Study on Capacity, Change and Performance: Interim Report

In 2002 the chair of the Govnet, the OECD's Network on Governance and Capacity Building, asked the European Centre for Development Policy Management (ECDPM) in Maastricht, the Netherlands, to undertake a study of the capacity of organisations and groups of organisations, mainly in low-income countries, its development over time and its relationship to improved performance. The specific purposes of this study were twofold:to enhance understanding of the interrelationships amongst capacity, change and performance across a wide range of development experiences; andto provide general recommendations and tools to support the effectiveness of external interventions aimed at improving capacity and performance

Values as a Driver for Capacity Development: Promoting Justice in Papua New Guinea

This case study shows how the Office of the Public Solicitor of Papua New Guinea developed a social change vision built on clearly articulated values and used this as a driver for enhancing both its legitimacy and its capacity more generally. The experience was monitored using the capacity development framework developed by the European Centre for Development Policy and Management. This emphasises individual empowerment and engagement as well as skills, and how these are articulated with collective capabilities in particular contexts to build a system's capacity to perform. The authors suggest that evolution of systemic capacity is a process that requires drivers beyond organisational self interest, personal advantage or greater efficiency. The experience of the OPS shows that capacity can emerge out of fruitful relationships among people holding common ideals who want to make a difference, rather than just resulting from improvements to technique, structure or assets

Prognostic Factors for Postrelapse Survival after ex Vivo CD34+-Selected (T Cell-Depleted) Allogeneic Hematopoietic Cell Transplantation in Multiple Myeloma

•Time to relapse after T cell-depleted hematopoietic cell transplantation defines distinct postrelapse outcomes.•Relapse with extramedullary disease is common and associated with dismal prognosis.•Donor lymphocyte infusion for relapse prevention improves postrelapse survival. Allogeneic hematopoietic cell transplantation (alloHCT) for multiple myeloma (MM), with its underlying graft-versus-tumor capacity, is a potentially curative approach for high-risk patients. Relapse is the main cause of treatment failure, but predictors for postrelapse survival are not well characterized. We conducted a retrospective analysis to evaluate predictors for postrelapse overall survival (OS) in 60 MM patients who progressed after myeloablative T cell-depleted alloHCT. The median patient age was 56 years, and 82% had high-risk cytogenetics. Patients received a median of 4 lines of therapy pre-HCT, and 88% achieved at least a partial response (PR) before alloHCT. Of the 38% who received preemptive post-HCT therapy, 13 received donor lymphocyte infusions (DLIs) and 10 received other interventions. Relapse was defined as very early (24 months; 22%). At relapse, 27% presented with extramedullary disease (EMD). The median postrelapse overall survival (OS) by time to relapse was 4 months for the very early relapse group, 17 months for the early relapse group, and 72 months for the late relapse group (P = .002). Older age, relapse with EMD, <PR before alloHCT, <PR by day +100, and no maintenance were prognostic for inferior postrelapse OS on univariate analysis. On multivariate analysis adjusted for age and sex, very early relapse (hazard ratio [HR], 4.37; 95% confidence interval [CI], 1.42 to 13.5), relapse with EMD (HR, 5.20; 95% CI, 2.10 to 12.9), and DLI for relapse prevention (HR, .11; 95% CI, 2.10 to 12.9) were significant predictors for postrelapse survival. Despite their shared inherent high-risk status, patients with MM have significantly disparate post-HCT relapse courses, with some demonstrating long-term survival despite relapse