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The optimal time for starting G-CSF application after autologous peripheral stem cell transplantation (APSCT) still remains undetermined. All previous studies used 'fixed' days (0 or +1 vs +5 or +7 post-transplant) for this purpose. As many other drugs have individual, patient-dependent criteria (eg antibiotics, blood products, etc), and the discontinuation of G-CSF also has strict patient-dependent criteria (surprisingly absent when starting the drug) we suppose that attempts to find general criteria suitable for every patient may not be successful. In order to also take the patients' individual predispositions into account we designed a randomized clinical trial to compare 'immediate' administration of G-CSF (day +1: group A) vs 'delayed, patient-dependent' (first day when absolute neutrophil count (ANC) was below 0.5 x 10[sup9]/l: group B) therapy with G-CSF (both groups received 10 μg/kg/day i.v.). A total of 70 patients after APSCT suffering from non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) conditioned with BEAM, or from multiple myeloma (MM) after melphalan (L-PAM: 200 mg/m²) were enrolled in this study (35 in each group). Both groups were comparable with regard to age, sex, disease stage and previous therapy as well as the number of CD34+ cells transplanted. In group B, G-CSF administration began on day +4 post-transplant (+2- +5). There were no detectable differences seen in the hematopoietic recovery (time to reach ANC more than 0.5 x 10[sup9]/1:12 days vs 13 days; time to platelet recovery, more than 50 x 10[sup9]/1:24 days in both groups), use of blood products or antibiotics, infections, or days of hospitalization. Delayed GCSF application led to significant cost saving in terms of APSCT (approximately US$1341 for each patient).... [ABSTRACT FROM AUTHOR]

Reports on an outpatient-based peripheral blood stem cells (PBSC) mobilizing regimen for hematological and non-hematological malignancies. Decsription of patients; Treatment using cyclophosphamide 3 g/m² and G-CSF; Measurment of complete blood counts and CD34[sup+] cells.

Identifying haemophilia patients with inhibitors for clinical trials is difficult due to the limited number of patients available. Registries are therefore being established as an additional means of data collection. The aim of this study was to investigate the effect of different recombinant activated factor VII (rFVIIa; NovoSeven®) dose ranges and dosing schedules on the incidence of re-bleeding in haemophilia patients with inhibitors. In this retrospective, uncontrolled study, data on the bleeding patterns of adult haemophilia patients with high responding inhibitors were analysed. Only data from the Czech Republic, obtained by the HemoRec registry, were used. This study analysed ‘real-life’ clinical data and focused on the collection of the same parameters in different patients: time from bleeding onset to first injection, effect of first injection, number of re-bleedings, total number of injections and total amount of haemostatic drug used. Fifteen patients met the inclusion criteria and were included into the study (128 bleeding episodes). Patients treated within 2 h of bleeding onset experienced less re-bleeding than patients treated after 2 h of bleeding onset (5.2% vs. 13.7%, respectively). In addition, patients who were treated after 2 h of bleeding onset experienced fewer re-bleedings when high-dose rFVIIa was used (15.8% and 0%; <120 μg kg−1 and >250 μg kg−1, respectively). Initial high-dose rFVIIa was also associated with a decline in total rFVIIa consumption. This registry has provided a unique insight into the bleeding patterns of inhibitor patients, highlighting the importance of early treatment initiation and appropriate starting dose. [ABSTRACT FROM AUTHOR]

We report a patient who underwent peripheral blood hematopoietic progenitor (PBHP) autologous transplantation for his third SAA relapse. Although his repeated relapses were always successfully reversed by immunosuppression, he developed anaphylaxis with horse, rabbit and mouse immunoglobulins as a side-effect of his previous treatment. He was mobilized with G-CSF and underwent three leukaphereses in the period of hematologic recovery after the second relapse. Fourteen months later, he suffered his third relapse, rescued by autologous PBHP transplantation after cyclophosphamide and melphalan conditioning. At present he is 15 months after transplantation without any treatment, transfusion-independent and in good condition. Others have published the observation that sufficient PBHP can be collected at least in some patients with SAA. Our experience shows that in repeatedly relapsing SAA with no other treatment options autologous transplantation with previously collected PBHP can result in successful hematologic reconstitution. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to acute gastrointestinal toxicity when substituting methotrexate with mycophenolate mofetil in the prevention of graft-versus-host disease in stem cell transplantation that was published online in the November 14, 2005 issue of the journal "Bone Marrow Transplantation."