Management of Spinal Lymphomas: Spinal Instability Assessment Using the Spinal Instability Neoplastic Score and a Proposed Treatment Algorithm.

AIM: To propose a treatment algorithm, and to assess spinal instability in patients diagnosed with spinal lymphoma. MATERIAL AND METHODS: Demographics, symptoms, tumor level and location, and presence of spinal instability were reviewed in 22 patients with spinal lymphomas. Each patient's neurological state was reviewed using the American Spinal Injury Association and modified McCormick scale scores, and spinal instability was assessed using the Spinal Instability Neoplastic Score (SINS). RESULTS: Initially, percutaneous biopsy was performed in 16 patients, and open biopsy was performed in 6 patients. Eight of the patients who underwent percutaneous biopsy were followed up with hematological examination alone, as they had no additional complaints. The SINS was used to evaluate the presence of spinal instability, and the type of surgery to be performed was decided accordingly. In the second surgery, decompression and stabilization were performed in 5 of the remaining 8 patients, and only decompression was performed in 3 of them. Neurological improvement was observed in 6 of 7 patients with acute neurological deficit. CONCLUSION: Percutaneous biopsy for tissue diagnosis is the first step in the management of spinal lymphomas. Patients without neurological deficit should be referred for hematological examination. Those with acute neurological deficit require emergency surgery, and those with chronic symptoms must undergo operation for decompression and/or stabilization. This study confirmed the safety of the SINS in the evaluation of spinal instability in spinal lymphoma cases.

Utility of minimally invasive thoracoscopy for assessment of residual mediastinal lymphoma.

BACKGROUND: Patients with primary mediastinal lymphomas frequently present with a residual mass after completion of first-line therapy. Although a positron emission tomography scan is usually recommended, it fails to distinguish between persistent lymphoma and inflammation. Although percutaneous biopsy may have a high diagnostic yield for the initial diagnosis of mediastinal lymphomas, this biopsy has poor accuracy for detecting persistent disease in a residual mass given the heterogeneity of these residual masses. Because persistent disease has important therapeutic implications, we evaluated the role of operative biopsy in detecting lymphoma in the residual mass. METHODS: Between 2009 and 2015, consecutive patients (n = 77) undergoing tissue biopsy for initial diagnosis as well as for a positron emission tomography-positive residual mass were included. Tissue biopsy for a residual mass was repeated until frozen section was diagnostic or at least the mass on the ipsilateral hemi-mediastinum was resected. RESULTS: Of the initial 77 patients, 34 underwent operative restaging for a residual mass after chemotherapy, while 43 had a complete response. In these 34 patients, operative biopsy revealed the presence of lymphoma in 53%, predominantly Hodgkin's disease and diffuse large B-cell lymphoma. There was no significant difference in tumor volume (51% versus 39%) and a decrease in the positron emission tomography-standardized uptake valuemax (68% vs 60%) in patients with or those without persistent lymphoma. There were no surgical complications and the duration of stay for all patients undergoing thoracoscopy was <24 hours. Residual lymphoma was treated with second-line therapy guided by the pathologic analysis. CONCLUSION: A large proportion of patients with residual positron emission tomography-avidity after first-line chemotherapy of mediastinal lymphomas have residual disease that can be detected safely using minimally invasive thoracoscopy.

Fulminant primary cardiac lymphoma with sudden cardiac death: A case report and brief review.

Primary cardiac lymphoma (PCL) is very rare, with the variable clinical manifestations potentially leading to a delayed diagnosis. PCL is usually detected incidentally through image studies, whereas the diagnosis can be confirmed via analysis of pericardial effusion, endomyocardial biopsy tissue, or surgical specimens. Although no standard therapy has been established for PCL, without treatment, the prognosis is grave, with the estimated overall survival being approximately 1 year. We report a difficult diagnosis and complicated case of fulminant PCL, which is the first comprehensively reported case of PCL with secondary hemophagocytosis. A man presented with progressive dyspnea for 3 weeks, and then sudden cardiac death with ventricular fibrillation occurred. After resuscitation, echocardiography revealed a thickened left ventricular wall and severe mitral regurgitation, and computed tomography showed a right atrial mass with diffuse myocardial lesions. PCL was confirmed through a pathological analysis of specimens collected during mitral valvuloplasty, which also implied extensive myocardial involvement. Bone marrow biopsy demonstrated no evidence of lymphoma involvement, but secondary hemophagocytosis was noted. Despite aggressive chemotherapy, the patient died of sepsis with multiorgan failure 26 days after the operation.

PET/CT for Lymphoma Post-therapy Response Assessment in Other Lymphomas, Response Assessment for Autologous Stem Cell Transplant, and Lymphoma Follow-up.

FDG-PET/CT is an established first-line diagnostic imaging tool used in the staging of most lymphomas and for post-therapy response assessment in Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL). Many of the subtypes of lymphoid neoplasms classified by the World Health Organization demonstrate significant FDG-avidity or uptake; however, many guidelines and Lugano classification do not recommend the use of FDG-PET/CT in assessing response to therapy for these non-HL, non-DLBCL subtypes as a first-line diagnostic tool. This article reviews the role of FDG-PET/CT in the evaluation of the other most common "FDG-avid" lymphomas than HL and DLBCL, the role of FDG-PET/CT before autologous stem cell transplant, and for post-treatment follow-up. Follicular lymphoma is most commonly FDG-avid with a wide range of uptake that generally correlates with the histologic grade, a major determinant of aggressiveness and prognosis. FDG-PET/CT is more sensitive and specific than CT for detecting residual disease post therapy for both aggressive and indolent follicular lymphoma. Post-treatment FDG-PET/CT for follicular lymphoma has significant prognostic value, that is, better predicts progression-free and overall survival than does conventional post-treatment assessment with CT. FDG-PET/CT is useful in the staging of mantle cell lymphoma, a very aggressive, incurable subtype of lymphoma; however, data show mixed results on the benefits of FDG-PET/CT over conventional CT assessment in post-therapy response evaluation. Peripheral T-cell lymphomas, a rare aggressive group of T-cell lymphomas, are often FDG-avid. Post-therapy FDG-PET/CT results have major prognostic value and therapeutic implications in many subtypes of peripheral T-cell lymphomas. Post-treatment FDG-PET/CT is superior to conventional CT for determining chemosensitivity of lymphoma, and therefore is better able to predict which patients will have a greater benefit or outcome with autologous stem cell transplant. There are mixed data on the value of FDG-PET/CT for surveillance after treatment because of high reported false-positive rates and accuracy that depends on the duration or timing of surveillance and the subtype of lymphoma.

Renal Complex Cystic Masses: Usefulness of Contrast-Enhanced Ultrasound (CEUS) in Their Assessment and Its Agreement with Computed Tomography.

INTRODUCTION: Around 10 % of renal cell carcinomas (RCC) are cystic, while some benign cysts have complex appearance in conventional diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI). These renal complex cystic masses (RCCMs) are a challenging entity in urological practice and sometimes have a difficult management, requiring surgical removal. Contrast-enhanced ultrasound (CEUS) is a very sensitive test detecting microvascularization in real time, and it has been used in the diagnostic workup of these kinds of lesions. The aim of our study was to assess the diagnostic power of CEUS in the evaluation of RCCM. MATERIAL AND METHODS: This is a prospective observational study between April 2011 and July 2014. A total of 66 patients with 67 RCCMs were enrolled (Bosniak 2-4). Twenty-four patients underwent surgical removal of the RCCM. All participants underwent CEUS (experimental) and CT (control). All CEUS procedures were performed by a single high-experienced observer (urologist). Benign lesions were defined as those Bosniak 2-2F, and malignant were Bosniak 3-4. Statistical analysis was made measuring consistency (kappa index and Landis-Koch scale) and validity (sensitivity, specificity, positive and negative predictive values) of the study. RESULTS: Median size of RCCM measured by CEUS and CT was 3.8 cm (interquartile range (AIQ) 3.2-4.6) and 3.9 cm (AIQ 3.2-4.5), respectively. Kappa index shows good agreement between both tests (0.71; 95 % CI 0.57-0.85), both overall and stratified by categories according to Bosniak classification. CEUS has a sensitivity 100 %, specificity 81.4 %, positive predictive value 70.4 %, and negative predictive value 100 %. A total of eight RCCMs were discordant, and seven of eight classified as malignant by CEUS and not by CT. Of those seven lesions classified as malignant by CEUS, six (six of seven, 85.7 %) were malignant in the pathological exam. CONCLUSIONS: CEUS is a very useful tool for assessing RCCM, with good results in terms of consistency and validity. It has a good diagnostic power, with a sensitivity of 100 % and a negative predictive value of 100 %. Its main limitations are the experience required, a special software, and being observer-dependent.

The burden of care and quality of life of caregivers of leukemia and lymphoma patients following peripheric stem cell transplantation.

This study was conducted to identify the burden of care and quality of life of caregivers of leukemia and lymphoma patients who had undergone peripheric stem cell transplantation. The sample consisted of 123 patient caregivers, all of whom were relatives. Data were collected using a survey, the Burden Interview, and the Caregiver Quality of Life Index Cancer Scale. Data evaluation was done using correlation analysis, Kruskall Wallis, and Mann-Whitney U tests. Factors that were significantly associated with quality of life and care burden perception included caring for an older patient, patient dependence for daily activities, and having low economic status.

Plerixafor on-demand combined with chemotherapy and granulocyte colony-stimulating factor: significant improvement in peripheral blood stem cells mobilization and harvest with no increase in costs.

To date, no prospective study on Plerixafor 'on-demand' in combination with chemotherapy and granulocyte colony-stimulating factor (G-CSF) has been reported. We present an interim analysis of the first prospective study in which Plerixafor was administered on-demand in patients affected by multiple myeloma and lymphoma who received high dose cyclophosphamide or DHAP (dexamethasone, cytarabine, cisplatin) plus G-CSF to mobilize peripheral blood stem cells (PBSC). One hundred and two patients were evaluable for response. A cohort of 240 patients receiving the same mobilizing chemotherapy was retrospectively studied. Failure to mobilize CD34(+) cells in peripheral blood was reduced by 'on-demand' strategy compared to conventional mobilization; from 13·0 to 3·0% (P = 0·004). Failure to harvest CD34(+) cells 2 × 10(6) /kg decreased from 20·9 to 4·0% (P = 0·0001). The on-demand Plerixafor strategy also resulted in a lower rate of mobilization failure (P = 0·03) and harvest failure (P = 0·0008) when compared to a 'bias-adjusted set of controls'. Evaluation of economic costs of the two strategies showed that the overall cost of the two treatments were comparable when salvage mobilizations were taken into account. When in combination with cyclophosphamide or DHAP plus G-CSF, the 'on-demand' use of Plerixafor showed, in comparison to conventionally treated patients, a significant improvement in mobilization of PBSC with no increase in overall cost.

Cutting cancer waiting times: streamlining cervical lymph node biopsy.

BACKGROUND: Patients with enlarged lymph nodes present to a number of different specialties and diagnosis is often made following a biopsy. OBJECTIVE: This study aimed to establish department waiting times for cervical lymph node biopsy, and compare these to the cancer services guidelines. METHODS: A retrospective audit was carried out to record patient waiting times (defined as the number of days from referral to biopsy) between May and December 2010. A proforma for referral was introduced. In addition, appointments for biopsies were arranged by a co-ordinator. A prospective re-audit was carried out from March to September 2011. RESULTS: The first audit showed that national guidelines were not met; there was a median waiting time of 74 days (interquartile range, 47-113). Re-audit demonstrated a significant reduction in waiting times using the proforma; the median waiting time had decreased to 18 days (interquartile range, 9-22). CONCLUSION: A proforma for lymph node biopsy and a designated co-ordinator streamlined the service, significantly reducing waiting times. Together, these can aid referral for meeting guidelines and improve patient care.

The costs of mobilisation and collection of peripheral blood stem cells in multiple myeloma and lymphoma in an European country: results from The Gruppo Italiano Trapianto Midollo Osseo (GITMO) and Società Italiana di Emaferesi e Manipolazione Cellulare (SIdEM) survey.

Scarce information is available about the cost of mobilisation/collection of peripheral blood stem cells for patients undergoing autologous transplant for relapsed Lymphoma or Multiple Myeloma. This paper reports the consumption of resources and costs collected through a survey among Italian Centres who adhere to the GITMO and SIdEM scientific societies. General transplant information was extracted from the European Promise database. Resources used alongside the phases of mobilisation/collection were retrieved. Resources for each of the process phases were quantified and averaged across centres and a unit cost value was attributed, based on administrative data from 3 centres, tariffs and market values. 25/89 Centres (34% of 2009 Promise transplants) provided data according to their standard practice. The mean cost/patient of the process of cell mobilisation/collection was € 6830 ± 1802 for Multiple Myeloma and € 7304 ± 1542 for Lymphoma. The organisational path for PBSC mobilisation/collection appears complex and cumbersome, spread amongst different treatment settings, with many different healthcare professionals being involved and considerable amounts of time and resources being currently dedicated to the management of patients requiring autologous transplantation.

Cost-effectiveness of hematopoietic stem cell mobilization strategies including plerixafor in multiple myeloma and lymphoma patients.

Peripheral blood stem cells (PBSCs) are preferred source of hematopoietic stem cells for autologous transplantation. Mobilization of PBSCs using chemotherapy and/or granulocyte colony-stimulating factor (G-CSF) however fails in around 20%. Combining G-CSF with plerixafor increases the mobilizations success. We compared cost-effectiveness of following schemes: the use of plerixafor "on demand" (POD) during the first mobilization in all patients with inadequate response, the remobilization with plerixafor following failure of the first standard mobilization (SSP), and the standard (re)mobilization scheme without plerixafor (SSNP). Decision tree models populated with data from a first-of-a-kind patient registry in six Czech centers (n = 93) were built to compare clinical benefits and direct costs from the payer's perspective. The success rates and costs for POD, SSP and SSNP mobilizations were; 94.9%, $7,197; 94.7%, $8,049; 84.7%, $5,991, respectively. The direct cost per successfully treated patient was $7,586, $8,501, and $7,077, respectively. The cost of re-mobilization of a poor mobilizer was $5,808 with G-CSF only and $16,755 if plerixafor was added. The total cost of plerixafor "on-demand" in the sub-cohort of poor mobilizers was $17,120. Generally, plerixafor improves the mobilization success by 10% and allows an additional patient to be successfully mobilized for incremental $11,803. Plerixafor is better and cheaper if used "on demand" than within a subsequent remobilization.

[Second expert review on lymphoma: assessment of a one year activity in a general hospital]. / Expertise systématique des lymphomes diagnostiqués au cours d'une année d'activité d'un centre hospitalier : évaluation.

A standardized second histological review for lymphomas was established by the French National Cancer Institute in 2010. The objective of our study was to assess the clinical impact of this process between a general hospital (reader 1) and an expert (reader 2). This prospective study was conducted between April 1st 2010 and April 1st 2011. Fifty-four cases of lymphoma were subjected to an expert review following the "LYMPHOPATH" recommendations and diagnoses of readers 1 and 2 were compared according to the WHO 2008 classification of lymphomas. We distinguished serious discrepancies (lymphoma versus other malignancy) from subtyping disagreement with or without impact on therapeutic strategy. We also determined the delays between the initial reception of the sample and reader 1's (period A) and reader 2's (period B) reports, respectively. Any additional analysis performed by second reader was also reported. Our study revealed one case of subtyping discordance (1.85%). The mean delays were 7 days for period A and 20 days for period B, respectively. Additional immunohistochemical techniques were requested by reader 2 in 11 cases (20.4%). These data provide evidence to suggest that in our department, a second review targeted on difficult diagnoses, rare lymphomas or when further analyses are required would be more relevant than a standardized second review.

A randomised phase II study of the efficacy, safety and cost-effectiveness of pegfilgrastim and filgrastim after autologous stem cell transplant for lymphoma and myeloma (PALM study).

AIM: To evaluate in a multicentre randomised study the effect on duration of febrile neutropenia (FN), the safety and cost-effectiveness of a single subcutaneous pegfilgrastim injection compared with daily injections of filgrastim after peripheral blood stem cell transplantation in patients receiving high dose chemotherapy for myeloma and lymphoma. METHODS: Patients were randomly assigned to a single dose of pegfilgrastim at day 5 (D5) or daily filgrastim from D5 to the recovery of absolute neutrophil count (ANC) to 0.5 G/L. Duration of FN, of neutrophil and platelet recovery, transfusion and antibiotic requirements were the main end-points of the study. Costs were calculated from D0 until transplant unit discharge. The incremental cost-effectiveness ratio was expressed as the cost per day of FN prevented. Probabilistic sensitivity analysis was performed by non-parametric bootstrap methods. RESULTS: Between October 2008 and September 2009, 10 centres enrolled 151 patients: 80 patients with lymphoma and 71 patients with myeloma. The mean duration of FN was 3.07 days (standard deviation (SD) 1.96) in the pegfilgrastin arm and 3.29 (SD 2.54) in the filgrastim one. Mean total costs were 23,256 and 25,448 euros for pegfilgrastim and filgrastim patients, respectively. There was a 62% probability that pegfilgrastim strictly dominates filgrastim. CONCLUDING STATEMENT: Pegfilgrastim after PBSC transplantation in myeloma and lymphoma is safe, effective when compared with filgrastim and could represent a cost-effective alternative in this setting.

Monte Carlo simulations applied to conjunctival lymphoma radiotherapy treatment.

INTRODUCTION: Small radiation fields are increasingly applied in clinical routine. In particular, they are necessary for the treatment of eye tumors. However, available treatment planning systems do not calculate the absorbed dose with the desired accuracy in the presence of small fields. Absorbed dose estimations obtained with Monte Carlo methods have the required accuracy for clinical applications, but the exceedingly long computation times associated with them hinder their routine use. In this article, a code for automatic Monte Carlo simulation of linacs and an application in the treatment of conjunctival lymphoma are presented. METHODS: Simulations of clinical linear accelerators were performed with the general-purpose radiation transport Monte Carlo code penelope. Accelerator geometry files, in electron mode, were generated with the program AutolinaC. RESULTS: The Monte Carlo simulation of an annular electron 6 MeV field used for the treatment of the conjunctival lymphoma yielded absorbed dose results statistically compatible with experimental measurements. In this simulation, 2% standard statistical uncertainty was reached in the same time employed by a hybrid Monte Carlo commercial code (eMC); however, eMC showed discrepancies of up to 7% on the absorbed dose with respect to experimental data. Results obtained with the analytic algorithm Pencil Beam Convolution differed from experimental data by 10% for this case. CONCLUSION: Owing to the systematic application of variance-reduction techniques, it is possible to accurately estimate the absorbed dose in patient images, using Monte Carlo methods, in times within clinical routine requirements. The program AutolinaC allows systematic use of these variance-reduction techniques within the code penelope.

Outcome, toxicity profile and cost analysis of autologous stem cell mobilization.

Autologous stem cell mobilization (ASCM) is conventionally done using high-dose CY plus granulocyte colony-stimulating factor (G). It is important to examine the outcomes, toxicity profile and costs of ASCM associated with CY+G. A retrospective study was conducted in 236 patients with myeloma or lymphoma undergoing ASCM with CY+G. An ideal outcome was defined as 2 × 10(6) CD34+ cells/kg collected on the planned day of collection in 1 or 2 apheresis without a negative clinical event. The total cost of ASCM including clinical events, were reported based on Medicare part-B physician, laboratory and ancillary fee schedule. ASCM was successful in 213 (90%) patients, but an ideal outcome was seen in only 50 (20%) patients. Median (interquartile range, IQR) total cost of CY+G stem cells mobilization was $10,605 ($9,230-$14,540). Ideal outcomes were associated with lower costs compared with non-ideal outcomes (median (IQR), $9914 ($8,743-$11,168) versus $11232 ($9,292-$15,518) respectively, P<0.001). The median (IQR) cost of non-ideal outcome was higher among lymphoma patients ($12,293 ($9578-$16,268)) compared with myeloma patients ($10,388 ($9,355-$14,360) (P=0.04). Although mobilization success is eventually realized with CY+G, it has a low rate of ideal outcome, associated with significant adverse events and costs.

Fluorine-18-fluorodeoxyglucose positron emission tomography in response assessment before high-dose chemotherapy for lymphoma: a systematic review and meta-analysis.

BACKGROUND: We conducted a systematic review and meta-analysis to better define the prognostic ability of fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) following salvage chemotherapy for relapsed or refractory Hodgkin's lymphoma (HL) and aggressive non-Hodgkin's lymphoma. METHODS: We searched PubMed (from inception to January 31, 2010), bibliographies, and review articles without language restriction. Two assessors independently assessed study characteristics, quality, and results. We performed a meta-analysis to determine prognostic accuracy. RESULTS: Twelve studies including 630 patients were eligible. The most commonly evaluated histologies were diffuse large B-cell lymphoma (n = 313) and HL (n = 187), which were typically treated with various salvage and high-dose chemotherapy regimens. Studies typically employed nonstandardized protocols and diagnostic criteria. The prognostic accuracy was heterogeneous across the included studies. (18)F-FDG PET had a summary sensitivity of 0.69 (95% confidence interval [CI], 0.56-0.81) and specificity of 0.81 (95% CI, 0.73-0.87). The summary estimates were stable in sensitivity analyses. In four studies that performed direct comparisons between PET and conventional restaging modalities, PET had a superior accuracy for predicting treatment outcomes. Subgroup and metaregression analyses did not identify any particular factor to explain the observed heterogeneity. CONCLUSION: (18)F-FDG PET performed after salvage therapy appears to be an appropriate test to predict treatment failure in patients with refractory or relapsed lymphoma who receive high-dose chemotherapy. Some evidence suggests PET is superior to conventional restaging for this purpose. Given the methodological limitations in the primary studies, prospective studies with standardized methodologies are needed to confirm and refine these promising results.

Overview of early response assessment in lymphoma with FDG-PET.

Early assessment of response to chemotherapy with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is becoming a routine part of management in patients with Hodgkin lymphoma (HL) and histologically aggressive non-Hodgkin lymphoma (NHL). Changes in FDG uptake can occur soon after the initiation of therapy and they precede changes in tumour volume. Recent studies in uniform populations of aggressive lymphomas (predominantly diffuse large B cell lymphomas) and HL have clarified the value of early response assessment with PET. These trials show that PET imaging after 2-3 chemotherapy cycles is far superior to CT-based imaging in predicting progression-free survival and can be at least as reliable as definitive response assessment at the end of therapy. This information is of great potential value to patients, but oncologists should be cautious in the use of early PET response in determining choice of therapy until some critical questions are answered. These include: When is the best time to use PET for response assessment? What is the best methodology, visual or quantitative? (For HL at least, visual reading appears superior to an SUV-based assessment). Can early responders be cured with less intensive therapy? Will survival be better for patients treated more intensively because they have a poor interim metabolic response? In the future, early PET will be crucial in developing response-adapted therapy but without further carefully designed clinical trials, oncologists will remain uncertain how best to use this new information.

Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation: the Hovon 22 study.

The present study analysed whether autologous peripheral blood stem cell transplantation (PSCT) improves engraftment, quality of life and cost-effectiveness when compared with autologous bone marrow transplantation (ABMT). Relapsing progressive lymphoma patients (n = 204; non-Hodgkin's lymphoma n = 166; Hodgkin's disease n = 38) were, after induction treatment with the DHAP-VIM (cisplatin, cytarabine, dexamethasone, etoposide, ifosfamide, methotrexate) regimen, randomly (2:1) assigned to the harvest of granulocyte-macrophage colony-stimulating factor-mobilized stem cells after the second DHAP course or autologous bone marrow cells before the second DHAP course. These stem cells were reinfused following high-dose myeloblative chemotherapy. After induction, 118 patients obtained a partial or complete response and were eligible for randomization. In the PSCT arm (n = 76) significantly faster engraftment of neutrophils [> or = 0.1 and > or = 0.5 x 10(9)/l: 10.7 d (7-36, median, range), 15 (9-45) versus 13 (8-25) and 26 (14-80), P < 0.01] and thrombocytes [> or = 20 x 10(9)/l: 13 d (7-51) versus 18 (11-65), P < 0.01] were observed. In addition, significantly fewer transfusions of red blood cells [6 (0-23) versus 8 (2-24), P < 0.01] and platelets [4 (0-60) versus 8 (2-55), P = 0.01] were required in the PSCT arm. These findings were associated with a significant reduction in the median days of intravenous antibiotics in patients with fever [8.5 (0-30) versus 14 (0-34), P = 0.04] and hospital stay [27 (8-51) versus 34 (24-78), P < 0.05]. Quality of life demonstrated a significant difference in favour of the PSCT arm. Total transplantation costs were significantly lower in the PSCT arm [$13,954 ($4913- 29,532) versus $17 668 ($10,170-44,083) P < 0.05], as a result of the reduced hospital stay and lower antibiotic costs. In summary, these results indicate that PSCT is superior to ABMT with regard to engraftment, supportive care, quality of life and cost.

The value of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: an assessment of its diagnostic potential and pitfalls.

This study was conducted to assess the diagnostic potential and pitfalls of performing fine-needle aspiration cytology (FNAC) for thyroid nodules. We retrospectively analyzed 1,012 aspirated samples obtained from 806 thyroid nodules by the ultrasound (US)-guided method. Of these 806 nodules, 226 (31%) had been surgically treated, 152 (67%) of which were histologically diagnosed as malignant. The rate of sufficient aspirate was 82%, being lower in nodules with a diameter of less than 5mm (73%, P = 0.10); either calcified (77%, P = 0.043) or benign (72%, P = 0.0002). The accuracy of FNAC was 75%, the rate of indeterminate diagnosis was 16%, the false negative rate was 13%, and the positive malignancy rate was 99%. The rate of indeterminate diagnosis was higher in adenomatous goiter, follicular carcinoma, and malignant lymphoma, at P = 0.015, P = 0.0008, and P = 0.035, respectively. The accuracy was lower in follicular carcinoma and malignant lymphoma (both at P = 0.013). Sufficient aspirate was finally obtained from 701 (87%) of the 806 nodules by repeated aspiration. Of 152 malignant nodules, 28 (18%) were diagnosed after two or more aspirations, and the accuracy was improved to 81% by repeating the procedure. These findings indicated that repeated aspiration may be a simple and effective method of improving the diagnostic potential of FNAC.

[Difference in costs of autologous transplantation of peripheral and bone marrow hematopoietic stem cells. A retrospective analysis over 1 year of transplantation in lymphoma, Hodgkin's disease and myeloma in a Center]. / Différence de coût des autogreffes de cellules-souches hématopoïétiques circulantes et médullaires.

The study analysed the financial benefits of transplantation with peripheral blood stem-cells primed after chemotherapy and growth factor in comparison with bone marrow transplantation. Twenty-three consecutive transplantations were performed during one year: 14 peripheral blood stem-cell (CSC group) and 9 bone marrow transplantations (MO group). No differences in patients characteristics were seen between the two groups except for higher number of "BEAM" conditioning in CSC group. Were analyzed delay in neutrophil and platelet recovery, numbers of days in hospital, with fever, under antibiotics, costs of supportive therapy, stem-cell collection and cryopreservation. Difference was significant for duration of neutropenia with advantages in CSC group, but the number on days in hospital, with fever or under antibiotics were similar. Number of platelet transfusions was reduced in CFC group: this economical advantage was lost with the cost of growth factor used for priming stem-cells stem-cell collections and cryopreservations. In our retrospective study, financial advantages associated to peripheral blood stem-cell transplantation was not verified.

[Influence of the granulocyte growth factor on the cost of bone marrow autografts in oncologic hematology]. / Influence du facteur de croissance granulocytaire sur le coût des autogreffes de moelle en onco-hématologie.

OBJECTIVE: It is now possible to achieve prolonged remission of malignant lymphoma and certain cancers with high-dose chemotherapy followed by autograft with haematopoietic stem cells. We tested such a protocol, evaluating haematologic recovery, in order to determine the total cost of hospitalization. METHODS: Sixteen patients were included in the study, 7 had severe or relapsing lymphoma, 7 had breast cancer or cancer of the ovary and 2 had cancer of the testicule. Mean age was 34 years, 14 patients reached complete remission and relapse occurred in 2. Ten patients were given granulocyte growth factor and 6 were given a placebo. RESULTS: The duration of aplasia (number of days with a white cell count below 1 x 10(9)1) ranged from 10 to 32 days. In patients treated with granulocyte growth factor, it was shorter (16 vs 22 days) as was hospitalization time (27 vs 33 days). The cost of the autograft ranged from 100,000 FF to 250,000 FF and the average cost for the 16 patients was 149,500 FF including: 83,600 FF (56.4%) for hospitalization itself, 33,200 FF (22%) for drugs, mostly antibiotics, and 19,000 FF (13%) for laboratory examinations and 14,000 FF (9%) for blood transfusions. Total cost was lower in patients given granulocyte growth factor, 142,000 FF vs 166,000 FF for those given placebo. CONCLUSION: In order to shorten the duration of the aplasia period, haematopoietic growth factors are widely used in autograft protocols. Our findings give an evaluation of the cost in 16 patients and show that cost decreases in patients given granulocyte growth factor. This reduction is cost is related to a lower hospitalization cost and not a reduction in the number of drugs and transfusions required.