47 results on '"Selby GB"'
Search Results
2. Inactivated varicella zoster vaccine in autologous haemopoietic stem-cell transplant recipients: an international, multicentre, randomised, double-blind, placebo-controlled trial
- Author
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Winston, Drew J, primary, Mullane, Kathleen M, additional, Cornely, Oliver A, additional, Boeckh, Michael J, additional, Brown, Janice Wes, additional, Pergam, Steven A, additional, Trociukas, Igoris, additional, Žák, Pavel, additional, Craig, Michael D, additional, Papanicolaou, Genovefa A, additional, Velez, Juan D, additional, Panse, Jens, additional, Hurtado, Kimberly, additional, Fernsler, Doreen A, additional, Stek, Jon E, additional, Pang, Lei, additional, Su, Shu-Chih, additional, Zhao, Yanli, additional, Chan, Ivan S F, additional, Kaplan, Susan S, additional, Parrino, Janie, additional, Lee, Ingi, additional, Popmihajlov, Zoran, additional, Annunziato, Paula W, additional, Arvin, Ann, additional, Basso, AC, additional, Bonvehi, P, additional, Cerana, S, additional, Dictar, MO, additional, Campbell, P, additional, Playford, G, additional, Sasadeusz, J, additional, Maertens, J, additional, Poire, X, additional, Sellesag, D, additional, Schots, R, additional, Theunissen, K, additional, Willems, E, additional, Alves, RS, additional, Camargo, JFC, additional, Castro, NS, additional, Maria Fogliatto, L, additional, Rodrigo, O, additional, Courture, F, additional, McGeer, A, additional, Miller, M, additional, Combariza, JF, additional, Sossa, CL, additional, Velez, JD, additional, Nemet, D, additional, Ostojic Kolonic, S, additional, Jebavy, L, additional, Mayer, J, additional, Novak, J, additional, Pohlreich, D, additional, Maldonado, B, additional, Gastinne, T, additional, Karlin, L, additional, Launay, O, additional, Cornely, OA, additional, Duerk, HA, additional, Haenel, M, additional, Heinz, W, additional, Kaufmann, M, additional, Panse, J, additional, Teschner, D, additional, Verbeek, M, additional, Wulf, G, additional, Aviv, F, additional, Grisariu, S, additional, Nagler, A, additional, Yeshurun, M, additional, Bosi, A, additional, Corradini, P, additional, Martinelli, G, additional, Onida, F, additional, Rambaldi, A, additional, Velardi, A, additional, Trociukas, I, additional, Gomez, AD, additional, Wondergem, MJ, additional, Ypma, PF, additional, Fanilla, E, additional, Moreno Larrea, MDC, additional, Abecasis, MM, additional, Ferreira, RB, additional, Geraldes, C, additional, Castro, J, additional, Afanasyev, BV, additional, Kruchkova, IV, additional, Zaritskiy, AY, additional, Cheong, JW, additional, Kim, SJ, additional, Lee, DG, additional, Yoon, SS, additional, Aguado Bueno, B, additional, Jarque Ramos, I, additional, Solano Vercet, C, additional, Cherif, H, additional, Ljungman, P, additional, Vaht, K, additional, Cook, G, additional, Kanfer, E, additional, Milligan, DW, additional, Parker, A, additional, Akard, L, additional, Bachier, C, additional, Ball, ED, additional, Betts, FR, additional, Braunschweig, I, additional, Brown, JM, additional, Carroll, MP, additional, Chandrasekar, PH, additional, Collins, R, additional, Cooper, B, additional, Craig, M, additional, D'Cunha, N, additional, Donato, ML, additional, Essell, J, additional, Flomenberg, P, additional, Freifeld, A, additional, Freytes, C, additional, Guarino, MJ, additional, Hall, MC, additional, Heimenz, JW, additional, High, KP, additional, Isola, LM, additional, Kaminer, L, additional, Klein, LM, additional, Janakiraman, N, additional, Kane, K, additional, Komanduri, K, additional, Krijanovski, OI, additional, Lawrence, SJ, additional, Leis, JF, additional, Lill, M, additional, Longo, WL, additional, Lynch, JP, additional, Mattar, BI, additional, Mehta, J, additional, Mullane, KM, additional, Nathan, S, additional, Papanicolaou, GA, additional, Pergam, SA, additional, Roy, V, additional, Rybka, W, additional, Safah, H, additional, Saltzman, D, additional, Segal, GM, additional, Selby, GB, additional, Schuster, MW, additional, Shoham, S, additional, Sloan, JM, additional, Strasfeld, LM, additional, Styler, M, additional, Sullivan, K, additional, Tse, W, additional, Vance, EA, additional, Winston, DJ, additional, and Yanovich, S, additional
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- 2018
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3. Formation of fibrin clots in cryopreserved stem cell bags during thawing procedure: lack of impact on engraftment in autologous stem cell transplantation
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Mandanas, RA, Kratochvil, K, Garner, T, and Selby, GB
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- 1999
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4. HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia.
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Arora M, Weisdorf DJ, Spellman SR, Haagenson MD, Klein JP, Hurley CK, Selby GB, Antin JH, Kernan NA, Kollman C, Nademanee A, McGlave P, Horowitz MM, Petersdorf EW, Arora, Mukta, Weisdorf, Daniel J, Spellman, Stephen R, Haagenson, Michael D, Klein, John P, and Hurley, Carolyn K
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- 2009
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5. Safety and feasibility of outpatient chimeric antigen receptor (CAR) T-cell therapy: experience from a tertiary care center.
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Borogovac A, Keruakous A, Bycko M, Holter Chakrabarty J, Ibrahimi S, Khawandanah M, Selby GB, Yuen C, Schmidt S, Autry MT, Al-Juhaishi T, Wieduwilt MJ, and Asch AS
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- Cell- and Tissue-Based Therapy, Feasibility Studies, Humans, Immunotherapy, Adoptive adverse effects, Outpatients, Receptors, Antigen, T-Cell therapeutic use, Tertiary Care Centers, Receptors, Chimeric Antigen therapeutic use
- Published
- 2022
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6. Serious Adverse Events in Related Donors: A Report from the Related Donor Safe Study.
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Seftel MD, Chitphakdithai P, Miller JP, Kobusingye H, Logan BR, Linenberger M, Artz AS, Haight AE, Jacobsohn DA, Litzow MR, Magalhaes-Silverman M, Selby GB, Vusirikala M, Horowitz MM, Switzer GE, Confer DL, Shaw BE, and Pulsipher MA
- Subjects
- Cohort Studies, Humans, Prospective Studies, Risk Factors, Unrelated Donors, Peripheral Blood Stem Cells
- Abstract
The incidence and risk factors for severe adverse events (SAEs) in related donors (RD) of hematopoietic cell transplants is unknown. The Related Donor Safe study is a prospective observational cohort of 1680 RDs and represents an opportunity to examine characteristics of SAEs in RDs. In this cohort, we found that SAEs were reported in a total 12 (0.71%) RDs. Of these, 5 SAEs occurred in bone marrow donors (5/404, 1.24%), and 7 (7/1276, 0.55%) were in donors of peripheral blood stem cells. All of the SAEs were considered to be related (definite, probable, or possible) to the donation process. There were no donor fatalities. Of the 12 RDs who experienced an SAE, 10 were either overweight or obese. Five of the 12 RDs had predonation medical conditions that would have resulted in either possible or definite ineligibility for donation were they being assessed as unrelated donors. These SAE data will be useful in the counseling of prospective RDs before planned donation and may be helpful in identifying donors who should be considered medically unsuitable for donation., (Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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7. Integration of Publicly Reported Center Outcomes into Standards and Accreditation: The FACT Model.
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LeMaistre CF, Wacker KK, Akard LP, Al-Homsi AS, Gastineau DA, Godder K, Lill M, Selby GB, Steinberg A, Anderson JM, Leahigh AK, and Warkentin PI
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- Humans, United States, Accreditation, Bone Marrow Transplantation
- Abstract
The rapid evolution of blood and marrow transplantation (BMT), coupled with diverse outcomes associated with heterogeneous groups of patients, led to the formation of 2 important organizations early in the development of the field: the Center for International Blood and Marrow Transplant Research (CIBMTR) and the Foundation for the Accreditation of Cellular Therapy (FACT). These organizations have addressed 2 of the 9 elements identified by the National Quality Strategy (NQS) for achieving better health care, more affordable care, and healthy people and communities: a registry that promotes improvement of care and accreditation based on quality standards. More recently, a federally mandated database in the United States addresses the third element of the NQS: public reporting of treatment results. Here we describe the current process by which FACT incorporates patient outcomes reported by the CIBMTR into standards for accreditation, the requirements for accredited programs with performance below expected outcomes to maintain accreditation, and preliminary findings of an assessment of corrective action plans intended to improve outcomes., (Copyright © 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
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- 2019
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8. Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study.
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Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, and Confer DL
- Subjects
- Adolescent, Adult, Aged, Blood Donors, Comorbidity, Female, Humans, Male, Middle Aged, Young Adult, Peripheral Blood Stem Cell Transplantation methods, Peripheral Blood Stem Cells metabolism
- Abstract
The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34
+ level before apheresis compared with younger RDs (age > 60, 59 × 106 /L; age 41 to 60, 81 × 106 /L; age 18 to 40, 121 × 106 /L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 109 /L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals., (Copyright © 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
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9. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors.
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, and Shaw BE
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Prospective Studies, Young Adult, Living Donors, Peripheral Blood Stem Cell Transplantation, Peripheral Blood Stem Cells, Quality of Life, Unrelated Donors
- Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P <0.001] and severe (OR 8.91; P <0.001) pain and toxicities (OR 1.84; P <0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P =0.021) and non-recovery from pain (OR 1.42; P =0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P <0.001) and non-recovery from toxicities (OR 3.71; P <0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P <0.001) and non-recovery from toxicities (OR 3.71; P <0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation ( P =0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636 ., (Copyright© 2019 Ferrata Storti Foundation.)
- Published
- 2019
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10. Stem cell transplant in inflammatory bowel disease: a promising modality of treatment for a complicated disease course.
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Salem GA and Selby GB
- Abstract
Inflammatory bowel disease (IBD) is a complex, relapsing and remitting, disease characterized by an exaggerated immune response in a susceptible host. The symptoms and complications of the disease can be debilitating. Advances in medical treatment in the last decade changed the course of the disease in many patients. Despite the use of novel agents for controlling disease, a proportion of patients' disease courses continue to be either refractory, or become resistant, to available therapeutic options. Stem-cell therapy, with hematopoietic stem cells (HSCs) or mesenchymal stem cells (MSCs), is a promising modality of treatment for severe refractory cases, mainly Crohn's disease (CD) patients. HSCs have the ability to migrate to damaged tissue, which provides them with further properties to differentiate to epithelial or immune-modulatory cells to restore normal mucosal tissue and integrity. MSCs therapy is a promising model for patients with perianal CD due to their immunosuppressive properties, ability to migrate to areas of injury, and demonstration of colonic healing, including fistulizing tracts. The results from ongoing clinical trials will provide a valuable understanding of the future of stem-cell therapy as a treatment option in refractory cases of IBD, a disease whose pathogenesis remains unknown, and is notoriously difficult to treat., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2017
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11. Impact of Health Care Insurance Status on Treatment Outcomes of Acute Myeloid Leukemia.
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Srour SA, Machiorlatti M, Pierson NT, Bhutta UZ, Cherry M, Selby GB, Thompson DM, Vesely SK, and Kurkjian CD
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- Aged, Female, Humans, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute therapy, Recurrence, Survival Analysis, Treatment Outcome, Insurance, Health statistics & numerical data, Leukemia, Myeloid, Acute economics
- Abstract
Introduction: Insurance status has been found to influence treatment outcomes in various solid tumors. Limited data with conflicting results are available in patients with acute myeloid leukemia (AML). We examined the impact of health insurance at diagnosis on AML treatment outcomes., Patients and Methods: All consecutive adult patients (≥ 18 years of age) diagnosed with AML between 2002 and 2011 and followed through August 2013 were included. Survival estimates were calculated by Kaplan-Meier survival curves. Logistic regression and multivariate Cox proportional hazards methods were used to explore the influence of multiple baseline covariates on treatment outcomes., Results: A total of 217 patients with complete medical records were identified. Of these, 161 patients had complete cytogenetic/molecular data for risk stratification and were included in the final efficacy analyses. Most patients (45.8%) were publicly insured, 36.3% were privately insured, and 17.3% were uninsured. No significant association was found between insurance source and cytogenetic/molecular risk status. Transplantation information was available for 157 patients, with no significant association found between transplant receipt and insurance source. After adjustment for age, cytogenetic/molecular risk, and transplant receipt, we found no statistically significant association between the insurance source and either event-free or overall survival., Conclusion: Insurance source at diagnosis has no impact on AML treatment outcomes. The consistency of our results with some, but not all, studies is probably driven primarily by access-to-care eligibility requirements among different states. Further efforts to better understand such disparities are warranted., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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12. The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplantation for Patients with Acute Leukemia.
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Holter-Chakrabarty JL, Pierson N, Zhang MJ, Zhu X, Akpek G, Aljurf MD, Artz AS, Baron F, Bredeson CN, Dvorak CC, Epstein RB, Lazarus HM, Olsson RF, Selby GB, Williams KM, Cooke KR, Pasquini MC, and McCarthy PL
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- Acute Disease, Adolescent, Adult, Child, Child, Preschool, Female, Graft vs Host Disease etiology, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Humans, Immunosuppressive Agents therapeutic use, Infant, Infant, Newborn, Leukemia immunology, Leukemia mortality, Leukemia pathology, Male, Middle Aged, Prospective Studies, Recurrence, Risk, Siblings, Survival Analysis, Transplantation, Homologous, Unrelated Donors, Whole-Body Irradiation, Cyclophosphamide therapeutic use, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation adverse effects, Leukemia therapy, Myeloablative Agonists therapeutic use, Transplantation Conditioning
- Abstract
Limited clinical data are available to assess whether the sequencing of cyclophosphamide (Cy) and total body irradiation (TBI) changes outcomes. We evaluated the sequence in 1769 (CyTBI, n = 948; TBICy, n = 821) recipients of related or unrelated hematopoietic cell transplantation who received TBI (1200 to 1500 cGY) for acute leukemia from 2003 to 2010. The 2 cohorts were comparable for median age, performance score, type of leukemia, first complete remission, Philadelphia chromosome-positive acute lymphoblastic leukemia, HLA-matched siblings, stem cell source, antithymocyte globulin use, TBI dose, and type of graft-versus-host disease (GVHD) prophylaxis. The sequence of TBI did not significantly affect transplantation-related mortality (24% versus 23% at 3 years, P = .67; relative risk, 1.01; P = .91), leukemia relapse (27% versus 29% at 3 years, P = .34; relative risk, .89, P = .18), leukemia-free survival (49% versus 48% at 3 years, P = .27; relative risk, .93; P = .29), chronic GVHD (45% versus 47% at 1 year, P = .39; relative risk, .9; P = .11), or overall survival (53% versus 52% at 3 years, P = .62; relative risk, .96; P = .57) for CyTBI and TBICy, respectively. Corresponding cumulative incidences of sinusoidal obstruction syndrome were 4% and 6% at 100 days (P = .08), respectively. This study demonstrates that the sequence of Cy and TBI does not impact transplantation outcomes and complications in patients with acute leukemia undergoing hematopoietic cell transplantation with myeloablative conditioning., (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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13. Catheter-related complications in patients with acute myeloid leukemia after hematopoietic stem cell transplant.
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Khalil MO, Pierson N, Selby GB, Cherry M, and Holter JL
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- Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Hematopoietic Stem Cell Transplantation adverse effects, Leukemia, Myeloid, Acute surgery, Prosthesis-Related Infections, Vascular Access Devices adverse effects
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- 2015
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14. Autoimmune hemolytic anemia and thrombocytopenia attributed to an intrauterine contraceptive device.
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Khawandanah MO, Weiss SM, Cherry MA, Maymani H, Selby GB, Aster RH, George JN, and Holter Chakrabarty JL
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- Adult, Agglutination Tests, Alemtuzumab, Anemia, Hemolytic, Autoimmune drug therapy, Anemia, Hemolytic, Autoimmune immunology, Anemia, Hemolytic, Autoimmune therapy, Animals, Antibodies, Monoclonal, Humanized therapeutic use, Blood Transfusion, Combined Modality Therapy, Device Removal, Drug Resistance, Female, Humans, Immunosuppressive Agents therapeutic use, Levonorgestrel, Mice, Mice, Inbred NOD, Mice, SCID, Plasma Exchange, Splenectomy, Thrombocytopenia drug therapy, Thrombocytopenia immunology, Thrombocytopenia therapy, Anemia, Hemolytic, Autoimmune chemically induced, Intrauterine Devices, Medicated adverse effects, Polyethylene adverse effects, Polyethylene Glycols adverse effects, Thrombocytopenia chemically induced
- Abstract
Background: Evans syndrome is a rare condition manifested by combined autoimmune hemolytic anemia (AIHA) and thrombocytopenia or neutropenia. It is often associated with other autoimmune disorders, immunodeficiencies, and non-Hodgkin's lymphoma., Case Report: We describe a patient with Evans syndrome that may have been related to exposure to a polyethylene-based intrauterine contraceptive device (IUD). A 26-year-old white female presented with severe, symptomatic AIHA and subsequently developed severe thrombocytopenia. She had a refractory course resistant to multiple treatments including corticosteroids, intravenous immune globulin, rituximab, splenectomy, cyclophosphamide, cyclosporine, eculizumab, and plasma exchange. It was then noticed that her serum autoantibody agglutinated red blood cells (RBCs) in the presence of polyethylene glycol (PEG) but not in the absence of PEG nor when an alternative agglutination enhancing technique, low-ionic-strength solution, was used. Therefore, her polyethylene-containing IUD, which was a polyethylene frame with a levonorgestrel-releasing device, was removed. Norgestrel-dependent, platelet (PLT)-reactive antibodies were not identified by either flow cytometry or in vivo in a NOD/SCID mouse. Testing for PEG-dependent antibodies was not possible. Remission, with no requirement for RBC or PLT transfusions and return of her hemoglobin and PLT counts to normal, followed removal of the IUD., Conclusion: The patient's recovery after removal of the IUD and the PEG dependence of RBC agglutination suggested a possibility that the IUD may have been a contributing factor to the etiology of Evans syndrome in this patient., (© 2014 AABB.)
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- 2015
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15. Role of topotecan, vinorelbine, thiotepa and gemcitabine chemotherapy in relapsed/refractory adult acute leukemia.
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Srour SA, Borders EB, Cherry MA, Holter J, Herman T, and Selby GB
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- Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Combined Modality Therapy, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Drug Resistance, Neoplasm, Humans, Recurrence, Retreatment, Thiotepa administration & dosage, Topotecan administration & dosage, Treatment Outcome, Vinblastine administration & dosage, Vinblastine analogs & derivatives, Vinorelbine, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Leukemia, Myeloid, Acute drug therapy, Leukemia, Myeloid, Acute pathology, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology
- Published
- 2015
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16. Autologous is superior to allogeneic hematopoietic cell transplantation for acute promyelocytic leukemia in second complete remission.
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Holter Chakrabarty JL, Rubinger M, Le-Rademacher J, Wang HL, Grigg A, Selby GB, Szer J, Rowe JM, Weisdorf DJ, and Tallman MS
- Subjects
- Adult, Disease-Free Survival, Female, Humans, Male, Middle Aged, Remission Induction, Retrospective Studies, Transplantation, Autologous, Transplantation, Homologous, Young Adult, Hematopoietic Stem Cell Transplantation methods, Leukemia, Promyelocytic, Acute therapy
- Abstract
To identify favored choice of transplantation in patients with acute promyelocytic leukemia (APL) in second complete remission, we studied 294 patients with APL in second complete remission (CR2) receiving allogeneic (n = 232) or autologous (n = 62) hematopoietic cell transplantation (HCT) reported to the Center for International Blood and Marrow Transplantation Research (CIBMTR) from 1995 to 2006, including 155 with pre-HCT PML/RAR∝ status (49% of allogeneic and 66% of autologous). Patient characteristics and transplantation characteristics, including treatment-related mortality, overall survival (OS), and disease-free survival, were collected and analyzed for both univariate and multivariate outcomes. With median follow-up of 115 (allogeneic) and 72 months (autologous), 5-year disease-free survival (DFS) favored autologous with 63% (49% to 75%), compared with allogeneic at 50% (44% to 57%) (P = .10). OS was 75% (63% to 85%) versus 54% (48% to 61%) (P = .002), for autologous and allogeneic transplantation, respectively. Multivariate analysis showed significantly worse DFS after allogeneic HCT (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.16 to 3.06; P = .011) and age > 40 years (HR, 2.30; 95% CI, 1.44 to 3.67; P = .0005). OS was significantly worse after allogeneic HCT (HR, 2.66; 95% CI, 1.52 to 4.65; P= .0006); age > 40 (HR, 3.29; 95% CI, 1.95 to 5.54; P < .001), and first complete remission < 12 months (HR, 1.56; 95% CI, 1.07 to 2.26; P = .021). Positive pre-HCT PML-RAR∝ status in 17 of 114 allogeneic and 6 of 41 receiving autologous transplantation did not influence relapse, treatment failure, or survival in either group. The survival advantage for autografting was attributable to increased treatment-related mortality (TRM) in the allogeneic group of 30% compared to 2% in the autologous group, in addition to the added mortality associated with GVHD. We conclude that autologous HCT yields superior OS for APL in CR2. Long-term DFS in autologous recipients, even with minimal residual disease-positive grafts, remains an important subject for further study., (Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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17. Challenges and potential solutions for recruitment and retention of hematopoietic cell transplantation physicians: the National Marrow Donor Program's System Capacity Initiative Physician Workforce Group report.
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Burns LJ, Gajewski JL, Majhail NS, Navarro W, Perales MA, Shereck E, Selby GB, Snyder EL, Woolfrey AE, and Litzow MR
- Subjects
- Career Choice, Focus Groups, Hematologic Diseases pathology, Humans, Tissue Donors, United States, Hematologic Diseases therapy, Hematopoietic Stem Cell Transplantation, Physicians supply & distribution, Registries
- Abstract
Hematopoietic cell transplantation (HCT) remains the only known curative therapy for many patients with hematologic, metabolic, and immunologic disorders. Furthermore, the use of HCT has increased with the emergence of HCT as a viable therapeutic option for older patients, those with significant comorbidities, and, with the demonstrated clinical effectiveness of alternative allogeneic donor sources, for those patients without a suitable sibling donor. The National Marrow Donor Program (NMDP) estimates that by 2020, it will facilitate 10,000 transplantations per year, double the number in 2010. To understand the needs of the HCT infrastructure to facilitate this number of transplantations, the NMDP organized the System Capacity Initiative 2020, centered on 6 working groups representing a diverse group of stakeholders. The Physician Workforce Group was tasked with addressing issues relating to recruitment and retention of transplantation physicians. We report here the results of our efforts and future initiatives., (Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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18. Impending challenges in the hematopoietic stem cell transplantation physician workforce.
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Gajewski JL, LeMaistre CF, Silver SM, Lill MC, Selby GB, Horowitz MM, Rizzo JD, Heslop HE, Anasetti C, and Maziarz RT
- Subjects
- Humans, Hematopoietic Stem Cell Transplantation, Physicians
- Abstract
With increasing use of high dose chemotherapy with autologous and allogeneic transplants the need for the transplant physician workforce requires reassessment. The types of transplants and patients are also shifting toward transplants being done in patients with more comorbidities and more commonly these types of patients require more work effort per patient from the transplant physician. Additionally, HSCT survivors often require ongoing care at the transplant center due to the inability of the primary care workforce or the hematology/oncology workforce to absorb caring for post complex post transplant patients. The adult transplant workforce has had very few physicians join under age 40. Nearly 50% of adult transplant physicians are over age 50 whereas only 28% of pediatric transplant physicians are over age 50. By 2020, it is projected that we will need 1,264 new adult transplant physicians and 94 pediatric transplant physicians. Training time for a physician is approximately 15 years. The capping of both medical school slots and residency slots since the early '80s is now having a very big impact on supply, but other factors are also affecting supplies such as generational differences, lifestyle expectations, and the change of the medical workforce from being mostly men. Workforce shortages are being reported for many specialities. Workforce problems are also present for nurses, pharmacists and medical technologists. So increasing use of general internists and mid-level providers may not exist as a solution. Transplant physicians must be actively engaged in the medical education process to show young medical students and residents who are not committed to another sub specialty career the excitement and challenges of a career in bone marrow transplantation, so that our field will have providers for the future.
- Published
- 2009
- Full Text
- View/download PDF
19. Difficulties in monitoring the glucose status of patients undergoing hematopoietic stem cell transplantation.
- Author
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Selby GB, Mosallaei-Benjamin M, Kalyanaraman V, Lancaster A, and Scofield RH
- Subjects
- Glucose Tolerance Test, Humans, Blood Glucose analysis, Hematopoietic Stem Cell Transplantation methods
- Published
- 2009
- Full Text
- View/download PDF
20. Bevacizumab in hereditary hemorrhagic telangiectasia.
- Author
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Bose P, Holter JL, and Selby GB
- Subjects
- Adult, Antibodies, Monoclonal, Humanized, Bevacizumab, Drug Therapy, Combination, Ferritins blood, Humans, Infusions, Intravenous, Male, Telangiectasia, Hereditary Hemorrhagic blood, Vascular Endothelial Growth Factor A immunology, Angiogenesis Inhibitors therapeutic use, Antibodies, Monoclonal therapeutic use, Iron therapeutic use, Telangiectasia, Hereditary Hemorrhagic drug therapy
- Published
- 2009
- Full Text
- View/download PDF
21. Thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation: an autopsy study.
- Author
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Siami K, Kojouri K, Swisher KK, Selby GB, George JN, and Laszik ZG
- Subjects
- Adolescent, Adult, Autopsy, Child, Female, Graft vs Host Disease diagnosis, Graft vs Host Disease pathology, Humans, Kidney blood supply, Kidney pathology, Male, Middle Aged, Thrombosis diagnosis, Thrombosis pathology, Transplantation, Homologous adverse effects, Hematopoietic Stem Cell Transplantation adverse effects, Thrombosis etiology
- Abstract
Background: Posttransplantation thrombotic microangiopathy (PTMA) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT). However, limited autopsy data are available, and it remains unclear whether PTMA is a discrete clinical and pathologic entity. The aims of this autopsy study were to determine the correlation between clinical and pathologic diagnosis of PTMA, to define the precise morphologic spectrum of PTMA, and to seek for potential etiologic factors., Methods: The study included 20 consecutive patients with HSCT autopsied at the University of Oklahoma, between 1994 and 2005. Applying strict clinical-laboratory criteria, 6 patients were diagnosed clinically with PTMA and treated with plasma exchange. Clinical variables, including underlying disease, conditioning regimen, stem cell donor status, duration and serum level of cyclosporine, infections, and acute graft versus host disease were compared statistically in patients with histologic signs of PTMA (n=8) with those without PTMA (n=12)., Results: PTMA was verified histologically in all 6 patients with a clinical diagnosis of PTMA but only 2 of the 14 patients who were not clinically diagnosed had histologic evidence of PTMA (P<0.0001). Kidneys were affected in all 8 patients with PTMA, and limited extrarenal involvement by PTMA was observed in 3 of these 8 patients. No statistically significant differences in relevant clinical and morphologic variables were identified between the PTMA and non-PTMA groups., Conclusions: This study documents a strong correlation between the clinical and morphologic diagnosis of PTMA. The kidney is the primary target of PTMA, with dominant glomerular and arteriolar involvement. The etiology is likely to be multifactorial.
- Published
- 2008
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- View/download PDF
22. Expression of the vascular endothelial growth factor receptors 1 and 2 in acute myeloid leukemia: incidence and feasibility of immunohistochemical staining.
- Author
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Kharfan-Dabaja MA, Patel SA, Osunkoya AO, Kojouri K, Kamble R, Yang J, Hashmi M, Ozer H, and Selby GB
- Subjects
- Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Immunohistochemistry methods, Male, Middle Aged, Bone Marrow chemistry, Leukemia, Myeloid, Acute metabolism, Vascular Endothelial Growth Factor Receptor-1 analysis, Vascular Endothelial Growth Factor Receptor-2 analysis
- Abstract
Vascular endothelial growth factor (VEGF) and its receptor tyrosine kinases, VEGFR-1 and VEGFR-2, are important therapeutic targets for various cancers including AML. Paraffin-embedded bone marrow samples (PE-BM) are, in most cases, the only tissue accessible to perform retrospective analyses of novel targets such as VEGF and/or its receptors. As a result, it limits our options to immunohistochemistry (IHS), or more expensive and less practical techniques such as enzyme-linked immunosorbent assay (ELISA) or fluorescence in situ hybridization (FISH). We analyzed the feasibility of IHS to measure VEGFR-1 and VEGFR-2 expression in 28 AML samples using monoclonal antibodies (moAbs) against Flt-1 (VEGFR-1) and KDR/Flk-1 (VEGFR-2). Medical records were reviewed for relevant clinical information. Expression of VEGFR-1 (+) and VEGFR-2 (+) were seen in 25% (7/28) and 43% (12/28) respectively. Forty-six percent (13/28) were dual-negatives for VEGFR-1 and VEGFR-2; 14% (4/28) were dual-positives for VEGFR-1 and VEGFR-2. An inferior survival was observed in patients whose myeloblasts express either VEGFR-1 (+) or VEGFR-2 (+), or both. Determination of expression of VEGF receptors (1 and 2) by IHS in PE-BM tissue is feasible. Prospective comparison of IHC to flow cytometry or other molecular techniques, and assessment of the prognostic significance of VEGF receptors in AML patients is warranted.
- Published
- 2006
- Full Text
- View/download PDF
23. Leukemia burden and outcome of allogeneic transplant in acute myelogenous leukemia.
- Author
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Kamble RT, Hjortsvang E, and Selby GB
- Subjects
- Adult, Hematopoietic Stem Cell Transplantation mortality, Humans, Leukemia, Myeloid, Leukemia, Myeloid, Acute pathology, Transplantation, Homologous, Treatment Outcome, Tumor Burden, Hematopoietic Stem Cell Transplantation methods, Leukemia, Myeloid, Acute therapy
- Published
- 2006
- Full Text
- View/download PDF
24. Iron overload manifesting as apparent exacerbation of hepatic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
- Author
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Kamble RT, Selby GB, Mims M, Kharfan-Dabaja MA, Ozer H, and George JN
- Subjects
- Adult, Biopsy, Bone Marrow Transplantation adverse effects, Combined Modality Therapy, Darbepoetin alfa, Diagnosis, Differential, Disease Progression, Epoetin Alfa, Erythropoietin analogs & derivatives, Erythropoietin therapeutic use, Female, Ferritins blood, Graft vs Host Disease drug therapy, Graft vs Host Disease etiology, Humans, Immunosuppressive Agents therapeutic use, Iron Overload complications, Iron Overload therapy, Liver Diseases etiology, Liver Diseases pathology, Male, Middle Aged, Pancreatic Diseases etiology, Phlebotomy, Prospective Studies, Recombinant Proteins, Skin Diseases etiology, Transferrin analysis, Transplantation Conditioning, Erythrocyte Transfusion adverse effects, Graft vs Host Disease diagnosis, Hematopoietic Stem Cell Transplantation adverse effects, Iron Overload diagnosis, Liver Diseases diagnosis, Transplantation, Homologous adverse effects
- Abstract
Iron overload presenting as exacerbation of hepatic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation has not been previously described. We report 6 patients with established hepatic GVHD in whom iron overload (median serum ferritin, 7231 mug/dL; median transferrin saturation, 77%) resulting from a lifetime median of 20 units of packed red blood cell transfusions was manifested by worsening of liver function. Liver biopsies performed in 4 patients confirmed severe iron overload and also hepatic GVHD. Analysis for the C282Y and H63D hemochromatosis gene mutation was negative for the homozygous state in all 6 patients. Erythropoietin-assisted phlebotomy resulted in normalization of liver function at a median of 7 months and of serum ferritin at a median of 11 months. Immunosuppressive therapy was successfully tapered in all 4 patients who completed the phlebotomy program, and this supported the impression that iron overload, rather than GVHD, was the principal cause of liver dysfunction. At a median follow-up of 50 months (range, 18-76 months) from the transplantation and 25 months (range, 5-36 months) from ferritin normalization, all 4 patients require maintenance phlebotomy. We conclude that iron overload can mimic GVHD exacerbation, thus resulting in unnecessary continuation or intensification of immunosuppressive therapy for GVHD, and that maintenance phlebotomy is necessary after successful iron-reduction therapy.
- Published
- 2006
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- View/download PDF
25. Delayed myeloid engraftment due to vancomycin in allogeneic haematopoietic stem cell transplant recipients.
- Author
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Kamble RT, Hamadani M, and Selby GB
- Subjects
- Humans, Male, Middle Aged, Anti-Bacterial Agents adverse effects, Graft Survival drug effects, Hematopoietic Stem Cell Transplantation, Neutropenia therapy, Transplantation, Homologous, Vancomycin adverse effects
- Published
- 2006
- Full Text
- View/download PDF
26. Increased mean corpuscular volume after autologous hematopoietic stem cell transplantation: incidence and significance.
- Author
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Kamble RT, Hamadani M, and Selby GB
- Subjects
- Adolescent, Adult, Aged, Bone Marrow Diseases diagnosis, Bone Marrow Diseases etiology, Child, Child, Preschool, Female, Hematologic Neoplasms blood, Hematologic Neoplasms complications, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation methods, Humans, Incidence, Infant, Male, Middle Aged, Retrospective Studies, Transplantation, Autologous, Erythrocyte Indices, Hematopoietic Stem Cell Transplantation adverse effects
- Published
- 2006
- Full Text
- View/download PDF
27. Microbial contamination of hematopoietic progenitor cell grafts-incidence, clinical outcome, and cost-effectiveness: an analysis of 735 grafts.
- Author
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Kamble R, Pant S, Selby GB, Kharfan-Dabaja MA, Sethi S, Kratochvil K, Kohrt N, and Ozer H
- Subjects
- Anti-Infective Agents therapeutic use, Antibiotic Prophylaxis, Bacterial Infections drug therapy, Bacterial Infections microbiology, Bacterial Infections prevention & control, Bacterial Infections transmission, Bone Marrow Cells microbiology, Ciprofloxacin therapeutic use, Cost-Benefit Analysis, Fetal Blood microbiology, Humans, Retrospective Studies, Specimen Handling, Treatment Outcome, Bacterial Infections economics, Bacterial Infections epidemiology, Hematopoietic Stem Cell Transplantation, Hematopoietic Stem Cells microbiology, Incidence
- Abstract
Background: Screening of progenitor cell grafts (marrow, peripheral blood, and cord blood) for microbial contamination is required by the standards of AABB. Clinical sequelae from infusion of these contaminated grafts, however, is uncommon., Study Design and Methods: A retrospective analysis of 735 consecutive marrow and peripheral blood progenitor cell harvests between 1998 and 2003 was performed. Analysis included incidence, clinical outcome, and cost outcomes of positive blood cultures and antibiotic therapy., Results: Thirty-three of 735 (4.5%) harvests were contaminated. The incidence of microbial contamination varied with the source of the graft (4 of 26 [15%] were cord blood, 8 of 177 [4.5%] were marrow, and 21 of 532 [3.9%] were peripheral blood). Coagulase-negative Staphylococcus (n=22) and Propionibacterium acnes (n=8) were most frequently isolated. Potentially pathogenic organisms were isolated in 6 of 735 (0.81%) grafts (methicillin-sensitive Staphylococcus aureus, 4; methicillin-resistant S. aureus, 1; and Enterobacter cloacae, 1). The estimated total cost of surveillance was approximately $81,585. The cost of vancomycin therapy in 4 patients who received prophylactic antibiotic therapy was approximately $10,000. No adverse sequelae followed infusion of contaminated grafts., Conclusion: Clinical sequelae following infusion of microbially contaminated progenitor cells is extremely rare. Prophylactic empiric antibiotics may be unnecessary. Routine microbial surveillance of progenitor cell grafts is a low-yield procedure.
- Published
- 2005
- Full Text
- View/download PDF
28. Re: failure to engraft after autologous stem cell transplantation: possible therapeutic role of cyclosporine.
- Author
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Kamble RT, Sethi S, and Selby GB
- Subjects
- Adult, Female, Hematopoiesis drug effects, Humans, Transplantation, Autologous, Cyclosporine therapeutic use, Graft Rejection drug therapy, Hematopoietic Stem Cell Transplantation adverse effects
- Published
- 2005
- Full Text
- View/download PDF
29. Thrombotic microangiopathy after allogeneic bone marrow transplantation: a pathologic abnormality associated with diverse clinical syndromes.
- Author
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George JN and Selby GB
- Subjects
- Diagnosis, Differential, Disease Management, Graft vs Host Disease diagnosis, Hemolytic-Uremic Syndrome etiology, Hemolytic-Uremic Syndrome pathology, Humans, Purpura, Thrombotic Thrombocytopenic etiology, Transplantation, Homologous, Bone Marrow Transplantation adverse effects, Purpura, Thrombotic Thrombocytopenic pathology
- Published
- 2004
- Full Text
- View/download PDF
30. Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome following allogeneic HPC transplantation: a diagnostic dilemma.
- Author
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George JN, Li X, McMinn JR, Terrell DR, Vesely SK, and Selby GB
- Subjects
- Hemolytic-Uremic Syndrome mortality, Humans, Purpura, Thrombotic Thrombocytopenic mortality, Transplantation, Homologous, Hematopoietic Stem Cell Transplantation adverse effects, Hemolytic-Uremic Syndrome diagnosis, Hemolytic-Uremic Syndrome etiology, Purpura, Thrombotic Thrombocytopenic diagnosis, Purpura, Thrombotic Thrombocytopenic etiology
- Abstract
Background: Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has been described as a specific sequela of allogeneic HPC transplantation (HPCT). Nevertheless, because multiple transplant-related sequela can cause the characteristic clinical features of TTP-HUS, the diagnosis is difficult., Study Design and Methods: All English-language articles describing patients with TTP-HUS following HPCT were identified. Articles reporting five or more total patients, including at least one patient diagnosed with TTP-HUS following allogeneic HPCT, were reviewed. All articles describing autopsies of patients diagnosed with TTP-HUS following allogeneic HPCT were also reviewed., Results: Thirty-five articles reporting 5 or more total patients described 447 patients diagnosed with TTP-HUS following allogeneic HPCT. The frequency of diagnosis of TTP-HUS following allogeneic HPCT varied by 125-fold (0.5%-63.6%). Twenty-eight different sets of diagnostic criteria were described in the 35 articles; 25 articles included both RBC fragmentation and increased serum LDH. Many risk factors described as correlating with the diagnosis of TTP-HUS also predict greater risk for multiple transplant-related complications. Benefit of plasma exchange treatment could not be documented. Survival information was reported for 379 patients, 232 (61%) died, and reported mortality rates varied from 0 to 100 percent. Autopsies have been reported for 35 patients who were diagnosed with TTP-HUS following allogeneic HPCT; none had systemic thrombotic microangiopathy, the diagnostic abnormality of TTP-HUS; and infection (19 patients) was the most commonly reported cause of death., Conclusions: The clinical features of TTP-HUS following allogeneic HPCT may be caused by common transplant-related complications; the benefit from plasma exchange treatment is uncertain.
- Published
- 2004
- Full Text
- View/download PDF
31. The influence of health insurance on outcomes of related-donor hematopoietic stem cell transplantation for AML and CML.
- Author
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Selby GB, Ali LI, Carter TH, Veseley S, and Roy V
- Subjects
- Adult, Humans, Insurance, Health economics, Leukemia, Myeloid mortality, Leukemia, Myeloid therapy, Middle Aged, Prognosis, Retrospective Studies, Social Class, Stem Cell Transplantation standards, Tissue Donors, Treatment Outcome, Insurance, Health statistics & numerical data, Leukemia, Myeloid economics, Stem Cell Transplantation economics
- Published
- 2001
- Full Text
- View/download PDF
32. Successful non-surgical treatment of disseminated polymicrobial fungal infection in a patient with pancytopenia and graft-versus-host disease.
- Author
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Roy V, Ali LI, Carter TH, and Selby GB
- Subjects
- Adult, Antifungal Agents therapeutic use, Bone Marrow Transplantation, Drug Combinations, Drug Therapy, Combination, Hematopoietic Stem Cell Transplantation, Humans, Immunocompromised Host, Lymphoma, Follicular complications, Lymphoma, Follicular therapy, Male, Opportunistic Infections drug therapy, Amphotericin B therapeutic use, Aspergillosis drug therapy, Graft vs Host Disease complications, Itraconazole therapeutic use, Mucormycosis drug therapy, Pancytopenia complications, Phosphatidylcholines therapeutic use, Phosphatidylglycerols therapeutic use
- Abstract
Invasive fungal infections after bone marrow transplantation have an extremely poor prognosis. Surgical excision in combination with antifungal therapy is considered necessary for treatment, especially for central nervous system (CNS) infection. We describe successful medical management with lipid complex amphotericin B (ABLC) and itraconazole, without surgical excision, of disseminated fungal infection involving the lungs and CNS in a patient with pancytopenia and graft-versus-host disease., (Copyright 2000 The British Infection Society.)
- Published
- 2000
- Full Text
- View/download PDF
33. Routine chest radiography for the evaluation of febrile neutropenic patients after autologous stem cell transplantation.
- Author
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Roy V, Ali LI, and Selby GB
- Subjects
- Adult, Aged, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Neutropenia complications, Fever etiology, Hematopoietic Stem Cell Transplantation adverse effects, Neutropenia etiology, Radiography, Thoracic standards, Transplantation, Autologous adverse effects
- Abstract
Chest radiographs are routinely obtained for diagnostic evaluation of neutropenic febrile patients. We investigated the frequency of chest radiographic abnormalities during febrile episodes after autologous PBSC transplants and assessed the relationship of these abnormalities to past history of pulmonary disease, pre-transplant chest radiographic abnormalities, and pulmonary signs or symptoms at time of fever. We also studied the impact of chest radiographic findings on patient management. Sixty-one consecutive adult autologous PBSC transplant recipients were studied. Fifty-two (85%) developed fever, and 20 (38%) of these showed new chest radiographic abnormalities suggestive of pulmonary infection. Patients with pre-transplant chest radiographic abnormalities were more likely to develop additional abnormalities with fever post-transplant. Pulmonary symptoms or signs had low sensitivity or specificity for predicting radiographic abnormalities. Only 40% of patients with pulmonary symptoms or signs had an abnormal chest radiograph. Twenty-six percent of patients with abnormal chest radiographs had no clinical findings suggestive of pulmonary infection. The identification of chest radiographic abnormality did not change empiric antibiotic treatment in any patient. The role of routine chest radiography for diagnostic evaluation of febrile autologous PBSC transplant patients should be re-evaluated., (Copyright 2000 Wiley-Liss, Inc.)
- Published
- 2000
- Full Text
- View/download PDF
34. Efficacy and safety of oral granisetron versus i.v. granisetron in patients undergoing peripheral blood progenitor cell and bone marrow transplantation.
- Author
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Abang AM, Takemoto MH, Pham T, Mandanas RA, Roy V, Selby GB, and Carter TH
- Subjects
- Administration, Oral, Adult, Aged, Double-Blind Method, Drug Administration Schedule, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Pilot Projects, Antiemetics administration & dosage, Bone Marrow Transplantation, Granisetron administration & dosage, Serotonin Antagonists administration & dosage, Stem Cell Transplantation, Vomiting prevention & control
- Abstract
This randomized, controlled, double-blind pilot study assessed the efficacy and safety of oral versus i.v. granisetron, both in combination with non-5-HT3 antiemetics, in preventing emesis caused by high-dose chemotherapy. Fifty-one patients who underwent peripheral blood progenitor cell transplantation (PBPCT) or bone marrow transplantation (BMT) were evaluated. Efficacy was assessed by the number of emetic episodes during the worst 24 h period. A complete response (CR) was defined as no vomiting, partial response (PR) as less than three emetic episodes and failure as three or more emetic episodes. Patients who received oral granisetron experienced significantly (p<0.0008) fewer emetic episodes than those who received i.v. granisetron; however, the number of emetic episodes over the worst 24 h was similar between the oral and i.v. granisetron groups (13 and 15, respectively), as were the overall response rates (CR+PR, 54.5 and 41.4%, respectively). Both dosage forms were well tolerated. Based on these findings, further comparative studies of oral granisetron are warranted in patients undergoing PBPCT or BMT.
- Published
- 2000
- Full Text
- View/download PDF
35. G-CSF-mobilized donor leukocyte infusions as immunotherapy in acute leukemia relapsing after allogeneic marrow transplantation.
- Author
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Mandanas RA, Saez RA, Selby GB, and Confer DL
- Subjects
- Acute Disease, Adult, Child, Combined Modality Therapy, Female, Humans, Leukemia immunology, Leukemia pathology, Male, Middle Aged, Radiotherapy, Recurrence, Transplantation, Homologous, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bone Marrow Transplantation, Immunotherapy, Adoptive, Leukapheresis, Leukemia therapy, Leukocyte Transfusion
- Abstract
Eight patients who relapsed with acute leukemia within a year after allogeneic BMT were treated with G-CSF-mobilized donor leukocyte infusions (mDLI) to induce GvHD as a form of immunotherapy. Prior to mDLI, 7 who had systemic relapse received one (2 AML, 1 ALL, 1 CML myeloid blast crisis) or two (2 AML, 1 ALL) rounds of conventional dose induction chemotherapy, and 1 patient with isolated central nervous system (CNS) lymphoid blast crisis CML received intrathecal chemotherapy followed by craniospinal irradiation. G-CSF (10 microg/kg/day) was given to original HLA-matched sibling donors for 4-5 days before leukapheresis of at least 6.0 x 10(8) mononuclear cells per kilogram of recipient weight. No GvHD prophylaxis was used when mDLI was given in 6 patients at the nadir of hematologic counts and in 2 who were in hematologic remission. There was no regimen-related mortality, as pancytopenic patients had rapid recovery of neutrophil counts (6-18 days after mDLI). All patients developed moderate to severe GvHD (5 grade III/IV, 3 grade II) at a median of 30 days (range 22-59) after mDLI. Two patients died of complications from refractory GvHD while in remission. The other 6 had short remissions lasting 2.2-9.4 months until leukemic relapse as their GvHD was reversed by corticosteroids with or without cyclosporine. Patients who relapse with acute leukemia within a year after BMT still have a poor prognosis. The success of GvHD as a form of immunotherapy in these patients may depend on the ability to control it to a state that is both safe and continually exerting an antileukemia effect.
- Published
- 1998
- Full Text
- View/download PDF
36. Marrow and stem cell transplantation in Oklahoma: fifteen years of experience and results.
- Author
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Mandanas RA, Carter TH, Epstein RB, Roy V, and Selby GB
- Subjects
- Acute Disease, Breast Neoplasms surgery, Humans, Leukemia, Myeloid mortality, Leukemia, Myeloid surgery, Oklahoma, Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality, Precursor Cell Lymphoblastic Leukemia-Lymphoma surgery, Survival Analysis, Treatment Outcome, Bone Marrow Transplantation, Hematopoietic Stem Cell Transplantation, Leukemia surgery
- Abstract
From September 1982 to August 1997, 767 bone marrow or peripheral blood stem cell transplants have been performed at the Health Sciences Center in Oklahoma. Five hundred and two (502) autologous transplants (AutoTX) preceded by high-dose myeloablative therapy were performed for breast cancer (BC, 36%), non-Hodgkin's lymphomas (NHL, 24%), Hodgkin's disease (HD, 10%), acute myeloid leukemia (AML, 8%), testicular cancer (TC, 4%), multiple myeloma (MM, 2%) and other malignancies (16%). Two hundred and sixty-five (265) allogeneic marrow transplants (AlloTX) (related, unrelated) were carried out in chronic myeloid leukemia (CML, 30%), AML (23%), acute lymphoid leukemia (ALL, 14%), myelodysplastic syndrome (MDS, 9%), severe aplastic anemia (SAA, 8%), and other diseases (14%). Compared between 1980s to 1990s, 100-day mortality rates have decreased from 28% to 5% for AutoTX and from 40% to 25% for AlloTX. In the AutoTX setting, major changes included the routine use of growth factors post-transplant and the switch from bone marrow to growth factor-mobilized peripheral blood as a source of stem cells over the last five years. In the AlloTX setting, improvements in recognition and control of cytomegalovirus and Candida organisms, the selective use of growth factors and screened blood products, and better selection of unrelated donors using DNA-based techniques of HLA-matching have contributed to reduce early mortality from infection and primary graft failure. The five-year survival outcomes are comparable to those reported in registry data from the International Bone Marrow Transplant Registry (IBMTR) and the National Marrow Donor Program (NMDP).
- Published
- 1998
37. Introducing case management to a general medicine ward team of a teaching hospital.
- Author
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Sivaram CA, Attebery S, Boyd AL, Secrest J, Selby GB, Parker DE, and Fine DP
- Subjects
- Academic Medical Centers, Aged, Comprehensive Health Care, Faculty, Medical, Female, Hospitals, Veterans organization & administration, Humans, Internship and Residency, Length of Stay, Male, Oklahoma, Patient Admission, Patient Discharge, Patient Readmission, Schools, Medical organization & administration, Students, Medical, Case Management organization & administration, Family Practice organization & administration, Hospital Units organization & administration, Hospitals, Teaching organization & administration, Patient Care Team
- Abstract
Purpose: To introduce case management to a general medicine ward team of a teaching hospital to improve patient care and ensure comprehensive longitudinal care., Method: The Department of Veterans Affairs Medical Center is one of four hospitals used by University of Oklahoma School of Medicine residents. There are five medicine teams, each comprising a second- or third-year resident, one or two interns, two medical students, and a faculty physician. The case-management program was initiated in November 1994. No attempt was made to limit the residents assigned to the case-managed team (i.e., many residents who worked with the case-managed team subsequently rotated through the other teams). Patients were assigned to the teams by rotation, and no attempt was made to adjust for the severity of illness among admissions. The teams were separated as follows: pre-case-management teams (all five teams prior to the case-management program), non-case-management teams (the four teams without case managers after the program's initiation), and the case-management team. The study periods were January-July 1994 (pre-case management) and January-July 1995 (after case management)., Results: The numbers of patients treated by the three groups were 1,305, 1,139, and 289, respectively. The median length of stay for pre-case-management patients was 5 days (interquartile range, 3-9 days); for non-case-management patients, 5 days (range, 3-8 days); and for case-management patients, 5 days (range, 3-7 days). The cumulative distribution of lengths of stay for case-management patients was significantly different from those of the other study groups by the Kolmogorov-Smirnov test (p = .02). More case-management patients were discharged by day 7. Rates of readmission were not significantly different between the teams., Conclusion: In this study a case-management program was effectively implemented in a teaching hospital, resulting in reduced lengths of stay for patients. As academic health centers become more concerned with efficiency and cost, case management should be seriously considered as a way to deal with such issues.
- Published
- 1997
- Full Text
- View/download PDF
38. Cytomegalovirus surveillance and prevention in allogeneic bone marrow transplantation: examination of a preemptive plan of ganciclovir therapy.
- Author
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Mandanas RA, Saez RA, Selby GB, and Confer DL
- Subjects
- Adolescent, Adult, Child, Cytomegalovirus Infections mortality, Female, Humans, Male, Middle Aged, Survival Analysis, Transplantation, Homologous, Antiviral Agents therapeutic use, Bone Marrow Transplantation adverse effects, Cytomegalovirus isolation & purification, Cytomegalovirus Infections prevention & control, Ganciclovir therapeutic use
- Abstract
Forty-two cytomegalovirus (CMV)-seropositive allogeneic marrow transplant patients or recipients of CMV-seropositive marrow allografts were entered into a surveillance program to detect and treat CMV infection during the first 120 days posttransplant. CMV infection was detected at a mean time of day 50 in 21/37 (58%) patients who had surveillance cultures. Twelve of 42 (28%) received preemptive ganciclovir treatment for virus isolated from blood (9 patients) or from bronchoalveolar lavage fluid (3 patients), and all had no CMV-associated sequelae. CMV disease was diagnosed in 5 patients (4 with pneumonia), 1 with gastroenteritis) who did not have positive cultures until the onset of their disease. CMV-related mortality was 4/42 (10%). Patients who earlier manifested lung injury or diffuse alveolar hemorrhage (DAH) were significantly predisposed to subsequent CMV pneumonia (P = 0.0013, Fisher's exact test) at a median onset of day 42. Restricted prophylactic use of ganciclovir in such patients may be indicated. Fifty percent of all patients never required ganciclovir during the surveillance period. When compared to a universal prophylaxis program of ganciclovir for the prevention of CMV disease, the use of ganciclovir in a preemptive strategy could avoid unnecessary therapy for a substantial number of patients and earn significant cost-savings.
- Published
- 1996
- Full Text
- View/download PDF
39. High-dose carboplatin, etoposide and cyclophosphamide with autologous bone marrow transplantation for the treatment of advanced malignancies: a phase I study.
- Author
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Saez RA, Slease RB, Strnad C, Selby GB, Confer DL, and Epstein RB
- Subjects
- Adolescent, Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Carboplatin administration & dosage, Combined Modality Therapy, Cyclophosphamide administration & dosage, Etoposide administration & dosage, Female, Humans, Kidney drug effects, Male, Middle Aged, Transplantation, Autologous, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bone Marrow Transplantation adverse effects, Neoplasms therapy
- Abstract
Carboplatin is a platinum-derivative widely used in conditioning regimens with ABMT, particularly in combination with cyclophosphamide and etoposide, drugs which co-express synergism in vitro. The objective of this study was to determine the maximum tolerated dose (MTD) of this combination. Thirty-four patients with refractory lymphoid or solid tumors were treated in a dose-escalation study with continuous infusion carboplatin (1.2-2 g/m2) on days -7 to -4, etoposide (1.2-2.4 g/m2) on days -7 to -5 and cyclophosphamide (120 mg/kg) given in two dose schedules: (1) day -3, -2; (2) day -9, -8. Autologous bone marrow or peripheral blood stem cells were infused on day 0. Mucositis/enterocolitis was dose limiting. In addition, severe cardiac dysfunction occurred in schedule 1 but not in schedule 2. Renal dysfunction occurred in the setting of fungemia, respiratory failure and congestive heart failure, and did not correlate with carboplatin dose. Hepatic and pulmonary dysfunction were minimal. The MTD was etoposide 2.1 g/m2 and carboplatin 2.0 g/m2, in combination with cyclophosphamide (120 mg/kg) on schedule 2. Responses were seen in 16 of 19 patients with measurable disease. Seven patients are disease-free survivors 50-60+ months post-ABMT. This study defines the MTD of carboplatin when combined with etoposide and cyclophosphamide in patients with adequate renal function and suggests significant anti-tumor activity.
- Published
- 1995
40. Long-term survival after autologous bone marrow transplantation for metastatic breast carcinoma.
- Author
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Saez RA, Slease RB, Selby GB, Strnad C, Epstein RB, and Confer DL
- Subjects
- Adult, Bone Neoplasms secondary, Bone Neoplasms therapy, Carmustine administration & dosage, Chemotherapy, Adjuvant, Cyclophosphamide administration & dosage, Disease-Free Survival, Doxorubicin administration & dosage, Female, Humans, Liver Neoplasms secondary, Liver Neoplasms therapy, Lung Neoplasms secondary, Lung Neoplasms therapy, Middle Aged, Prospective Studies, Soft Tissue Neoplasms secondary, Soft Tissue Neoplasms therapy, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bone Marrow Transplantation, Breast Neoplasms pathology, Breast Neoplasms therapy
- Abstract
A phase II study of doxorubicin (Adriamycin)-based induction chemotherapy followed by cyclophosphamide/BCNU (CyBCNU) intensification and autologous bone marrow transplantation (ABMT) was conducted in 20 consecutive women with hormone-resistant metastatic breast cancer referred to our center. Of these 20 women, aged 24 to 56 (median age, 41), 9 had complete remission and 11 had partial remission after induction chemotherapy. Predominant sites of metastases included liver (5), lung (4), bone/bone marrow (5), and soft tissue (6). The dose of cyclophosphamide was 160 mg/kg and the dose of BCNU, 600 mg/m2, followed by infusion of a mean 2.30 x 10(8) nucleated marrow cells per kilogram of body weight. All patients achieved durable engraftment. Three patients remain disease-free at 62+, 67+, and 73+ months; two of these were in complete remission before ABMT. Actual relapse-free survival at 5 years is 15% and median survival from ABMT is 17 months. Induction chemotherapy followed by CyBCNU intensification in metastatic breast cancer can achieve prolonged relapse-free survival in 15% of patients, some of whom may be cured.
- Published
- 1995
- Full Text
- View/download PDF
41. Autologous bone marrow transplantation for metastatic breast cancer.
- Author
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Saez RA, Selby GB, Slease RB, Epstein RB, Mandanas RA, and Confer DL
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms mortality, Breast Neoplasms pathology, Combined Modality Therapy, Female, Humans, Middle Aged, Neoplasm Metastasis, Remission Induction, Survival Rate, Treatment Outcome, Bone Marrow Transplantation, Breast Neoplasms therapy
- Abstract
Unlabelled: Metastatic breast cancer accounts for 18% of cancer deaths among women in the U.S. Conventional combination chemotherapy produces responses in 50% to 80% of women with metastatic breast cancer, but is never curative. A major medical center administered high-dose chemotherapy and autologous bone marrow transplantation to 68 women with metastatic breast cancer between 1983 and 1993. Forty-nine of these women had estrogen receptor-negative tumors, a poor prognostic sign. Eighteen women with estrogen receptor-positive tumors had failed prior hormonal manipulation or had metastatic breast cancer at initial diagnosis. Prior to transplantation, 37 women were in first complete or partial remission, 8 were in their second complete or partial remission, 4 had stable disease, 14 had progressive disease, and 5 were in untreated relapse. Bone marrow transplantation preparatory regimens included high doses of single agents or combination chemotherapy. Among women not in remission before transplantation, 71% entered a partial or complete remission following transplantation. Overall, 29 women (43%) were in complete remission after marrow transplantation. Twelve women (18% overall) remain free of disease between 2 and 73+ months post-ABMT. Those in first complete or partial remission prior to transplant (37 patients) had a higher response rate (86%) and higher complete responses (62%), and 10 (27%) are free of disease. There were nine treatment-related deaths (13%). Forty-seven patients (69%) have died from breast cancer following autologous transplantation. Relapses occurred primarily at sites of previous disease. All relapses have occurred within 22 months of ABMT., Conclusion: Autologous bone marrow transplantation for metastatic breast cancer in first complete or partial remission has produced a 27% disease-free survival. This therapy should be considered for selected patients with metastatic breast cancer.
- Published
- 1994
42. Autologous bone marrow transplantation for non-Hodgkin lymphoma.
- Author
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Saez RA, Slease RB, Selby GB, Puckett C, Epstein RB, Mandanas RA, and Confer DL
- Subjects
- Adolescent, Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Child, Preschool, Combined Modality Therapy, Female, Humans, Lymphoma, Non-Hodgkin drug therapy, Lymphoma, Non-Hodgkin radiotherapy, Male, Middle Aged, Prognosis, Recurrence, Transplantation, Autologous, Treatment Outcome, Bone Marrow Transplantation, Lymphoma, Non-Hodgkin therapy
- Abstract
Unlabelled: Non-Hodgkin lymphomas (NHLs) are a group of malignant disorders that can be cured with chemotherapy and/or radiotherapy in 30% to 50% of cases. For those who fail initial therapy, cure is rarely achieved with standard dose chemotherapy; therefore higher doses of chemotherapy have been used with autologous bone marrow support. This major medical center has performed 74 autologous bone marrow transplants (ABMT) for patients with non-Hodgkin lymphoma who had failed initial therapy between 1984 and 1993. Preparatory regimens included high doses of chemotherapy with or without radiotherapy. There were 14 patients with low grade, 41 with intermediate grade, and 18 with high grade histologies. Among patients with low grade histologies, 90% responded and 50% are relapse-free between 1 and 33 months post-ABMT. Among patients with intermediate and high grade histologies, 25% are relapse-free between 2 and 80 months post-ABMT., Conclusion: Autologous bone marrow transplantation is effective in patients with relapsed non-Hodgkin lymphoma and should be considered an important therapeutic option.
- Published
- 1994
43. Hematocrit and performance: the effect of endurance training on blood volume.
- Author
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Selby GB and Eichner ER
- Subjects
- Hematocrit, Hemodilution, Hemolysis physiology, Hemorrhage physiopathology, Humans, Physical Exertion physiology, Blood Volume physiology, Physical Education and Training, Physical Endurance physiology
- Published
- 1994
44. A phase II evaluation of fazarabine in high-grade gliomas: a Southwest Oncology Group study.
- Author
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Selby GB, Upchurch C, Townsend J, and Eyre HJ
- Subjects
- Adult, Aged, Antineoplastic Agents adverse effects, Astrocytoma drug therapy, Azacitidine adverse effects, Brain Neoplasms drug therapy, Female, Glioblastoma drug therapy, Humans, Male, Middle Aged, Southwestern United States, Treatment Failure, Antineoplastic Agents therapeutic use, Azacitidine therapeutic use, Glioma drug therapy
- Published
- 1994
- Full Text
- View/download PDF
45. Allogeneic bone marrow transplantation: experience with 92 patients.
- Author
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Selby GB, Saez RA, Epstein RB, Slease RB, and Confer DL
- Subjects
- Adolescent, Adult, Anemia, Aplastic therapy, Child, Female, Humans, Leukemia therapy, Lymphoma therapy, Male, Middle Aged, Myelodysplastic Syndromes therapy, Retrospective Studies, Transplantation, Homologous, Bone Marrow Transplantation
- Abstract
Allogeneic bone marrow transplantation (BMT) is potentially curative therapy for leukemia, lymphoma, and marrow failure. Ninety-two patients have received allogeneic BMT at Oklahoma Memorial Hospital in the past 10 years. Patients with acute myelogenous leukemia (AML; N = 30), chronic myelogenous leukemia (CML; N = 27), acute lymphoblastic leukemia (ALL; N = 12), myelodysplastic syndromes (MDS; N = 8), lymphomas (N = 8), and aplastic anemia (N = 7) were treated with a variety of myeloablative preparative regimens. The major causes of mortality were bacterial, viral, and fungal infections, or disease relapse. Standard and high risk (refractory or multiply-relapsed disease) AML, CML, and ALL patients had median survivals of 14.5 months vs. 3 months, > 18 months vs. 9 months, and 10 months vs. 4.5 months (p = 0.01), respectively. At 7.5 years median follow-up, 71% of the aplastic anemia patients are disease-free. Guidelines for the optimal time for BMT have been developed that encourage transplantation earlier in the course of the disease, thus facilitating better outcomes with these otherwise fatal disorders.
- Published
- 1993
46. High-dose combination alkylating agent therapy with autologous bone marrow rescue for refractory solid tumors.
- Author
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Slease RB, Benear JB, Selby GB, Reitz CL, Hughes WL, Watkins CL, and Epstein RB
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Bacterial Infections etiology, Carmustine administration & dosage, Carmustine adverse effects, Combined Modality Therapy, Cyclophosphamide administration & dosage, Cyclophosphamide adverse effects, Drug Evaluation, Female, Humans, Male, Middle Aged, Neoplasms drug therapy, Neoplasms mortality, Remission Induction, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Bone Marrow Transplantation, Neoplasms therapy
- Abstract
Twenty-six adults, ages 27 to 60, with refractory metastatic solid tumors were treated with high-dose cyclophosphamide (Cy) + carmustine (BCNU) at one of three escalating dose schedules followed by autologous bone marrow transplantation (ABMT). Toxicity was severe and dose-related, with the maximum tolerated dose for the combination determined to be Cy 160 mg/kg and BCNU 900 mg/m2. Median time to WBC recovery (greater than or equal to 1,000/microL) was 13 days post-ABMT (range, nine to 22 days) and to a platelet count of greater than or equal to 50,000/microL, 22 days (range, 13 to 83 days). Sixteen of 20 evaluable patients (80%) responded to therapy with at least 50% reduction in measurable tumor, and three patients achieved complete remission (CR). Responders included eight of nine evaluable patients with breast carcinoma, two of five with melanoma, two of two with sarcoma, and four of four with colon carcinoma. Response durations were short (median, 4 months), even for complete responders, and relapses generally occurred at sites of previous metastases. In order for this approach to have a more significant impact on overall survival, it may need to be applied earlier in the natural history of the malignancy.
- Published
- 1988
- Full Text
- View/download PDF
47. Endurance swimming, intravascular hemolysis, anemia, and iron depletion. New perspective on athlete's anemia.
- Author
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Selby GB and Eichner ER
- Subjects
- Adolescent, Adult, Female, Ferritins blood, Haptoglobins analysis, Hemoglobins analysis, Humans, Male, Anemia, Hypochromic etiology, Hemolysis, Iron metabolism, Swimming
- Abstract
Swimmers were evaluated for the anemia, intravascular hemolysis, and iron deficiency reported in endurance runners. Plasma concentrations of ferritin, haptoglobin, and hemoglobin were measured in nine collegiate swimmers through the competitive season and in 23 adult swimmers before and after endurance races of 1.5 km to 10 km. About 10 percent of the swimmers had low hemoglobin concentrations. The severity of this "swimmer's anemia" correlated with the amount of swimming in both men and women. Intravascular hemolysis occurred during all the races; the fastest swimmers in the longest races had the greatest decreases in haptoglobin. About 25 percent of the swimmers had low baseline haptoglobin concentrations. Iron depletion was found in 11 percent of the men and 57 percent of the women, but their athletic performance was not notably impaired. Iron depletion, anemia, and intravascular hemolysis in athletes in a nontraumatic sport suggest that mechanisms other than footstrike are components of athlete's hemolysis.
- Published
- 1986
- Full Text
- View/download PDF
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