Treatment of Acquired von Willebrand Syndrome and Prevention of Bleeding Postautologous Stem Cell Transplant during Severe Pancytopenia with IVIG.

The use of high dose chemotherapy followed by autologous hematopoietic stem cell transplantation for remission consolidation after initial induction represents standard of care for patients with multiple myeloma. Patients with myeloma and Acquired von Willebrand Syndrome (AVWS) undergoing autologous stem cell transplant (ASCT) are at significant risk of bleeding due to the profound thrombocytopenia, low Factor VIII levels, fever, and toxicities associated with the preparative regimen. We report a patient with AVWS associated with multiple myeloma who underwent autologous stem cell transplants as consolidation after initial induction and again at relapse. He was successfully treated with high dose intravenous immunoglobulin (IVIG) prior to each transplant with rapid resolution of AVWS.

Harnessing and understanding feedback technology in applied settings.

Research on the influence of augmented feedback effects on both skill learning and performance has been examined from two differing positions, generally reflective of two core movement science disciplines: motor learning and biomechanics. The motor learning approach has been to examine the content and timing of feedback under tightly controlled laboratory settings, with a focus on simple tasks and the influence of movement outcome feedback. At the other end of the spectrum are biomechanical approaches, which have been primarily devoted to demonstrating the capacity of measurement technology to quantify and report on movement pattern effectiveness. This review highlights the gap left by these two approaches and argues that advancement of our understanding of feedback application in practical settings requires a shift towards a multi-disciplinary focus. A particular focus of the review is on how researchers and practitioners need to harness our understanding and subsequent application of the emergent feedback technologies most prevalent in elite sport settings and clinical sports medicine. We highlight important considerations for future applied multidisciplinary research driven by relevant theory and methodological design to more comprehensively capture how feedback systems can be used to facilitate the development of skilled performance.

Decitabine improves patient outcomes in myelodysplastic syndromes: results of a phase III randomized study.

BACKGROUND: Aberrant DNA methylation, which results in leukemogenesis, is frequent in patients with myelodysplastic syndromes (MDS) and is a potential target for pharmacologic therapy. Decitabine indirectly depletes methylcytosine and causes hypomethylation of target gene promoters. METHODS: A total of 170 patients with MDS were randomized to receive either decitabine at a dose of 15 mg/m2 given intravenously over 3 hours every 8 hours for 3 days (at a dose of 135 mg/m2 per course) and repeated every 6 weeks, or best supportive care. Response was assessed using the International Working Group criteria and required that response criteria be met for at least 8 weeks. RESULTS: Patients who were treated with decitabine achieved a significantly higher overall response rate (17%), including 9% complete responses, compared with supportive care (0%) (P < .001). An additional 12 patients who were treated with decitabine (13%) achieved hematologic improvement. Responses were durable (median, 10.3 mos) and were associated with transfusion independence. Patients treated with decitabine had a trend toward a longer median time to acute myelogenous leukemia (AML) progression or death compared with patients who received supportive care alone (all patients, 12.1 mos vs. 7.8 mos [P = 0.16]; those with International Prognostic Scoring System intermediate-2/high-risk disease, 12.0 mos vs. 6.8 mos [P = 0.03]; those with de novo disease, 12.6 mos vs. 9.4 mos [P = 0.04]; and treatment-naive patients, 12.3 mos vs. 7.3 mos [P = 0.08]). CONCLUSIONS: Decitabine was found to be clinically effective in the treatment of patients with MDS, provided durable responses, and improved time to AML transformation or death. The duration of decitabine therapy may improve these results further.