ABO incompatibility does not influence transfusion requirements in patients undergoing single-unit umbilical cord blood transplantation.

Hematopoietic stem cell transplantation is usually performed without considering the ABO compatibility between donor and recipient. There are few studies analyzing ABO matching impact on transfusion outcome of umbilical cord blood transplantation (UCBT) recipients. The aim of this study was to analyze factors influencing transfusion outcome, highlighting the ABO matching between donor and recipient. This study has reviewed data from 318 patients who underwent single unit UCBT at la Fe University Hospital from January 2000 to December 2014. There were no differences between RBC and platelet (PLT) requirements or RBC and PLT transfusion independence according to ABO matching between donor and recipient. RBC and PLT requirements were statistically correlated (ρ=0,841, P<0.001). A total of 170 and 188 patients achieved RBC and PLT independence, respectively, within 180 days after UCBT. Persistence of recipient isoagglutinins was detected in 6.8% of patients with major ABO incompatibility at median of 176 days (103-269) after UCBT. Autoimmune haemolytic anemia was diagnosed in 15 patients, 12 of them due to cold antibodies. In conclusion, ABO matching has not influenced transfusion requirements of patients undergoing UCBT.

[Factors associated the control of hypertension among older Spaniards, over 60 years of age]. / Factores asociados al control de la hipertension arterial en personas mayores de 60 años en España.

BACKGROUND: In the last decade, improvement has been observed in the control of arterial hypertension in Spain. Such control has an effect in the decrease of cardiovascular morbidity and mortality. The objective of the study was to identify factors associated to the control of arterial hypertension in awareness of hypertension among males and females who receive pharmacological treatment. METHODS: A cross-sectional analysis, made in basis of the following study data: "Arterial Hypertension and other risk factors in the population of 60 years old and more in Spain". The sample included 1461 hypertensive patients treated pharmacologically, selected by probabilistic and multistage sampling. The information recollected about the control of arterial hypertension, social and demographic variables, lifestyle, healthcare service usage, and life quality related to health, by residence interviewing. RESULTS: No differences between gender were observed in the control of hypertension (p = 0.09), In men control were significantly linked to: residence in rural areas (OR = 1.83; CI at 95%: 1.06-3.14); being single (OR = 3.40; CI at 95%: 1.32-8.74); and exercising (OR = 1.69; CI at 95%: 1.06-2.69). Women who consume alcohol in a moderate way controlled themselves more (OR = 1.63; CI at 95% 1.14-2.33). CONCLUSIONS: This research determines, according to gender, some factors related with the control of arterial hypertension in awareness of hypertension patients treated pharmacologically. In male patients the control is related to: living in rural areas, being single and physical activity. While in females control was associated with moderate alcohol consumption.

Factores asociados con el conocimiento de la hipertensión en españoles mayores de 60 años / Factors associated awareness of hypertension among older Spaniards, over 60 years of age

Objetivo. Identificar los factores asociados al conocimiento de padecer hipertensión en varones y mujeres españoles mayores de 60 años. Material y métodos. Estudio poblacional de 4.009 sujetos a partir de los datos del estudio: “Hipertensión arterial y otros factores de riesgo en la población de 60 años y más de España”. Entrevista en el domicilio que recoge información sobre el conocimiento de padecer hipertensión arterial, además de variables sociodemográficas, estilo de vida, uso de servicios de salud y calidad de vida relacionada con la salud. Resultados. Las mujeres conocen más la condición de ser hipertensas que los varones (69,2 % frente a 60,2%; p80 años (OR: 0,57). A medida que dejan de acudir a la consulta médica desconocen más, presentan cifras altas de presión arterial sistólica (OR: 0,98) y peor calidad de vida en el índice sumarial físico (OR: 0,98). Las obesas conocen que son hipertensas (OR: 1,52). Conclusiones. El conocimiento se relaciona con diferencias de género, regional, en el estilo de vida y en la calidad de vida. Es recomendable diseñar estrategias diferenciadas por las anteriores variables a fin de incrementar el conocimiento de la hipertensión arterial

Objective. To identify factors associated with the awareness of hypertension among man and women Spaniards age 60 years and older. Material and methods. The data of the study: “Arterial hypertension and other factors of risk in the elderly (?60 years) Spanish population”. This was a population-based survey of 4,009 older Spaniards. Information for this survey was obtained thorough household personal interviews to evaluate the awareness of hypertension and associated factors socio-demographic variables, the use of health system, lifestyles and the quality of life related to health. Results. The women more awareness of hypertension that men (69.2% versus 60.2 %). In men, aged ? 80 years the unawareness to hypertension (OR: 0,61). The less being counseled more knowledge their condition (p trends <0,0001). The awareness associated who having had a previous hospitalization (OR: 1,46) having drunk alcoholic products moderately (OR: 1,63). In women ?80 years of age, unawareness of hypertension (OR: 0,57). The reason is that in according to stop attending medical appointments (OR: 0,98), the systolic pressure will increase 1 mmHg (OR: 0,98) and likewise the physical summary index of life quality will do, but in one point (OR: 0,98). However who know more their situation of hypertension they are the obese ones (OR: 1,52). Conclusions. There are regional differences, gender, lifestyles and to measure health-related quality of life. This demonstrates poor awareness about high blood pressure, so the strategy should be directed toward in these variables mentioned

Social network and health-related quality of life in older adults: a population-based study in Spain.

This study examined the association between social network and health-related quality of life (HRQL) in older adults and compared this against the association between HRQL and a disabling disease such as osteoarthritis. A cross-sectional survey was done on 3600 subjects representative of the Spanish non-institutionalised population aged 60 years and over. Data were collected through home-based personal interview and physical examination. HRQL was measured with the SF-36 health questionnaire. Data analysis was performed with multiple linear regression models with adjustment for the main confounders. Of the total sample, 38.6% of subjects were unmarried, 17.6% were living alone, 4.7% saw their family seldom or never, and 2.9% saw their friends seldom or never. Unmarried status and living alone were associated with lower scores in the social and mental quality-of-life components, though statistical significance was not in general attained (p > 0.05). Seeing family members seldom or never was associated (p < 0.05) with worse scores in the following scales of SF-36 questionnaire: role-physical, body pain, general health and mental health. HRQL was lower among those who saw friends seldom or never, and the reduction in HRQL proved similar to that associated with osteoarthritis, on the physical functioning (coefficients -8.4 vs. -8.1) and general health scales (-7.8 vs. -6.6); the reduction in HRQL was even greater than that associated with osteoarthritis for other scales, such as vitality (-9.6 vs. -6.7; p > 0.05) and social functioning (-14.5 vs. -3.7; p < 0.05). We conclude that only a small proportion of Spain's elderly population lack frequent social relationships, yet low frequency of relationships with friends is associated with a decline in quality of life similar to or greater than that associated with osteoarthritis.

Relation between body weight and health-related quality of life among the elderly in Spain.

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Infectious complications in patients undergoing unrelated donor bone marrow transplantation: experience from a single institution.

OBJECTIVE: To analyze the incidence and characteristics of documented infections in patients with hematologic malignancies undergoing unrelated donor bone marrow transplantation (UD-BMT). METHODS: We studied the occurrence of infections in 22 patients with hematologic malignancies or severe aplastic anemia who underwent UD-BMT from April 1990 to December 2000. The median age was 26 years (range 13-46). Acyclovir-ganciclovir, co-trimoxazole, fluconazole-nystatin and ciprofloxacin were administered for anti-infectious prophylaxis. RESULTS: We registered 61 infectious episodes. During the early post-transplant period, there were eight clinically documented infections (CDIs), four cases of fever of unknown origin (FUO), seven cases of bacteremia, two cases of cytomegalovirus (CMV) antigenemia, and one case of CMV disease. In the intermediate period (days 30-100 after BMT), there were nine cases of CMV antigenemia, three bacterial infections, two fungal infections, one case of disseminated toxoplasmosis, and one case of FUO. In the late period (day 100 and later), we documented 13 viral infections, eight bacterial infections, one CDI, and one case of invasive aspergillosis. Infections contributed to death in 10 of 17 patients. Citrobacter bacteremia and sepsis of unknown origin were the main causes of infectious mortality in the early period. Infection was the main cause of death in six of seven patients in the late period. CONCLUSION: A high incidence of life-threatening infections and infection-related mortality was observed. A high rate of CMV infection in the early period, and death caused by multiresistant Gram-negative microorganisms in the late period, were the main findings in this series.

[Smoking-attributable deaths in Spain in 1998]. / Mortalidad atribuible al tabaquismo en España en 1998.

BACKGROUND: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998. POPULATION AND METHOD: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over. RESULTS: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke. CONCLUSIONS: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

Standardized, unrelated donor cord blood transplantation in adults with hematologic malignancies.

The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults remains unclear. This study reports the results of UD-CBT in 22 adults with hematologic malignancies following conditioning with thiotepa, busulfan, cyclophosphamide, and antithymocyte globulin in 21, with thiotepa, fludarabine, and antithymocyte globulin in 1, and graft-versus-host disease (GVHD) prophylaxis with cyclosporine and prednisone. Median age was 29 years (range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). HLA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases. Median number of nucleated cells infused was 1.71 x 10(7)/kg (range, 1.01 x 10(7)/kg to 4.96 x 10(7)/kg). All 20 patients surviving more than 30 days had myeloid engraftment, and only 1, who received the lowest cell dose, developed secondary graft failure. Median time to reach an absolute neutrophil count of at least 0.5 x 10(9)/L was 22 days (range, 13-52 days). Median time to platelets numbered at least 20 x 10(9)/L was 69 days (range, 49-153 days). Seven patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patients. Twelve patients remained alive and disease-free 3 to 45 months after transplantation. Disease-free survival (DFS) at 1 year was 53%. Age strongly influenced DFS (P =.01). For patients aged 30 years or younger, the DFS at 1 year was 73%. These preliminary results suggest that UD-CBT should be considered a reasonable alternative in young adults with hematologic malignancy and no appropriate bone marrow donor.

Marked reduction in the incidence of hepatic veno-occlusive disease after allogeneic hematopoietic stem cell transplantation with CD34(+) positive selection.

Veno-occlusive disease of the liver (VOD) is a common and severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). To determine the incidence of, and the risk factors for the development of VOD, we performed a retrospective analysis of a series of 178 patients, who underwent allogeneic HSCT at our institution between 1990 and 1999. Busulfan and cyclophosphamide constituted the conditioning regimen most frequently administered. Bone marrow was the source of stem cells in 129 patients (73%), and peripheral blood (PBSC) in 49 patients (27%). Thirty-one patients of the PBSC group received CD34(+) positively selected grafts. Most patients were given cyclosporin A and methotrexate (MTX) as graft-versus-host disease (GVHD) prophylaxis. Overall, 30 patients (17%) developed VOD. In univariate analyses, the incidence of VOD was significantly higher in recipients of unmanipulated grafts (20% vs 0%; P = 0.01), in patients with active malignant disease at transplantation (24% vs 9%; P = 0.03), in recipients of marrow from unrelated donors (33% vs 15%; P = 0.03), in patients grafted with bone marrow (21% vs 6%; P = 0.03), and in those receiving MTX as GVHD prophylaxis (21% vs 6%; P = 0.05). Under multivariate analysis, only CD34(+) positive selection (P = 0.0004) and the status of the disease at transplant (P = 0.03) were statistically significant variables for the development of VOD. We conclude that CD34(+) positively selected PBSC transplantation could result in a marked reduction in the incidence of VOD after allogeneic HSCT.

Recent improvements in outcome for elderly patients with de novo acute myeloblastic leukemia.

A retrospective analysis was performed on 263 consecutive patients aged over 60 with de novo acute myeloid leukemia (AML) diagnosed in a single institution between 1979 and 1998. Eighty-nine patients (33%) received only palliative treatment, while 174 patients (67%) were treated with different intensive chemotherapy regimens. The 5- and 10-year overall survival (OS) for the whole series was 7.7+/-1.2 and 4.3+/-1.6%, respectively. For patients receiving chemotherapy, OS was 10.5+/-2.5 and 7+/-2.6%, while for those patients receiving supportive treatment it was 1.1+/-1.1 and 0%, respectively (P=0.002). Within the group of patients receiving chemotherapy, the complete remission (CR) rate was 46%; treatment failure rate was 54% (36% due to treatment-related mortality and 18% due to resistant disease). Variables influencing CR rate were FAB subtype, CD7 positivity, chemotherapy regimen, creatinine level, hepatomegaly, and period of diagnosis. Median disease-free survival (DFS) duration was 8.4 months with a probability of being disease-free at 10 years of 10+/-5%. There were no significant differences in DFS according to age. According to the period of diagnosis (1979-1986 vs. 1987-1998), improvements in the CR rate (27 vs. 56%, P=0.0002), and OS (10.9 vs. 15.7 months, P=0.0007) were observed. This large single-center study of unselected de novo AML elderly patients substantiates the progressive improvement achieved in the management of elderly patients with AML, probably due to an improvement in supportive care and the administration of conventional induction chemotherapy.

Cutaneous promyelocytic sarcoma at sites of vascular access and marrow aspiration. A characteristic localization of chloromas in acute promyelocytic leukemia?

Extramedullary disease (EMD) is a rare clinical event in acute promyelocytic leukemia (APL). Although the skin is involved in half of the reported EMD cases, the occurrence of cutaneous promyelocytic sarcoma (PS) has been described very rarely. We report here three cases of PS which have the peculiarity of appearing at sites of punctures for arterial and venous blood and marrow samples (sternal manubrium, antecubital fossa, wrist over the radial artery pulse, catheter insertion scar). At presentation, all patients had hyperleukocytosis and a morphologic diagnosis of microgranular acute promyelocytic leukemia variant confirmed at the genetic level by demonstration of the specific chromosomal translocation t(15;17). A BCR3 type PML/RARa transcript was documented in the two patients for whom diagnostic RT-PCR was available. Patients had morphologic bone marrow remission at the time the PS appeared. A predilection for the development of cutaneous PS at sites of previous vascular damage has been noted, but the pathogenesis remains largely unknown. A potential role for all-trans retinoic acid has been advocated, although one of the three patients in our series had received no ATRA. A review of the literature revealed six similar cases and hyperleukocytosis at diagnosis was a consistent finding in all of them. A careful physical examination of these particular sites in the follow-up of patients at risk, as well as cutaneous biopsy and laboratory examination of suspected lesions are strongly recommended.