Survival following allogeneic transplant in patients with myelofibrosis.

Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P < .0001; DIPSS-Int-2 and higher: HR, 0.39, P < .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P < .0001; DIPSS-Int-2 and higher: HR, 2.55, P < .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up.

Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report.

BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P < .001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P < .001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P < .001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P = .005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141-9. © 2017 American Cancer Society.

Hematopoietic Stem Cell Transplantation Activity in Pediatric Cancer between 2008 and 2014 in the United States: A Center for International Blood and Marrow Transplant Research Report.

This Center for International Blood and Marrow Transplant Research report describes the use of hematopoietic stem cell transplantation (HSCT) in pediatric patients with cancer, 4408 undergoing allogeneic (allo) and3076 undergoing autologous (auto) HSCT in the United States between 2008 and 2014. In both settings, there was a greater proportion of boys (n = 4327; 57%), children < 10 years of age (n = 4412; 59%), whites (n = 5787; 77%), and children with a performance score ≥ 90% at HSCT (n = 6187; 83%). Leukemia was the most common indication for an allo-transplant (n = 4170; 94%), and among these, acute lymphoblastic leukemia in second complete remission (n = 829; 20%) and acute myeloid leukemia in first complete remission (n = 800; 19%) werethe most common. The most frequently used donor relation, stem cell sources, and HLA match were unrelated donor (n = 2933; 67%), bone marrow (n = 2378; 54%), and matched at 8/8 HLA antigens (n = 1098; 37%) respectively. Most allo-transplants used myeloablative conditioning (n = 4070; 92%) and calcineurin inhibitors and methotrexate (n = 2245; 51%) for acute graft-versus-host disease prophylaxis. Neuroblastoma was the most common primary neoplasm for an auto-transplant (n = 1338; 44%). Tandem auto-transplants for neuroblastoma declined after 2012 (40% in 2011, 25% in 2012, and 8% in 2014), whereas tandem auto-transplants increased for brain tumors (57% in 2008 and 77% in 2014). Allo-transplants from relatives other than HLA-identical siblings doubled between 2008 and 2014 (3% in 2008 and 6% in 2014). These trends will be monitored in future reports of transplant practices in the United States.

Atribuciones de la motivación al logro y sus implicaciones en la formación del pensamiento lógico-matemático en la Universidad / Motivational attributions and their implications in the development of the logical-mathematical reasoning at University level / Atribuições da motivação para o sucesso e suas implicações na formação do pensamento lógico-matemático na Universidade

El propósito del estudio fue analizar algunas de las atribuciones de la motivación al logro en educación matemática en referencia al desempeño en diferentes aspectos del razonamiento cuantitativo demostrado por estudiantes universitarios. La modalidad de investigación fue no experimental con un diseño ex-post facto. Fue escogida intencionalmente una muestra de 92 estudiantes provenientes de una población de 1800 inscritos en la asignatura Matemática I del semestre I-2008 en la Facultad de Ciencias Económicas y Sociales, Universidad de Carabobo, Venezuela. Los resultados indican que algunas causas atribucionales de motivación afectan el potencial lógico-numérico y contribuyen en el desempeño de los estudiantes en algunas dimensiones del pensamiento matemático.

The purpose of this study was to analyze some of the attributions of the motivation for achievement in mathematics, referred to performance shown by university students in diverse aspects of quantitative reasoning. The research modality was non-experimental with an ex-post facto design. A sample of 92 beginning students out of a population of 1800 enrolled in the course Mathematics I in semester I-2008 was chosen intentionally at the Economic and Social Sciences College, University of Carabobo, Venezuela. The results indicate that some atribucional causes of motivation affect the logical-numerical potential and contribute to students performance in some dimensions of the mathematical thought.

O propósito do estudo foi analisar algumas das atribuições da motivação para o sucesso na educação matemática em referência ao desempenho em diferentes aspectos do raciocínio quantitativo demonstrado por estudantes universitários. A modalidade de investigação foi não experimental com um desenho ex-post facto. Foi escolhida intencionalmente uma amostra de 92 estudantes provenientes de uma população de 1800 inscritos na disciplina Matemática I do semestre I-2008 na Faculdade de Ciências Econômicas e Sociais, Universidade de Carabobo, Venezuela. Os resultados indicam que algumas causas atribucionais de motivação afetam o potencial lógico-numérico e contribuem no desempenho dos estudantes em algumas dimensões do pensamento matemático.

[Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Spanish hospitals: 2nd multicenter study (GEIH-BLEE project, 2006)]. / Escherichia coli y Klebsiella pneumoniae productoras de betalactamasas de espectro extendido en hospitales españoles: segundo estudio multicéntrico (proyecto GEIH-BLEE 2006).

INTRODUCTION: During the year 2000, the 1st nationwide project (GEIH-BLEE Project 2000) on Escherichia coli and Klebsiella pneumoniae producing extended-spectrum ss-lactamases (ESBL) was carried out in Spain. The 2nd nationwide study was developed in 2006 to investigate the evolution of this problem. METHODS: A prospective multicenter study was designed, including all ESBL-producing E. coli and K. pneumoniae strains isolated at 44 Spanish hospitals between February and March 2006. Identification was verified at the coordinating centre and ESBL production was confirmed following CLSI guidelines. RESULTS: A total of 1021 E. coli and 162 K. pneumoniae strains were collected. ESBL-producing E. coli strains were isolated in all the participating hospitals, whereas ESBL-producing K. pneumoniae were isolated in 34. The overall percentage (range) of ESBL production among E. coli and K. pneumoniae was 4.04% (0.4-20.3) and 5.04% (0-30), respectively. In ESBL E. coli (Ec) cases, acquisition was considered community-acquired in 32%, related to health care in 36%, and nosocomial in 30%; and in ESBL K. pneumoniae (Kp) cases, acquisition by these routes was 10%, 18%, and 68% respectively. The samples most commonly showing these microorganisms were urine (77% Ec and 48.2% Kp) and wound exudate (8.6% Ec and 14.8% Kp). CONCLUSIONS: Since 2000, the percentage of ESBL-producing strains among E. coli and K. pneumoniae isolates in Spain has increased 8-fold and 2-fold, respectively. The increase in ESBL-producing E. coli mainly occurred in isolates from outpatients, and most commonly in urine samples.

Transient donor cell-derived myelodysplastic syndrome with monosomy 7 after unrelated cord blood transplantation.

Donor cell leukaemia or myelodysplastic syndromes are extremely rare complications that have been observed not only after haematopoietic transplantation with progenitor cells harvested from bone marrow and peripheral blood, but also after cord blood transplantation. We describe the early onset of monosomy 7 in donor cells after cord blood transplantation in a patient diagnosed with myelodysplastic syndrome 3 months after transplantation. Fluorescent in situ hybridisation analysis performed in a cryopreserved aliquot of the cord blood showed 2.5% of nuclei with monosomy 7. The cord blood donor was studied and he showed neither peripheral blood cytopenias nor cytological or cytogenetic features of myelodysplasia. The cell blood counts (CBC) of the girl have improved over 2 yr while decreasing the percentage of monosomic cells. The monosomic clone has finally disappeared and the CBC are finally normal. This case of transient monosomy 7 started very early after engraftment emphasises the relevance of clonal instability of specific progenitor cells in the early engraftment, and host immune status, in cytogenetic abnormalities founded in donor cell-derived MDS and acute leukaemia. Moreover, the clinical follow-up of this patient, recommends a more conservative treatment for this clonal disease early developed after transplantation.