RESUMO
PURPOSE: Allogeneic bone marrow transplantation (alloBMT) is the only cure for many primary immune deficiency disorders (PIDD), primary immune regulatory disorders (PIRD), and inherited bone marrow failure syndromes (IBMFS). METHODS: We report the results of 25 patients who underwent alloBMT using reduced intensity conditioning (RIC), alternative donors, and post-transplantation cyclophosphamide (PTCy). In an attempt to reduce regimen-related toxicities, we removed low-dose TBI from the prep and added mycophenolate mofetil and tacrolimus for graft-versus-host disease (GVHD) prophylaxis for all donor types in the latter 14 patients. Donors were haploidentical related (n = 14), matched unrelated (n = 9), or mismatched unrelated (n = 2). The median age was 9 years (range 5 months-21 years). RESULTS: With a median follow-up of 26 months (range 7 months-9 years), the 2-year overall survival is 92%. There were two deaths, one from infection, and one from complications after a second myeloablative BMT. Three patients developed secondary graft failure, one at 2 years and two at >3 years, successfully treated with CD34 cell boost in one or second BMT in two. The remaining 20 patients have full or stable mixed donor chimerism and are disease-free. The incidence of mixed chimerism is increased since removing TBI from the prep. The 6-month cumulative incidence of grade II acute GVHD is 17%, with no grade III-IV. The 1-year cumulative incidence of chronic GVHD is 14%, with severe of 5%. CONCLUSION: This alloBMT platform using alternative donors, RIC, and PTCy is associated with excellent rates of engraftment and low rates of GVHD and non-relapse mortality, and offers a curative option for patients with PIDD, PIRD, and IBMFS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04232085.
Assuntos
Transtornos da Insuficiência da Medula Óssea/tratamento farmacológico , Transplante de Medula Óssea/efeitos adversos , Ciclofosfamida/uso terapêutico , Síndromes de Imunodeficiência/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Lactente , Recém-Nascido , Masculino , Ácido Micofenólico/farmacologia , Tacrolimo/uso terapêutico , Doadores de Tecidos , Condicionamento Pré-Transplante/métodos , Adulto JovemAssuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Hospitalização/estatística & dados numéricos , Tempo de Internação/tendências , Padrões de Prática Médica/estatística & dados numéricos , Viroses/diagnóstico , Infecções Bacterianas/complicações , Infecções Bacterianas/terapia , Febre/epidemiologia , Febre/terapia , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Recém-Nascido , Guias de Prática Clínica como Assunto , Estados Unidos , Viroses/complicações , Viroses/terapiaRESUMO
Bullying is a serious issue for adolescents, with health consequences both at the time of victimization and later on in adulthood. Aggression in the media is an area that has been explored as a contributing factor to bullying behavior. This study aims to determine if the incidence of aggression in popular television shows over the past 50 years has changed. A total of 198 episodes of the most popular television shows between the years 1960 and 2010 were coded for incidents of aggression and analyzed using simple linear regression. The mean number of events per episode was 8.8. No statistically significant correlation was found between number of bullying events and the years in which they occurred. Whereas it is possible that aggression on television may have an impact on bullying behaviors, there is no evidence that the incidence of bullying on television has changed significantly in the past 5 decades.
