscopy

Background Tibial plateau fractures are a common injury that require anatomic reduction to obtain the best functional results. Assisted arthroscopy seems to be more satisfactory in reducing the risks of open reduction and internal fixation. Aim of the study This study evaluated the functional results of percutaneous fixation of displaced tibial plateau fractures assisted by arthroscopy. Patients and methods The study was carried out between July 2012 and June 2013 in Suez Canal University Hospitals. This was a prospective study and 20 patients were included, 16 men and four women, mean age 40 years (range 21-72 years) at the time of surgery. Patients with closed tibial plateau fractures type I-IV according to the Schatzker classification were included in the study with step-off of the articular surface more than 3 mm and condylar widening more than 5 mm. All patients underwent preoperative and postoperative clinical and radiological assessment, and the outcomes were scored by the Rasmussen system. Results The results of the current study showed a significant difference between preoperative and postoperative Rasmussen scores. For the postoperative Rasmussen score, the median clinical score at the 1-year follow-up was 28 (range 22-30) and the median radiological score was 9 (range 6-10). According to clinical and radiological assessments, we found that 95% of the patients had satisfactory results. All fractures were united and no permanent complications developed. Conclusion Percutaneous fixation of displaced tibial plateau fractures with assisted arthroscopy is a safe and effective procedure with excellent results and early mobilization.

Prospective Study Of Mobilization Kinetics Up To 18 Hours After Late Afternoon Dosing Of Plerixafor

Background Plerixafor (Mozobil®, Genzyme, Cambridge, MA) is approved for hematopoietic progenitor cell (HPC) mobilization into peripheral blood (PB) in combination with granulocyte colony stimulating factor (G-CSF) at ∼11 hours (hr) prior to apheresis initiation. Since apheresis facilities typically open at 8-9 AM, this 11 hr interval requires plerixafor dosing between 9-10 pm, impractical unless the patient self-administers the drug. No studies have examined mobilization kinetics beyond 15 hr in the target MM and NHL patient population. This is the first study in this target population to examine a total interval time of 17-18 hr post-plerixafor, important because, practically, leukapheresis may not be initiated until 10-11 AM. Even if initiated earlier between 8-9 AM, a standard leukapheresis typically lasts ∼3 hr. Therefore, it is important to rule out a significant decrease in PB [CD34+] extending through this interval. Study Design and Methods A single-center, prospective cohort, IRB-approved study where 11 patients with NHL and MM underwent HPC mobilization from March 2010 to October 2011. Patients met the same entry criteria specified in the initial studies leading to FDA approval. Plerixafor 240 ug/kg was administered at 5pm on day 4 of AM G-CSF 10 ug/kg. PB [CD34+] and [CD34+CD38-] concentrations were enumerated every 2 hours from 5PM to 7AM and immediately pre-apheresis on day 5, for a total interval time of 17-18 hr post-plerixafor. Leukapheresis (3 total blood volumes) was performed if the 7 am peripheral blood CD34+ concentration was ≥10/uL. Data was analyzed used mixed model analysis of repeated measures. Results 9 of 11 subjects , including all 5 patients who had received 3-9 cycles of lenalidomide, achieved a CD34+ product count of >5x106/kg with a single leukapheresis. All 9 patients (in contrast to the other 2) had a pre-plerixafor PB CD34+ concentration > 10/uL. PB [CD34+] did not differ between 10-18 hours post-plerixafor (p≈0.8). In contrast, PB [CD34+CD38-] increased from 10 to 18 hours post-plerixafor (p=0.03). 10 subjects underwent transplant with a median CD34+ dose of 6.0x106/kg (range 3.8-10.8x 106/kg) and engrafted within normal time frames. Using post- to (5PM) pre-plerixafor [CD34+] ratios to compare efficacy of plerixafor kinetics, the median ratio of the 17-18hr post/pre-plerixafor [CD34+] was 4.0 (range 1.8-6.8), not significantly different (p=0.09) from that of the peak post/pre-plerixafor [CD34+] of 4.7 (range 1.9-9). The 3 subjects with lowest mobilization had diabetes, but the peak post/pre [CD34+] ratio was not adversely affected. Two of these three reached their peak [CD34+] mobilization at 8hr post-plerixafor, whereas all other donors reached their peak [CD34+] ≥ 10hr post-plerixafor. The correlation coefficient of 0.54 between the PB [CD34+] and [CD34+CD38-] was weak. Conclusions In MM and NHL patients with adequate pre-plerixafor CD34+ concentration, which includes those with prior lenalidomide, leukapheresis initiated 17-18 hours post-plerixafor may not impair CD34+ product yield and may increase more primitive CD34+CD38- yield. Patient with risk factors for poor mobilization, such as diabetes or salvage chemotherapy, may be an exception. The three donors with post-plerixafor PB [CD34+] < 100/uL all had diabetes, which has been established to impair G-CSF induced stem cell mobilization. Our data supports murine data that plerixafor overcomes sympathetic nervous system-related defects in mobilization, since the peak post/pre plerixafor [CD34+] ratio was > 4 in all 3 patients. Interestingly, the donor with the second highest mobilization also had diabetes but a low peak/pre [CD34+] ratio of 2.9 (i.e. excellent mobilization with G-CSF alone); her mobilization impairment from diabetes may have been overcome by concurrent use (for asthma) of the β2-adrenergic agonist albuterol, previously associated with high mobilization. Consistent with previous studies, the 2 patients with poor [CD34+] mobilization reached their peak PB [CD34+] < 11 hours post-plerixafor. Finally, given the weak correlation between PB [CD34+] and [CD34+CD38-] , the utility of using PB [CD34+CD38-] to help determine the optimal time for collection may be worth exploring, given the correlation between CD34+CD38- graft content and long-term hematopoietic reconstitution in autologous transplantation. Disclosures: Off Label Use: Plerixafor administered up to 18 hours prior to apheresis initiation, rather than the FDA-approved 11 hours.

High dose salvage therapy with dose intensive cyclophosphamide, etoposide and cisplatin may increase transplant rates for relapsed/refractory aggressive non-Hodgkin lymphoma

Only one-quarter to one-third of patients with relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL) treated with common salvage chemotherapy regimens and autologous stem cell transplant (ASCT) achieve 5-year progression-free survival (PFS). Worse outcomes have been reported after failure of prior rituximab-containing induction, initial time to progression (TTP) < 1 year or age-adjusted International Prognostic Index (aaIPI) = 2–3 at relapse. In Calgary, we have treated patients with r/r-aNHL with dose-intensive cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2 and cisplatin 105 mg/m2 (DICEP) for both re-induction therapy and autologous blood stem cell mobilization. In this study we retrospectively analyzed 113 consecutive transplant-eligible patients with r/r-aNHL who received one cycle of DICEP (n = 93) or R-DICEP (n = 20) from 1995 to 2009. Patient characteristics included: median age = 49 years (22–69); TTP < 1 year = 85; elevated lactate dehydrogenase (LDH) = 60; Eastern Cooperative Oncology Group performance status (ECOG) 2–4 = 42; aaIPI 2–3 = 59; bulk > 10 cm = 26, prior rituximab = 27. The median number of CD34 + cells collected was 19 × 106/kg (0.3–142), 83.5% responded and 90% (102) proceeded to ASCT. The 5-year PFS rate was 42% for all patients, 32% for those with relapse aaIPI = 2–3, 35% for initial TTP < 1 year and 56% for those who failed initial rituximab induction. In conclusion, (R)DICEP is an effective re-induction regimen for r/r-aNHL, leading to excellent stem cell mobilization, a high chance of proceeding to ASCT and encouraging long-term PFS rates.

Dose-intensive cyclophosphamide, etoposide, cisplatin reinduction for relapsed/refractory aggressive non-Hodgkin lymphoma (r/r-aNHL).

6548 Background: Approximately 2/3 r/r-aNHL patients (pts) respond to salvage R-ICE or R-DHAP, 1/2 proceed to autologous stem cell transplantation (ASCT), and 1/3 achieve 3 year (yr) progression-free survival (PFS); however, PFS is only 20% if prior Rituximab, time to progression (TTP)&lt;1yr, or age-adjusted International Prognostic Index (aaIPI)=2-3 [JCO 2010;28: 4184-90]. Since 1995, we re-induced poor prognosis r/r-aNHL with dose-intensive Cyclophosphamide 5.25g/m2, Etoposide 1.05g/m2 and Cisplatin 105mg/m2 (DICEP), G-CSF days (d) 14-19, and apheresis d19,20, or 21. Rituximab was added d0,7 after 2006. Methods: We retrospectively analyzed 113 consecutive transplant eligible r/r-aNHL pts [diffuse large B-cell=95, transformed=9, peripheral T-cell=6, other=3] who received one cycle of DICEP (n=93) or R-DICEP (n=20) from 1995-2009. Patient characteristics included: median age=49yr (22-69); primary refractory=68; TTP&lt;1yr=85; elevated LDH=60; ECOG 2-4=42; aaIPI 2-3=59; bulk&gt;10cm=26. Results: Of 113 pts, 77% responded to DICEP and 90% (102) proceeded to ASCT. The median CD34+ cells collected was 19x106/kg (0.3-142). Early treatment-related mortality (TRM) occurred in 3 pts (2.7%), and 4 others developed late second cancers (MDS/AML=2). With 94 months median follow-up (26-194), 5 and 10yr OS rates for all 113pts are 48% and 41%, and PFS rates are 42% and 37%, respectively. 5 year PFS rates for ASCT vs no-ASCT are 46% vs 9%, for relapse aaIPI=0-1 vs aaIPI=2-3 are 53.3% vs 32.1% (p=0.01), and for TTP&gt;1yr vs &lt;1yr are 63.9% vs 35.2% (p=0.009). Other predictors of inferior PFS in univariate analysis were elevated LDH, ECOG 2-4, no response to DICEP; however, PFS for 27 pts who failed prior Rituximab-chemotherapy (56%) was similar to other 86 pts (38%) (logrank p=0.09). Predictors of PFS and OS in multivariate analysis include: TTP&lt;1yr, elevated LDH, bulk, no response to DICEP. Conclusions: (R)DICEP is an effective re-induction regimen for r/r-aNHL, leading to excellent stem cell mobilization and a high chance of proceeding to ASCT. Long-term PFS and OS rates compare favourably to reports of other re-induction regimens, and a prospective multicentre trial is warranted.

Double high-dose therapy with dose-intensive cyclophosphamide, etoposide, cisplatin (DICEP) followed by high-dose melphalan and autologous stem cell transplantation for relapsed/refractory Hodgkin lymphoma

The purpose of the present study was to review retrospectively our results of double high-dose therapy with DICEP (dose-intensified cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2, and cisplatin 105 mg/m2) re-induction followed by high dose melphalan 200 mg/m2 (HDM) and autologous stem cell transplantation (ASCT) for 73 consecutive patients with relapsed (n = 43) or refractory (n = 30) classical Hodgkin lymphoma (HL) treated between June 1995 and November 2009. DICEP chemotherapy resulted in successful stem cell mobilization in 71 patients (97%), with a median CD34 + cell collection of 15.6 × 106/kg. With a median follow-up of 56 months post-DICEP, the 5-year progression free survival (PFS) and overall survival (OS) rates were 61% [95%CI = 49–72%] and 80% [95%CI = 69–89%], respectively. The 5-year PFS was 65% vs. 30% for DICEP responders vs. nonresponders (logrank p = 0.003) and 89% for International Prognostic Score (IPS) = 0–1, 56% for IPS = 2–3, and 24% for IPS = 4–7 (logrank p < 0.001). Response to DICEP and IPS at relapse were the only two factors that independently predicted PFS and OS in multivariate analyses. Treatment-related mortality was 1%. In conclusion, DICEP-HDM/ASCT is well tolerated double high-dose therapy associated with excellent stem cell mobilization and favorable PFS and OS outcomes for relapsed as well as primary refractory HL.

A Better Mobilization Regimen for Newly Diagnosed Multiple Myeloma Patients,

Abstract 4051 Introduction:What constitutes an acceptable mobilization regimen for collecting CD34+ cells depends on whether the goal of collection is to obtain a minimum number versus optimal number of cells. When treating patients with high-risk myeloma it may be important to obtain an optimal number. Here we compare retrospectively our earlier mobilization regimen, VTD-PACE, with MVTD-PACE in newly diagnosed, previously untreated multiple myeloma patients. Materials and Methods : We reviewed data for all patients who collected hematopoietic progenitor cells on Total Therapy protocols TT3a/TT3b with VTD-PACE (n=394) from February 2004 to September 2008 (138 females and 256 males, median age 59y; range 31–75), and on TT4/TT5 with MVTD-PACE (n=188) from August 2008 to May 2011 (78 females and 110 males, median age 61y, range 30–76). Based on their predicted first day collection with a large volume leukapheresis (30L processed), using our center’s predictive formula (Blood 2010; 116(21):1182a), patients were stratified into 4 mobilizer types: poor (<2×106 CD34+ cells/kg), intermediate (≥2 to 10×106), good (>10 to 20×106) and excellent (>20×106). Variables examined included number of CD34+ cells/μl blood on day 1 and day 2 of collection (we have a minimum 2 day collection requirement), number of collection days to reach our minimum goal of 20×106 CD34+ cells/kg, and total CD34+ cells/kg collected for both chemotherapy groups. Variables for both groups stratified by mobilizer type were compared using two-tailed student’s t-tests, except for the poor mobilizer group, where population size was too small for formal statistical analyses (VTD-PACE n=7, MVTD-PACE n=4), although averages were calculated. Results : There was no significant difference between VTD-PACE and MVTD-PACE for CD34+ cells/μl blood on day 1 of collection among the excellent [mean 368.9 (n=184) vs. 434.6 x106 (n=92); p-value 0.07], good [mean 138.6 (n=102) vs. 128.6 x106 (n=40); p-value 0.19], and intermediate [mean 60.1 (n=100) vs. 55.9 x106 (n=52); p-value 0.39] groups. A statistically significant difference between VTD-PACE and MVTD-PACE was found for CD34+ cells/μl blood on day 2 of collection for excellent mobilizers [mean 333.8 (n=184) vs. 460 ×106 (n=92); p-value <0.001], but not for the good [mean 165.7 (n=102) vs. 189.5×106 (n=40); p-value 0.21] and intermediate [mean 80.1 (n=101) vs. 102.3 ×106 (n=52); p-value 0.07] groups. When CD34+ cell/kg collection totals with VTD-PACE and MVTD-PACE were compared, a significant difference was seen for the intermediate mobilizer group only [mean 23.6 (n=101) vs. 26.3 ×106 (n=52); p-value 0.03]. For the poor mobilizer group, VTD-PACE had an average CD34+ cells/μl blood of 13.5×106 for day 1 of collection and 17.0 ×106 for day 2, with a total of 14.5×106 CD34+cells/kg collected; while MVTD-PACE had an average of 13.2×106 CD34+ cells/μl blood for day 1 of collection, 24.9×106 for day 2, with a total of 24.2×106CD34+ cells/kg collected. The number of collection days was similar between VTD-PACE and MVTD-PACE in the excellent mobilization group (2 days), but was slightly more for VTD-PACE compared to MVTD-PACE for the good (2.1 vs. 2 days), intermediate (3.2 vs. 2.9 days), and poor (6.1 vs. 5.8 days) groups. Conclusion : Both regimens allow more than minimum collections, but MVTD-PACE provides a higher peak number of CD34+ cells/μl blood, resulting in a slightly lower mean number of days of collection than VTD-PACE to reach an optimal collection. Disclosures:No relevant conflicts of interest to declare.

Autologous hematopoietic cell transplantation for high-risk ALL

The role of autologous hematopoietic cell transplantation (AHCT) in the treatment of ALL remains unclear.1 Several phase III studies have failed to demonstrate the superiority of AHCT over conventional chemotherapy.2, 3, 4, 5 We hypothesized that an intensified approach might improve the outcomes of AHCT for adults with ALL. We used an intensive consolidation treatment with high-dose cytarabine and etoposide that has been used in AHCT for AML and has produced excellent hematopoietic cell mobilization.6 The aims of this consolidation therapy were to decrease leukemia cell burden in the patient, produce good progenitor cell mobilization and provide in vivo purging of the graft. We performed ex vivo purging of the graft with a combination of monoclonal antibodies and complement in order to further reduce leukemic contamination.7 We developed an intensified preparative regimen that would be unsuitable for allogeneic transplantation, but that we thought would be appropriate for autologous transplantation, based on the high-dose fractionated TBI (FTBI) plus etoposide program developed at the City of Hope National Medical Center,8 by adding CY 100 mg/kg. In order to ascertain the efficacy of the overall approach in a phase II study, we enrolled only high-risk patients who would be expected to have a very poor outcome if treated with chemotherapy alone and in whom no allogeneic hematopoietic cell donor was available or AHCT was not appropriate.

Estrategias de comunicación en campañas electorales: El caso de la contienda presidencial de Estados Unidos 2008

The essay analyzes the communication strategies used by Barack Obama in order to win the democratic nomination to the presidency of the Unites States and the strategies used by republicans and democrats in the constitutional election in 2008. It is concluded that Obama won the presidential nomination be cause he was the candidate more competitive in communicate with voters. His elevated communication competences, his excellent organization and mobilization strategies of voters and the creativity of his campaign allowed him to defeat to Hillary Clinton’ electoral machinery

Leukocyte and platelet counts can be used to guide collection of autologous stem cells after G-CSF mobilization on the first two days of leukapheresis but not beyond

When donors are treated with G-CSF to collect stem cells for allogeneic transplantation, the combination of a pre-apheresis leukocyte count of ≥25 × 109/L and a pre-apheresis platelet count of ≥100 × 109/L is associated with excellent mobilization as measured by an absolute peripheral blood CD34+ cell count (PBCD34) of 20/μL, and can be used to guide harvest timing (Tomblyn et al Bone Marrow Transplantation advance online publication 01 August 2005; doi: 10.1038/sj.bmt.1705117). We wanted to see if this observation could be extended to patients receiving 10–16 μg/kg G-CSF daily as the sole mobilizing agent for autologous stem cell collection. Data from 161 leukapheresis procedures (65 day 1 collections, 47 day 2 collections, and 49 collections done beyond day 2) were analyzed to determine correlation between pre-apheresis leukocytes, platelets, and PBCD34. Overall, when leukocytes ≥25 and platelets ≥100, PBCD34 was 2.9–515.5 (median 31.8); significantly (P < .0001) higher than PBCD34 of 0.6–226.0 (median 6.0) when leukocytes were <25 and/or platelets were <100. Among day 1 collections, with leukocytes ≥25 and platelets ≥100, PBCD34 was 20 and 10 in 63% and 78% of the time compared to 16% and 36% of the time if leukocytes were <25 and/or platelets were <100 (P = .0001 and P = .001, respectively). Similarly, PBCD34 levels of 20 and 10 were obtained 63% and 87% of the time with day 2 collections when leukocytes were ≥25 and platelets ≥100, compared with 19% and 35% of the time when leukocytes were <25 and/or platelets were <100 (P = .003 and 0.001, respectively). Beyond day 2, when leukocytes ≥25 and platelets ≥100, PBCD34 was 20 50% of the time compared with 7% when leukocytes were <25 and/or platelets were <100 (P = .047). Our data suggest that in patients with hematologic malignancies receiving G-CSF for mobilization of autologous stem cells, the combination of a leukocyte count of ≥25 and a platelet count of μ100 is associated with excellent mobilization of stem cells in the majority of patients on the first and second harvest days but not beyond. Conversely, lower leukocyte and/or platelet counts predict for poor mobilization beyond the second day, but not on the first two days. Thus, on the first and second days of stem cell collection in patients mobilized with G-CSF, apheresis can be initiated based on favorable hematologic parameters without necessarily awaiting PBCD34 levels. However, beyond the second day, PBCD34 levels should guide apheresis.

Experimental Investigation of Nonconventional Confinement for Concrete Using FRP

The present study investigates experimentally the behavior of concrete confined with fiber reinforced polymers (FRP) in the form of jackets which are applied according to a number of nonconventional techniques. First, the effectiveness of various jacketing configurations combined with anchors as a measure of increasing the strength and deformability of L-shaped columns is investigated. It is concluded that easy to install and low-cost anchors made of resin impregnated fibers properly placed at the reentrant corner of L-shaped columns enable excellent mobilization of confining stresses supplied by the FRP jackets. Next, a number of alternative confinement methods are investigated on concrete cylinders, aimed at quantifying the effectiveness of (1) unbonded jacketing, (2) spirally applied strips attached only at their ends, and (3) jacketing directly on concrete with mortar plastering. Although the study may be regarded as preliminary, it provides useful experimental support to a number of techniques which have the potential to open new horizons in the field of externally applied FRP for enhancing concrete confinement.

Leukocyte and Platelet Counts Can Be Used To Guide Collection of Autologous Stem Cells after G-CSF Mobilization on the First Two Days of Leukapheresis but Not Beyond.

We have shown recently that when healthy donors are treated with G-CSF to collect stem cells for allogeneic transplantation, the combination of a pre-apheresis leukocyte count of ≥25 x 109/L and a pre-apheresis platelet count of ≥100 x 109/L is associated with excellent mobilization as measured by an absolute peripheral blood CD34+ cell count (PBCD34) of ≥20/μL, and can be used to guide harvest timing (Tomblyn et al. Bone Marrow Transplantation advance online publication 01 August 2005; doi: 10.1038/sj.bmt.1705117). We wanted to see if this observation could be extended to patients receiving 10–16 μg/kg G-CSF daily as the sole mobilizing agent for autologous stem cell collection. Data from 161 leukapheresis procedures (65 day 1 collections, 47 day 2 collections, and 49 collections done beyond day 2) were analyzed to determine correlation between pre-apheresis leukocytes, platelets, and PBCD34. Overall, leukocytes (4.5–86.3; median 29.2) and platelets (26–452; median 121) correlated with PBCD34 (0.6–515.5; median 8.6); r=0.38 and 0.41 respectively (P<0.0001 for both). With leukocytes ≥25 and platelets ≥100, PBCD34 was 2.9–515.5 (median 31.8); significantly (P<0.0001) higher than PBCD34 of 0.6–226.0 (median 6.0) when leukocytes were <25 and/or platelets were <100. Among day 1 collections, with leukocytes ≥25 and platelets ≥100, PBCD34 was ≥20 in 63% of the time compared to 16% of the time if leukocytes were <25 and/or platelets were <100 (P=0.0001). On day 1, PBCD34 ≥10 was seen 78% of the time with leukocytes ≥25 and platelets ≥100, compared with 36% of the time with lower leukocyte or platelet counts (P=0.001). Similarly, PBCD34 levels of ≥20 and ≥10 were obtained 63% and 87% of the time with day 2 collections when leukocytes were ≥25 and platelets ≥100, compared with 19% and 35% of the time when leukocytes were <25 and/or platelets were <100 (P=0.003 and 0.001 respectively). For collections done beyond day 2, with leukocytes ≥25 and platelets ≥100, PBCD34 was ≥20 50% of the time compared with 7% when leukocytes were <25 and/or platelets were <100 (P=0.047). Beyond day 2, PBCD34 was ≥10 50% of the time with leukocytes ≥25 and platelets ≥100 compared with 8% of the time when leukocytes were <25 and/or platelets were <100 (P=0.18). Our data suggest that in patients with hematologic malignancies receiving G-CSF for mobilization of autologous stem cells, the combination of a leukocyte count of ≥25 and a platelet count of ≥100 is associated with excellent mobilization of stem cells as measured by PBCD34 in the majority of patients on the first and second harvest days. However, the relationship between good counts and PBCD34 is not as strong from the third day onwards, and a good leukocyte-platelet count combination is less powerful at predicting good mobilization. Conversely, lower leukocyte and/or platelet counts strongly predict for poor mobilization beyond the second day, but somewhat less strongly on the first two days. Thus, on the first and second days of stem cell collection in patients mobilized with G-CSF, apheresis can be initiated based on favorable hematologic parameters without necessarily awaiting PBCD34 levels. However, beyond the second day, PBCD34 levels should guide apheresis rather than surrogate markers such as leukocyte and platelet counts.

Excellent Stem Cell Mobilization Using Escalated BEACOPP in High-Risk Patients with Hodgkin's Disease.

Introduction: After intensive treatment regimens have been established, the survival rate for patients with advanced Hodgkin's disease is approximately 91 % after five years and 13 % of the patients have a relapse or have primary progressive disease (2 %) within the first five years. For patients with relapse after conventional chemotherapy +/− radiotherapy, however, there is a real chance of achieving remission again. Since it is often difficult to harvest autologous stem cells following an intensive pretreatment, our center embarks on the strategy to harvest autologous blood stem cells in high-risk patients, defined according to the risk stratification of the German Hodgkin Study Group, already as part of the initial polychemotherapy.Results: Between 9/2003 and 5/2005, we analyzed the results of the stem cell harvest of 12 consecutive patients with Hodgkin's disease who were mobilized with the escalated BEACOPP regimen. There were 7 female and 5 male patients. Escalated BEACOPP was the primary therapy in ten patients and a relapse was treated in two patients; the previous treatment was 4 or 6 cycles of the ABVD regime + involved field radiation. The ten patients who did not receive previous treatment were classified as having Ann Arbor stage IIA/2 IIB/5, IIIB/2 and IVB/1 and all of them had a large mediastinal bulk as an additional risk factor. The two patients who did receive a previous treatment were classified as having an initial Ann Arbor stage IIA or IIB, without an additional risk factor. The stem cells were collected in 1 patient from cycle 2, in 8 patients from cycle 3 and in 3 patients from cycle 4 of the escalated BEACOPP regimen. A total of 11 patients received a standard dose of filgrastim, 5μg/kg body weight s.c., from day 8 up to the last apheresis and 1 patient received pegfilgrastim 6mg s.c. All aphereses were performed using an Amicus cell separator® (Baxter, MNC set, closed two-arm). 7 patients required only 1 apheresis and the remaining 5 patients required 2 aphereses. An apheresis result sufficient for a possible reinfusion could be achieved in all patients (4.26 – 14.4 x10e6 CD34 pos. cells/kg/body weight, mean: 7.7).Summary: According to our experience, escalated BEACOPP regimen is very suitable for the harvesting of stem cells in high-risk patients with Hodgkin's disease even though they are receiving procarbazine. A sufficient quantity of stem cells can also be collected from pretreated patients. The stem cell mobilization can be integrated into the escalated BEACOPP regimen safely and without a delay in treatment and thus creates, already at an early stage, the pre-condition for a high-dose therapy, which might be required in high-risk patients.

Use of total leukocyte and platelet counts to guide stem cell apheresis in healthy allogeneic donors treated with G-CSF

Healthy stem cell donors start leukapheresis 4-5 days after starting G-CSF based on the peripheral blood CD34+ cell count (PBCD34). Data from 137 harvests (68 donors) were analyzed to determine correlation between pre-apheresis leukocytes (11.0-94.8x10(9)/l; median 38.8) and platelets (49-374x10(9)/l; median 180), and PBCD34 (3-276/microl; median 40). PBCD34 correlated positively with leukocytes (r=0.48; P<0.0001) and platelets (r=0.40; P<0.0001). When pre-apheresis leukocytes were >or=25 and platelets were >or=100, PBCD34 and CD34+ collection were 5-276/microl (median 57) and 0.5-27.6x10(6)/kg (median 4.7), respectively; significantly higher than PBCD34 of 3-74/microl (median 17) and CD34+ collection of 0.2-8.9 x 10(6)/kg (median 2.2) when leukocytes were <25 and/or platelets were <100. With leukocytes >or=25 and platelets >or=100, PBCD34 was low (<20/microl) 8% of the time, compared to 57% of the time with leukocytes <25 and/or platelets <100 (P<0.0001). Our data suggest that it is not always necessary to measure PBCD34 to guide leukapheresis in healthy donors because pre-apheresis leukocytes and platelets >or=25 and >or=100, respectively, are associated with excellent mobilization. When blood counts do not meet these criteria, PBCD34 should be determined prior to initiation of apheresis.

ESHAP plus G-CSF as an effective peripheral blood progenitor cell mobilization regimen in pretreated non-Hodgkin's lymphoma: comparison with high-dose cyclophosphamide plus G-CSF

The ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) regimen has been shown to be effective as an active salvage therapy for lymphoma. Mobilizing stem cells following ESHAP should decrease time to transplantation by making separate mobilizing chemotherapy (MC) unnecessary, while controlling a patient's lymphoma. We therefore assessed the mobilization potential of ESHAP plus G-CSF in 26 patients (ESHAP group) with non-Hodgkin's lymphoma (NHL) and compared these results with those of 24 patients with NHL who received high-dose (4 g/m2l) cyclophosphamide (HDCY) as MC (HDCY group). The age, sex, and radiotherapy to the axial skeleton were well matched between groups, but the number of patients with poor mobilization predictors was higher in the ESHAP group. Significantly higher numbers of CD34+ cells (x 10(6)/kg) (17.1+/-18.8 vs 5.8+/-5.0, P=0.03) and apheresis day 1 CD34+ cells (x 10(6)/kg) (5.5+/-6.6 vs 1.7+/-2.0, P=0.014) were collected from the ESHAP group than from the HDCY group, and the number of patients who achieved an optimal CD34+ cell target of 5 x 10(6)/kg was higher in the ESHAP group (81 vs 50%, P=0.022). Log-rank test revealed that time to target peripheral blood progenitor cell collection (> or =5 x 10(6)/kg) was shorter in the ESHAP group (P=0.007). These results indicate that ESHAP plus G-CSF is an excellent mobilization regimen in patients with relapsed and poor-risk aggressive NHL.

Miniature Access Chait Cecostomy: A New Approach to the Management of Fecal Incontinence

The antegrade continence enema is a well-established procedure in the management of children with fecal incontinence. Chait and Shandling described the percutaneous approach for the management of these children. This procedure eliminates the need for an operation, can be performed under sedation and local anesthesia, and is clinically effective with minimal morbidity. However, it entails several important disadvantages. First, it is a blind procedure. Second, the cecum is not secured to the abdominal wall. Third, the procedure requires a skilled interventional radiologist. And fourth, it must be performed in two stages. We chose to alter the procedure by using a miniature access surgical approach. Miniature access Chait cecostomy was performed in four children with fecal incontinence. Under laparoscopic visualization, the cecum was identified, mobilized, and sutured to the anterior abdominal wall; the Chait device was then inserted. The procedure permitted excellent cecal visualization and mobilization. P...