Favorable long-term outcome of patients with multiple myeloma using a frontline tandem approach with autologous and non-myeloablative allogeneic transplantation.

Despite survival improvement with novel agents and use of autologous hematopoietic stem cell transplantation (HSCT), cure of patients with multiple myeloma (MM) remains anecdotal. Initial observations suggested that chronic GvHD was accompanied by an anti-myeloma effect after myeloablative HSCT, but unfortunately this procedure was hampered by high non-relapse mortality (NRM). To maximize the anti-myeloma effect and minimize NRM, we developed a non-myeloablative (NMA) regimen associated with a high incidence of chronic GvHD and tested its efficacy on patient survival and disease eradication. From 2001 to 2010, 92 patients aged ⩽ 65 years with a compatible sibling donor received autologous HSCT followed by an outpatient NMA allogeneic HSCT using a conditioning of fludarabine and cyclophosphamide. Patient median age was 52 years and 97% presented Durie-Salmon stages II-III disease. After a median follow-up of 8.8 years, probability of 10-year progression free and overall survival were 41% and 62%, respectively. Although the cumulative incidence of extensive chronic GvHD was high (at 79%), the majority of long-term survivors were off immunosuppressive drugs by year 5 and NRM was low (at 10%). Together, our results suggest that potential MM cure can be achieved with NMA transplantation regimens that maximize graft-versus-myeloma effect and minimize NRM.

Screening for depression in a sample of Egyptian secondary school female students.

BACKGROUND: Depression is common in female adolescents. Data on prevalence rates, socio-demographic correlates, and putative risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the point prevalence of depression in a representative sample of Egyptian female students; to detect the sensitivity and specificity of CDI as a screening tool, and to highlight some putative risk factors associated with depression. METHOD: Multistage random selection of 602 female students from public and private secondary schools in Eastern Cairo. All participants were subjected to screening using the Children Depression Inventory (CDI) and the Non-patient version of the Structured Clinical Interview for DSM-IV axis-I disorders. RESULTS: Depression was estimated to be 15.3% by CDI in comparison to 13.3% by SCID-I/NP. The sensitivity and specificity of CDI were 74.8% and 97.6% respectively. Regression Analysis pointed to a number of predictive factors as; academic underachievement, quarrelsome family atmosphere, socioeconomic status, negative life events and family history of psychiatric disorders. LIMITATIONS: The cross-sectional design, the lack of collateral information and access to records precluded inference of casualty. The lack of the rural comparator and samples from other governorates limits the generalisation of results. CONCLUSION: Depression was prevalent in a sample of Egyptian female secondary school students. It correlated with some psychosocial factors and can be effectively screened using CDI. Hence, there is a need for better screening, Psychoeducational programmes, and services for better identification, early intervention and targeting for those at risk.

Blood and marrow transplantation in elderly acute myeloid leukaemia patients - older certainly is not better.

Acute myeloid leukaemia in the elderly is a disease with distinct biological properties, commonly associated with leukaemic cell treatment resistance and with an increased number of high-risk features, including concomitant myelodysplasia and poor-risk cytogenetic abnormalities such as monosomy 5 and 7. Complete remission rates after standard induction chemotherapy in patients above age 60 years are less than 50%, with long-term survival rates below 10%. Post-remission stem cell transplant therapies have not been studied extensively. Autologous transplants can result in an acceptable 3-year leukaemia-free survival rate of up to 47%, yet this procedure is applicable only to a small minority of patients. Myeloablative allogeneic transplants similarly show feasibility in selected few patients and in general are very toxic. Non-myeloablative allogeneic transplants are associated with reduced toxicity, but are plagued by an increased relapse rate. The latter strategy appears promising, but must be validated in larger, multi-centre prospective trials, in which outcomes are compared to non-transplant approaches.