34 research outputs found
Achieving early molecular response in chronic myeloid leukemia in chronic phase to reduce the risk of progression: clinical relevance of the 3- and 6-month time points
No full textPatients with chronic myeloid leukemia in chronic phase who achieve early molecular response (EMR; generally defined as BCR-ABL ≤ 10% on the International Scale at 3 or 6 months) have improved outcomes. However, there is no consensus on whether EMR failure at 3 months requires a change in therapy, and the value of the 6-month time point remains under debate. Some patients who do not achieve EMR at 3 months achieve significant decreases in BCR-ABL levels by 6 months, whereas others have progressive disease. For patients who do not achieve EMR at either time point, the risk of disease progression is higher both between 3 and 6 months and over the longer term, underlining the therapeutic relevance of the 3- to 6-month time period. For patients with EMR failure at 3 months, although there is currently no consensus on whether to switch therapy or wait until the 6-month assessment, some patients may benefit from an early change in treatment. This review synthesizes key clinical data demonstrating improved outcomes associated with the achievement of EMR and discusses the relevance of the 3- and 6-month time points on survival and the risk of disease progression. Several potential clinical situations are also presented to explore when a change in therapy may be considered.Simona Lapusan, Agnes Yong, Bipin N. Savani, Mohamad Moht
Infectious complications after post-transplantation cyclophosphamide and anti-thymocyte globulin-based haploidentical stem cell transplantation
No full textNumerical Shape Planning Algorithm for Hyper-Redundant Robots Based on Discrete Bézier Curve Fitting
No full textThe paper proposes a novel numerical method S-GUIDE that provides real-time planning of the shape of hyper-redundant robots with serial architecture by means of a guidance curve, represented in parametrized analytical form and in numerical form by a set of key points associated with the robot structure. To model the shape of the robot, the method uses an equivalent model, and a shape guidance curve obtained through a controlled adjustment of a Bézier curve. This is achieved in three computing steps were the robot equivalent structure, it’s associated kinematic parameters and the robot actuation parameters in joint space are calculated. The proposed method offers several advantages in relation with the precision, computing time and the feasibility for real-time applications. In the paper, the method accuracy, execution time, and the absolute error for different work scenarios are determined, compared and validated
Incidence and risk factors for hemorrhagic cystitis in unmanipulated haploidentical transplant recipients
No full textBackground: Hemorrhagic cystitis (HC) is a common complication after hematopoietic allogeneic stem cell transplantation (HSCT) associated with intensity of the conditioning regimen, cyclophosphamide (Cy) therapy, and BK polyomavirus (BKPyV) infection. Methods: We analyzed 33 consecutive haploidentical (haplo) HSCT recipients transplanted for hematologic diseases. Eleven patients had a previous transplant. Median follow-up was 11 months. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine + mycophenolate mofetil and post-HSCT Cy. Results: Thirty-two of 33 patients achieved neutrophil recovery. Cumulative incidence (CI) of platelet recovery was 65%. CI grade II-IV acute GVHD was 44%. Twenty patients developed HC in a median time of 38 days. CI of HC at day 180 was 62%. BKPyV was positive in blood and urine of 91% of patients at HC onset. HC resolved in 18/20 patients. Factors associated with HC were previous transplant (P = 0.01) and occurrence of cytomegalovirus reactivation before HC (P = 0.05). Grade II-IV acute GVHD was not associated with HC (P = 0.62). CI of day 180 viral infections was 73%. Two-year overall survival (OS) was 50%; HC did not impact OS (P = 0.29). Conclusion: The incidence of HC after haplo with post-HSCT Cy is high and is associated with morbidity, especially in high-risk patients such as those with a previous transplant history and with impaired immune reconstitution
Fractionated gemtuzumab ozogamicin in association with high dose chemotherapy: a bridge to allogeneic stem cell transplantation in refractory and relapsed acute myeloid leukemia
No full textOptimization of the salvage regimen is required to improve prognosis in primary refractory or relapsed acute myeloid leukemia (AML). In fit patients, a bridge to allogeneic transplant is the primary purpose of salvage. We tested the combination of fractionated gemtuzumab ozogamicin with cytarabine and mitoxantrone (MYLODAM schema) with primary endpoint of efficacy and safety. We also attempted to define predictive factors for survival and response after salvage. We included 58 patients with a median age at salvage of 56 years. The overall response rate was 67%. Leukemia-free survival (LFS) and overall survival (OS) at 2 years was 36% (95% CI: 23–49) and 54% (95% CI: 39–68), respectively. Treatment-related mortality was 7%. Three veno-occlusive diseases (SOS/VOD) occurred during salvage. In the allogeneic group of 28 patients (48%), LFS and OS at 2 years was 57 % (95% CI: 36.3–77.5) and 69 % (95% CI: 49.3–88.7), respectively. Incidences of nonrelapse mortality, grade II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 16%, 40%, and 45%, respectively. A GO-based intensive regimen is a viable option for salvage therapy and a feasible schedule as a bridge to allogeneic transplant
