[Show abstract][Hide abstract] ABSTRACT: Angioimmunoblastic T-lymphoma (AITL) is a poor prognosis malignancy. Because of relatively rare incidence and lack of publications in Czech, we decided to share our experience.
Retrospective analysis of newly diagnosed AITL patients treated at our institution between 1/2000-12/2010.
Twelve patients with median age of 64 (43-82) years were analysed. Two patients over 80 years were treated with corticosteroids. Ten patients were treated with 6 cycles of CHOP-21 chemotherapy resulting in: 2/10 (20%) stable disease, 5/10 (50%) partial remission and 3/10 (30%) complete remission. The median EFS and OS of chemotherapy-treated patients were 8 and 10 months, resp. The EFS and OS were both significantly longer in patients who achieved complete remission within the first line of CHOP or autologous stem cells transplantation therapy: 43 vs 6 (p = 0.0052) and 46 vs 6 months (p = 0.0023), respectively. It was not possible to perform autologous transplantation in 4/7 (57%) patients in need for further reduction of the disease because of poor performance status or early progression of lymphoma and death during salvage chemotherapy.
AITL is a poor prognosis malignancy with a very high risk of early relapse after CHOP induction chemotherapy. In fit patients, autologous transplantation should be performed immediately after induction chemotherapy; information about availability of stem cells donor, both in the family or any available register, should be found during the induction treatment.
Full-text · Article · Jun 2012 · Klinická onkologie: casopis Ceské a Slovenské onkologické spolecnosti
[Show abstract][Hide abstract] ABSTRACT: In 2009, the recommendations of the Czech Collaborative Group for Ph- Myeloproliferative Diseases (CZEMP) for diagnosis and treatment of BCR/ABL-negative myeloproliferative diseases (MPD), i.e., essential thrombocythemia (ET), polycythaemia vera (PV) and primary myelofibrosis (PMF) were updated and extended. The present article gives the rationale of the recommendations in full detail. The CZEMP diagnostic criteria for ET and PMF are based on histopathological (HP) findings, which must unconditionally be in line with the given clinical and laboratory characteristics of ET or of a certain stage of PMF, respectively. The platelet count is not decisive for diagnosis. In cases lacking an adequately taken and read HP finding, the Polycythemia Vera Study Group (PVSG) criteria are recommended. The diagnosis of typical PV is based on demonstration of the V617F mutation of the JAK2 gene along with a significant increase of red cell parameters. If these are close to borderline, the demonstration of increased total red cell mass (RCM) is required. In atypical cases lacking polyglobulia or elevated RCM, the HP picture of PV (in accordance with WHO description) plus JAK2 V617F mutation is satisfactory for diagnosis, or, in cases lacking JAK2 V617F mutation, the HP picture of PV along with polyglobulia (or increased RCM) is sufficient. The treatment principles of ET and other MPDs with thrombocythemia (MPD-T; i.e., the early stages of PMF and PV) are identical. The patients are stratified by their thrombotic risk (preceding thrombosis, another thrombophilic state, jAK2 mutation), presence of disease symptoms (mainly microcirculatory), platelet count and age. Only patients up to 65 years lacking the above mentioned risks with a platelet count < 1000 x 10(9)/l are considered as low-risk and do not demand cytoreducing therapy. The others are high-risk ones and have an indication for thromboreduction. In patients older than 65 years, the potentially leukemogenic drug hydroxyurea (HU) may be used. In the younger ones, the choice is between anagrelide (ANG) or interferon-alpha (IFN). In high-risk patients, the treatment goal is to maintain platelet counts below 400, and in low-risk ones, below 600 x 10(9)/l. In PV, polycythemia itself is another thrombotic risk factor. The condition is treated by bloodletting or erythrocytaphereses. If hematocrit levels < or =45 are not achieved, cytoreductive therapy using HU in patients over 65 years, or IFN in younger individuals is required. All patients with thrombocythemia in PV are high-risk and have an indication for cytoreduction. Acetylsalicylic acid is given to all patients with MPD-T with platelets < 1000 x 10(9)/l (at higher counts, hemorrhage is imminent), and to all individuals with PV, unless contraindication is present. In case of platelet count normalization, it may be withdrawn in cases of low-risk ET or PMF, not in JAK2+ PV. The treatment of advanced stages of PMF is symptomatic, with substitution of blood derivatives being the basis. The only curative treatment is allogeneic stem cell transplantation, which should not be indicated too early seeing to its risks, but also not too late--we must not allow transition into acute leukemia, which is heralded by blasts in the blood picture. The indication is the presence of any of the following criteria: values of hemoglobin < 10 g/dl, WBC < 4 x 10(9)/l and platelets < 100 x 10(9)/l, any percentage of blasts or > or = 10% immature granulocytes in the differential picture, >1 erythroblast per 100 cells--all at repeated examinations within at least a 2-month interval, and in addition, rapid progression of hepato-/splenomegaly, presence of general symptoms of the disease, portal hypertension and extensive swellings.
Full-text · Article · Feb 2011 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: Regardless of its curative potential, the role and indications of the allogeneic stem cell transplantation (SCT) in multiple myeloma remain an issue of discussions. Because of high mortality, morbidity and relapse rate, the allogeneic SCT with myeloablative or reduced-intensity conditioning regimen is not considered a standard treatment approach. The retrospective analysis of our cohort of transplanted patients verified the unacceptable mortality within the conventional conditioning regimen Bu/CY2 (n=4). In the group of 14 patients after SCT with reduced intensity conditioning regimen FLU/MEL ( fludarabine, melphalan), there was the overall response rate of 93% with 43% complete remissions, the transplantation related mortality (TRM) 21%, probability of the 2-year and 4-year progression free survival (PFS) 34% and 17% and the 5-year overall survival (OS) 47%. Better results were observed in patients transplanted without progressive or minimal responding disease. Performing the allogeneic SCT did not limit future treatment of myeloma progressions with the use of bortezomib or thalidomide. Our results are in concordance with those published by other authors. Allogeneic SCT should be performed according to defined protocols and in the frame of multicentre clinical and laboratory cooperation, if possible. The potential of combining the allogeneic SCT with bortezomib, thalidomide or lenalidomide treatment is a challenge for future research.
No preview · Article · Dec 2009 · Transfuze a Hematologie Dnes
[Show abstract][Hide abstract] ABSTRACT: Since 2005, registers of patients treated with Thromboreductin (anagrelid) kept by some centres in the Czech Republic have been supplied with data concerning patients whose treatment with this preparation started in 2004. The purpose of the register is to record responses to therapy by Thromboreductin and adverse events in patients with essential thrombocytemia and other myeloproliferations, and to subsequently analyse the data. Another objective is to detect predisposition to clinical symptomatology and disease complications. Apart from thrombocyte count, additional risk factors are monitored. The database currently contains data for 336 patients. Initial analyses of data from the register point to the fact that anagrelid is a highly effective thromboreductive agent the administration of which is associated with relatively low incidence of adverse events (11.8 %) of mild and usually transitory nature. The therapeutic objective is attained at a relatively slow rate (according to overall stratification under 400 or under 600 x 10(9)/l thrombocytes), which is probably due to insufficient dose adjustment.
No preview · Article · Jul 2007 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: Aim. Extramedullary hematopoiesis is a compensatory mechanism associated with bone marrow insufficiency. Most commonly it can be observed in chronic anemias (e.g. thalassemia) and myelofibrosis. Less frequently it may occur in malignant infiltration and toxic or radiation damage to the bone marrow. Method. Our case study demonstrates ultrasound and computed tomography findings in an unusual case of extramedullary hematopoiesis involving kidneys in a patient with myelofibrosis. Findings in other organs and magnetic resonance features of this rare condition are also discussed. Conclusion. Imaging findings in extramedullary hematopoiesis are usualy non-specific and may mimic more serious diseases. Ultrasound, computed tomography, and magnetic resonance findings discussed in this paper in patients with chronic anemias or pathologic processes destructing bone marrow evoke suspition of this condition but final diagnosis necessitates histologic verification.
No preview · Article · Feb 2007 · Ceska Radiologie
[Show abstract][Hide abstract] ABSTRACT: The number of newly diagnosed cases of multiple myeloma in the Czech Republic is about 3-4 per 100 000 persons per year. In the higher age groups, the incidence increases. Multiple myeloma is an illness that reacts well to treatment which can result in periods of remission lasting for years. Some of the patients are even able to return to work. A pre-requisite for successful treatment is early diagnosis and this is usually in the hands of first line physicians. This is the reason why the Czech Myeloma Group, in conjunction with neurologists, orthopedicians and radio diagnosticians has issued the following recommendations for first line physicians containing a more detailed description of the symptoms and the diagnostic pitfalls of the disease. This disease reminds a chameleon for the variety of its symptoms. For the sake of clarification, we shall divide multiple myeloma symptoms into five points, each of which is reason enough to warrant an examination to confirm or rule out a malignant cause of health problems (a negative result does not automatically mean exclusion). If any of the recommended examinations results positive, the diagnostic process must be continued, in which case a general practitioner refers the patient to a specialist health centre. Observing these recommendations should minimize the number of cases of late diagnosis. 1. Bone destruction symptoms. - Unexplained backache for more than one month in any part of spine even without nerve root irritability or without pain in other part of skeleton (ribs, hips, or long bones). - Pain at the beginning of myeloma disease is very similar to benigne common discopathy, however the intensity of backache is decreasing within one months in benigne disease. In the case of malignant process the intensity of bone pain is steadily increasing. - Immediate imaging and laboratory investigation are indicated by resting and night pain in spinal column or in any part of skeleton. - Backache with the sign of spinal cord or nerve compression should be sent for immediate X Ray, and focussed CT/MRI followed by acute surgery if needed. - Osteoporosis especially in men and premenopausal women. 2. Features of changed immunity or bone marrow function. Persistent and recurrent infection, typical is normochromic anaemia, with leucopenia and trombocytopenia. 3. Raised erythrocyte sedimentation rate even increase concentration of total plasma protein. 4. Impaired renal function. Increased level of creatinin or proteinuria, nephrotic syndrome with bilateral legs oedema. 5. Hypercalcemia with typical clinical symptoms (polyuria with dehydratation, constipation, nausea, low level conscience, coma). Every one from these points has to be reason for general medical doctor to start battery of tests: -X-ray of bones focused to painful area (mandatory before physiotherapy, local anaesthesia or other empiric therapy). If plain X-ray does not elucidate pain and symptoms are lasting more than one month, please consider all circumstances and results from laboratory investigation. This patient needs referral to the centre with MRI/CT facilities (CT or MRI is necessary investigation in case of nerve root or spine compression). -Investigation of erythrocyte sedimantion rate (high level of sedimentation of erythrocyte can indicate multiple myeloma). -Full blood count. -Basic biochemical investigation serum and urine: serum urea, creatinin, ionts including calcium, total protein, and albumin CRP (high concentration of total protein indicates myeloma, low level of albumin indicates general pathological process, similary increased concentration of fibrinogen, impaired renal function indicates myeloma kidney, however hypercalcemia is typical for highly aggressive myeloma). -Quantitative screening for IgG, IgM and IgA in serum (isolated raised level one of immunoglobulin with decreased level of the others indicates myeloma). -Common electrophoresis of serum is able to detect monoclonal immunoglobulin level at few gramm concentration. If all the laboratory investigation are in normal level the possibility that the current problems are multiple myeloma origine is smaller, but it does not exclude one of rare variant--non secretory myeloma (undifferentiated plasmocyt lost characteristic feature to produce monoclonal immunoglobulin). If any of tests indicate the possibility of myeloma, patient require urgent specialist referral to department with possibility to make diagnosis of malignant myeloma.
No preview · Article · Dec 2006 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: Multiple myeloma incidence in the Czech Republic is 3 to 4 cases per 100 000 inhabitants. Incidence increases in the older age groups. Multiple myeloma responds well to treatment, and disease remission persisting for years is common. Following treatment some patients return to full employment. Early diagnosis is paramount for successful treatment and it depends in many cases on the first contact doctors. Therefore, in cooperation with neurologists, orthopaedists and radiologists, the Czech Myeloma Group has issued the following brief guidelines, followed by detailed text, describing the symptoms and diagnostic pitfalls of the disease for the first contact doctors. This disease has the characteristics of a chameleon with respect to the variety of symptoms. For ease we will summarize multiple myeloma symptoms into 5 subparagraphs. Each of them is a reason for examination with the aim of confirming or not confirming (NOTE: not to rule out) the malignant origin of the problem. If one of these recommended examinations is positive, it is a reason for continuing the diagnostic process. A general practitioner usually refers the patient to the specialised department for this follow-up examination. Observance of these guidelines should minimize the number of belatedly diagnosed cases. 1. Symptoms of bone destruction • Unexplained pain of some of the spinal segments persisting for more than one month even without signs of radicular irritation or pain in other skeletal parts (ribs, hips or long bones). Pains caused by incipient multiple myeloma are similar to the pain in patients with common vertebrogenous problems of non-malignant origin. The intensity of common vertebrogenous problems diminishes very often by one month, whereas the intensity of bone pain caused by malignant disease increases continually. • Rest and night backache or pain of other skeletal parts is indication for immediate radiographic examination and eventually for other imaging and laboratory examinations. • Backache with signs of spinal cord or radicular compression is an indication for urgent referral to a specialised department where X-ray and targeted CT/MRI examinations can be carried out and if necessary, the appropriate urgent operation can be performed. • Osteoporosis, especially in men and premenopausal women 2 Symptoms of compromised immunity and/or impaired bone marrow function Recurrent or persistent infections, anaemia, typically normochromic associated with leucopenia and thrombocytopenia 3 Persistent elevation of erythrocyte sedimentation rate or eventually elevated total plasma protein concentration 4 Impairment of renal function Elevation of creatinine level or proteinuria, leading to nephrotic syndrome with bilateral leg oedema 5 Hypercalcaemia with typical clinical symptoms (Polyuria leading to dehydratation, constipation, nausea, somnolence or deeper consciousness disturbance) Each of these subparagraphs is a reason for the general practitioner to make the following set of basic examination: • X-ray examination of the skeleton in the area of pain (always before referring the patient for rehabilitation or before administration of injections or other empiric therapy). If X-ray does not elucidate the origin of pain and symptoms persist for more than one month, it is necessary to consider, taking into account other conditions and laboratory findings, referral of the patient to the department where bone MRI or CT could be indicated and performed (CT and MRI is urgent if radicular irritation or spinal compression occurs), • examination of erythrocyte sedimentation (very high ESR can indicate multiple myeloma) • blood count • basic examination of blood and urine: serum concentration of urea, creatinine, ions including calcium, total protein and albumin, CRP and erythrocyte sedimentation rate (high total protein concentration indicates myeloma, low albumin indicates pathologic process in general, likewise high elevated concentration of fibrinogen and impairment of renal function may indicate myeloma kidney, hypercalcaemia indicates high aggressive myeloma) • quantitative analysis of IgG, IgM, IgA immunoglobulins in serum (isolated elevation of concentration of one type of immunoglobulin and decrease in others indicates myeloma) • common electrophoresis of serum proteins detects monoclonal immunoglobulin only in high concentrations of several grams Normal results of laboratory examinations play down the probability of multiple myeloma as a cause of the patient's problem, but they do not exclude the possibility of an uncommon type of non-secretory myeloma (non-differentiated plasmocytes having lost their ability to produce monoclonal immunoglobulin). The patient must be referred to a specialised department for confirmation of the suspicion if some of these examinations indicate a possibility of myeloma.
[Show abstract][Hide abstract] ABSTRACT: The standardization of biochemical measurement procedures in multiple myeloma is necessary for reliable prognostic stratification of patients in multicentric trials. The new prognostic index International Staging System for multiple myeloma uses only two laboratory markers, albumin and beta-2 microglobulin. Our study compared results of albumin, beta-2 microglobulin and monoclonal immunoglobulin measurements from six centers which provide treatment for multiple myeloma in the Czech Republic and attempted to standardize the analytic procedures. We have found that the measurement of albumin is well standardized and the results from all laboratories were comparable. The measurement of beta-2 microglobulin achieved comparability only after a partial unification of analytical methods. The determination of monoclonal immunoglobulin concentration provided comparable results for concentrations higher than 20 g/l with higher variability for lower values.
[Show abstract][Hide abstract] ABSTRACT: Questionnaires on the quality of life and tolerance of different parts of maintenance treatment were sent to a total of 83 patients with multiple myeloma. All patients were for more than one year on maintenance treatment which involved either interferon alpha monotherapy (I), 3 million u. three times per week till signs of relapse developed or sequence administration of interferon alpha and dexamethazone 40 mg on day 1 to 4, 10 to 13 and 20 to 23 and then after a four-week interval again interferon alpha, again till progression of the disease occurred. The patients evaluated the presence or absence of different undesirable effects of treatment during the first two weeks of treatment and throughout the year and listed their intensity into four categories defined in the questionnaire. The quality of life was evaluated by means of a basic module of the questionnaire of the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30). The results of the questionnaire are to a certain extent surprising as from the patients' answers ensues that this maintenance treatment is associated with more numerous undesirable effects than the physicians realized when in contact with the patient. In this summary we can list only the most frequent effects (deterioration of eyesight, impaired sleep, depressions, irritability and unrest, chill, pain in muscles and joints, general weakness and dyspnoea). From the questionnaires on the quality of life ensues a markedly poorer quality of life of these patients as compared with the healthy population. There are however no basic differences between individual groups. The questionnaires were handed only to patients who had maintenance treatment for more than one year and thus patients were eliminated where maintenance treatment was discontinued because of undesirable effects. To give a general idea of the tolerance of the above maintenance treatment the authors mention that to the date of Aug. 31, 2001 113 patients were randomized into one of the branches of maintenance treatment. Maintenance treatment had to be discontinued in 6% patients (in two instances on account of severe hypothyroidism, in one case on account of hallucinations, in three instances on account of severe mental depression caused by this treatment). Reduction of interferon doses in 20% patients usually because of cytopenia but also on account of psychic problem. To the question what length of prolongation of life compensates the undesirable effects of maintenance treatment the following replies were obtained from patients receiving ID, possibly I: 3 months--47.6 and 38.3%, 6 months--4.3 and 10.6%, 9 months--0 and 4.3%, 12 months--47.6 and 46.8% of the addressed patients. In reply to the question whether the patients would prefer, assuming equal effectiveness, a maintenance monotherapy with interferon alpha or dexamethazone more patients preferred interferon to dexamethasone. For practice ensues from this article informing on undesirable effects of maintenance treatment and the effect of maintenance treatment on the quality of life: 1. the necessity of thorough knowledge of physicians of all possible undesirable effects as only a doctor knowing possible undesirable effects of treatment can recognize them, 2. regular monitoring not only of the activity of the basic disease, but also undesirable effects of maintenance treatment and the influence of treatment on the patients' quality of life, 3. the necessity to assess the quality of life in clinical trials as an important parameter for deciding on the way of treatment.
No preview · Article · Apr 2002 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: High-dose therapy (HDT) and autologous stem cell transplantation (ASCT) is superior than conventional therapy in response rates as well as in prolongation of event-free survival (EFS) and overall survival (OS) in multiple myeloma (MM). Optimal maintenance therapy after ASCT is unclear. In order to assess the role of interferon alfa (IFN) and IFN plus dexamethasone (IFN/DEX) as the maintenance therapy after ASCT, 212 previously untreated patients with multiple myeloma (MM) were enrolled to trial 4W from 1996 to 2002. Patients received primary therapy with four cycles of VAD regimen (vincristine, doxorubicin dexamethasone) followed by mobilization with cyclophosphamide 5g/m2 and G-CSF 10 μg/kg. A conditioning regimen with melphalan 200mg/m2 was used for first and second transplantation. The later was indicated only in patients who did not achieve a good remission (>75% reduction of M-component). After transplantation patients were randomized to two arms of maintenance therapy: IFN 3 × 106 units three times weekly s.c. or the same dose of IFN in alternating cycles with dexamethasone 40 mg in days 1-4, 10-13, 20-23. Data of 151 randomized patients to 31st August 2001 were evaluated in this analysis. One month after transplantation 6 % of patients achieved complete remission (M-component 0% and negative immunofixation), 58 % remission (<75 % reduction of starting level of M-component), 24 % partial remission (<50 % reduction of M-component). Transplant related mortality at day +100 was 2.35 %. All 151 randomized patients received the maintenance therapy, 77 patients in the IFN arm and 74 patients in the IFN/DEX arm. Median of EFS for all 151 patients was 36 months and median of OS was not yet achieved. In this interim analysis, the OS and EFS curves have shown no significant differences between the IFN and IFN/DEX groups (p = 0.593 for EFS; p = 0.316 for OS). Longer follow-up is required to receive final results comparing efficacy of the two types of maintenance therapy after autologous transplantation.
[Show abstract][Hide abstract] ABSTRACT: In the clinical 4W study patients with newly diagnosed multiple myeloma are included where the state of the disease calls for treatment, while high dose chemotherapy is not contraindicated. Treatment according to protocol 4W comprises induction chemotherapy VAD, mobilization of haematopoietic cells (cyclophosphamide 5 g/m2). This is followed by autologous transplantation (as a conditioning regime melfalan 200 mg/m2 is administered). The patients are randomized into two groups, the first one is given interferon alpha as maintenance treatment, in the second group alternates cyclically interferon alpha and dexamethasone treatment. So far between 1996 and Aug. 31 2000 in the 4W clinical study 167 patients were included. 113 patients after transplantation were evaluated incl. 13 (12%) who achieved complete remission of the disease (absence of paraprotein, negative immunofixation), 63 patients (56%) with remission of the disease (decline of paraprotein, by more than 75%). Another 24 patients (21%) achieved partial remission (decline of paraprotein by more than 50% but less than 75%). The peritransplantation mortality is 2.67%. So far there is no significant difference between the two groups on maintenance treatment as regards the mean period before a relapse of the disease (p = 0.567). The median of the mean survival was not reached so far. The authors describe the results of the internal analysis of data incl. statistical processing.
No preview · Article · Oct 2001 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: The authors compare the results of allogenic bone marrow transplantations of relatives in patients with chronic myeloid leukaemia during the initial years of the transplantation programme 1991-1995 (group 1, 15 patients) with results achieved in 1996-1998 (group 2, 30 patients) and evaluate the effect of changes concerning supportive treatment and new diagnostic methods. The age median of group 1 was 35 years, the median age of group 2 46 years. In other parameters the groups were comparable. In 1991-1995 a high transplantation mortality by the 100th day was recorded (40% as compared with 17%) and a higher incidence of stage III and IV of the acute reaction of the graft against the host (GVHD) in group 1 (20% vs. 6%). In group 2 there was a higher transplantation mortality after day 100 associated with a more frequent chronic GVHD (0% vs. 16.5%). The total survival is insignificantly better in group 2 (60% in group 1 survive with a median of 58 months follow up and 67% of group 2 with a median follow up of 33 months). Group 2 comprises however older patients. In the improved early transplantation mortality participated new methods, a change of the posttransplantation immunosuppression, experience with care of transplanted patients and better collaboration with other medical disciplines. The authors did not observe a substantial effect of changes in the basic supportive treatment on results of transplantation. Late transplantation mortality associated in particular with a higher incidence of chronic GVHD could be in the authors' opinion reduced by longer administration of immunosuppression after transplantation, in particular in older patients.
No preview · Article · Oct 2001 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: In order to assess the incidence and analyze reasons which cause prolongation of hospital stay in patients engrafted after peripheral blood stem cell transplantation (PBSCT), we performed this retrospective analysis. One hundred patients (receiving 123 conditioning regimens) were included in the analysis. Criteria for discharge were presence of myeloid engraftment and absence of severe concomitant problems. Ninety subjects (73%) were discharged just after engraftment was reached on day +12 (10-14). Discharge was delayed in 33 patients (27%) and the mean prolongation was 3 days (1-11). In 31 patients (25%) delayed discharge was due to complications: in 14 patients (11.4%) because of GIT problems, in 16 patients (13%) because of infectious complications and in one patient because of cardiotoxicity. A significantly higher number of infectious complications was found in patients conditioned with BEAM (19.7% vs 4.2%, P < 0.05) while GIT toxicity was the most common reason for discharge delays in patients conditioned with melfalan 200 mg/m2 (8.2% vs 14.7%, NS). No risk factors of hospital stay prolongation were determined. We conclude that in spite of rapid engraftment, non-hematological toxicities and infections remain important limitations for further reduction of the length of patient hospitalization in a significant number of patients after PBSCT.
Full-text · Article · Oct 2000 · Bone Marrow Transplantation