RESUMEN
This retrospective report compared the 4-year outcomes of allogeneic stem cell transplantation (allo-SCT) in 651 adult patients with acute myeloid leukemia receiving a reduced-intensity (RIC) or nonmyeloablative conditioning (NMA) regimen according to the type of unrelated donors. These were either umbilical cord blood (UCB, n = 205), a 9/10 mismatched unrelated donor (MisMUD, n = 99), or a 10/10 matched unrelated donor (MUD, n = 347) graft. Neutrophil recovery was slower in UCB (74.5% by day 42) compared with MisMUD (94.8%) and MUD (95.6%) (P < .001). There was no significant difference in nonrelapse mortality between UCB and both MUD (hazard ratio [HR], 1.05; 95% confidence interval [CI], .62 to 1.78; P = .85) and MisMUD (HR, 1.58; 95% CI, .88 to 2.83; P = .13) The relapse/progression was similar between UCB and MisMUD (HR, .62; 95% CI, .37 to 1.03; P = .07), but was significantly lower in MUD compared with UCB (HR, .60; 95% CI, .39 to .92; P = .02). The rate of extensive chronic graft-versus-host disease (GVHD) was similar between UCB and both MUD (HR, 2.15; 95% CI, .93 to 4.97; P = .08) and MisMUD (HR, 1.84; 95% CI, .68 to 4.95; P = .23). The rate of severe grade III and IV acute GVHD was significantly increased in MisMUD compared with UCB (HR, 2.61; 95% CI, 1.30 to 5.23; P = .007). There was no significant difference in overall survival between UCB and both MisMUD (HR, .98; 95% CI, .66 to 1.45; P = .92) and MUD (HR, .74; 95% CI, .52 to 1.03; P = .08). These data suggest that in the setting of RIC/NMA, allo-SCT UCB is a valid alternative graft source, with significantly less chronic GVHD, compared with MisMUD, when there is no MUD available or when urgent transplantation is needed.
Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda/terapia , Agonistas Mieloablativos/uso terapéutico , Acondicionamiento Pretrasplante/métodos , Adulto , Anciano , Enfermedad Crónica , Femenino , Francia , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/genética , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/patología , Prueba de Histocompatibilidad , Humanos , Leucemia Mieloide Aguda/inmunología , Leucemia Mieloide Aguda/mortalidad , Leucemia Mieloide Aguda/patología , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Hermanos , Sociedades Médicas , Análisis de Supervivencia , Trasplante Homólogo , Donante no EmparentadoRESUMEN
OBJECTIVE: The economic profile of acute myeloid leukaemia (AML) is badly known. The few studies published on this disease are now relatively old and include small numbers of patients. The purpose of this retrospective study was to evaluate the induction-related cost of 500 patients included in the AML 2001 trial, and to determine the explanatory factors of cost. SETTING: "Induction" patient's hospital stay from admission for "induction" to discharge after induction. METHOD: The study was performed from the French Public Health insurance perspective, restrictive to hospital institution costs. The average management of a hospital stay for "induction" was evaluated according to the analytical accounting of Besançon University Teaching Hospital and the French public Diagnosis-Related Group database. Multiple linear regression was used to search for explanatory factors. MAIN OUTCOME MEASURE: Only direct medical costs were included: treatment and hospitalisation. RESULTS: Mean induction-related direct medical cost was estimated at 41,852 ± 6,037, with a mean length of hospital stay estimated at 36.2 ± 10.7 days. After adjustment for age, sex and performance status, only two explanatory factors were found: an additional induction course and salvage course increased induction-related cost by 38% (± 4) and 15% (± 1) respectively, in comparison to one induction. These explanatory factors were associated with a significant increase in the mean length of hospital stay: 45.8 ± 11.6 days for 2 inductions and 38.5 ± 15.5 if the patient had a salvage course, in comparison to 32.9 ± 7.7 for one induction (P < 10â»4). This result is robust and was confirmed by sensitivity analysis. CONCLUSION: Consideration of economic constraints in health care is now a reality. Only the control of length of hospital stay may lead to a decrease in induction-related cost for patients with AML.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Costos de Hospital , Hospitalización/economía , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/economía , Adolescente , Adulto , Distribución de Chi-Cuadrado , Ensayos Clínicos como Asunto/economía , Ensayos Clínicos Fase III como Asunto/economía , Costos y Análisis de Costo , Costos de los Medicamentos , Femenino , Francia , Humanos , Tiempo de Internación/economía , Modelos Lineales , Masculino , Persona de Mediana Edad , Modelos Económicos , Estudios Multicéntricos como Asunto/economía , Programas Nacionales de Salud/economía , Admisión del Paciente/economía , Alta del Paciente/economía , Estudios Retrospectivos , Terapia Recuperativa/economía , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
The clinical and radiological presentations of Epstein-Barr virus (EBV) encephalitis are pleomorphic, but a common and characteristic finding is an increased T2-weighted signal in the bilateral thalami and basal ganglia. We report here a case of post-transplant acute limbic encephalitis (PALE) syndrome that was possibly related to EBV infection. Six weeks after hematopoietic stem-cell transplantation, the patient developed confusion and anterograde amnesia. Brain magnetic resonance imaging (MRI) was performed and revealed bi-hippocampal and amygdala signal abnormalities. The technetium-99m single-photon emission computed tomography ((99m)Tc SPECT) imaging confirmed bilateral limbic structural involvement. The clinical, biological and radiological presentations were consistent with a diagnosis of EBV-induced PALE syndrome. To our knowledge, this is the first described case of PALE syndrome possibly related to EBV infection.