Post-transplant events Combined administration of alpha-erythropoietin and filgrastim can improve the outcome and cost balance of autologous stem cell transplantation in patients with lymphoproliferative disorders

autologous transplantation; erythropoietin; engraftment kinetic

Conditioning regimens in acute myeloid leukemia.

Current intensive consolidation chemotherapy for patients with acute myeloid leukemia (AML) produces median remission duration of 12-18 months, with less than 30% of patients surviving 5 years free of disease. Post-remission therapy is necessary to prevent relapse in most patients with AML; therefore, the aim of post-remission treatment is to eradicate the minimal residual disease. Nevertheless, the optimal form of treatment is still under debate. The choice among the possible approaches (intensive chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation) relies on two main factors: the expected risk of relapse, as determined by biological features, and expected morbidity and mortality associated with a specific option. In this review, we focus on the different preparative regimens before autologous and allogeneic hematopoietic stem cell transplantation in patients with AML, stressing the importance of an adequate conditioning regimen as a mandatory element of a successful AML therapy, in both the allogeneic and the autologous transplant setting

BNP levels are related to days of hospitalization independently to the pathology in critical care settings

Background: Increased brain natriuretic peptide (BNP) levels have been related to several conditions, such as acute heart failure (AHF), pulmonary embolism (PE) and acute coronary syndromes (ACS). Particularly among elderly patients, a longer hospitalization is related to higher morbidity and mortality. The usefulness of BNP as a prognostic factor is amply demonstrated in different subpopulations of both medical and surgical patients. Aims: To evaluate the relationship between BNP levels and length of in-hospital stay in patients with PE, ACS, AHF, septic and cardiogenic shock admitted to our internal medicine department (IMD). Methods: We retrospectively evaluated 500 consecutive patients admitted to our IMD. BNP was evaluated at the admission in all the patients. Each patient underwent a complete diagnostic workup. We evaluated the curve-fit correlation between BNP levels and days of hospitalization using SPSS 13.0 for windows systems. Results: Mean age was 80 \ub1 9.85 years, males representing 58 % of the sample. AHF represented 74.9 %, ACS 13.5 %, PE 11.6 % of the sample. We found that BNP levels and days of hospitalization were better described by a logarithmic regression model (R2: 0.674, p\0.0001) (Figure 1). Conclusions: Among elderly patients admitted in an IMDs, higher BNP levels are associated to longer hospitalizations independently to the pathology. This relationship is better described by a logarithmic regression model. However, larger cohorts are required to validate this observation

BNP levels at the admission are related with days of hospitalization in patients with acute heart failure and the overall risk of death

Background: Acute Heart Failure (AHF) is a frequent condition associated to poor prognosis among elderly patients admitted to Internal Medicine departments (IMDs). Length of hospitalization is associated to higher mortality among medical patients. Increased brain natriuretic peptide (BNP) levels have been associated, in this subset, to a raised mortality and morbidity. Aims: to evaluate whether BNP levels at admission could be associated to longer hospitalizations and survival time in the subset of patients who die of AHF. Methods: we enrolled 400 consecutive patients admitted to our IMD with a clinical diagnosis ofAHF.BNPwas evaluated in all patients at the admission. Subjects were stratified in four categories: BNP less than 100 pg/ml (group 1), 101\u2013500 pg/ml (group 2), 501\u20131500 pg/ml (group 3) and BNP higher than 1501 pg/ml (group 4). Each patient underwent to a complete diagnosticworkup. PatientswithBNP levels less than 100 pg/ ml or a final diagnosis other than AHF were excluded. Kaplan\u2013Meier model with log-rank test was used to assess the differences. Statistical analysis was performed with SPSS 13 package for Windows systems. Results: 293 patients were suitable for final analysis. Mean age was 80 \ub1 9.85 years, males representing 58 % of the sample. Among patients who were successfully dismissed, group 4 had a significantly longer hospitalization time (16.6 days, 95 %CI: 13.7\u201319.5) than patients in group 3 (13.1 days, 95 %CI:11.7\u201314.6) or group 2 (12.3 days, 95 % CI: 10.6\u201313.9) (p\0.05, all ties, Figure 1).Among patientswho died of AHF, subjects in group 2 had a significantly longer survival time (mean: 46.0 days, SE 3.71) than patients in group 3 (mean: 36.7 days, SE 2.51) or group 4 (mean: 22.9 days, SE 1.88) (p\0.05, all ties, Figure 2). Conclusions: BNP is useful for diagnosis and prognostic stratification in patients with AHF. If confirmed in larger cohorts, it could also be used to predict longer hospitalizations among specific subsets of patients. Among elderly patients admitted into IMD who will die of AHF, higher BNP levels are independently associated to a faster progression of the pathology and death. BNP levels at the admission of patients should be considered as a powerful tool that can help the physicians not only in diagnosis but also in the prognostic stratificatio