MPN-215 Outcomes of Myelofibrosis Patients Post Allogeneic-HSCT at the University of Southern California, a Retrospective Study
Vincent Louie MendiolaKrithika ChennapanDenaly ChenJack RodmanAbdullah LadhaEric TamKarrune WoanGeorge Yaghmour
0
Citation
0
Reference
10
Related Paper
Abstract Purpose Nowadays, myelofibrosis can be cured only by allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the transplantation experience is very limited worldwide. We retrospectively investigated the treatment outcome of myelofibrosis patients post allo-HSCT at National Taiwan University Hospital. Results Eleven myelofibrosis patients received allo-HSCT. The median age at transplantation was 51 years old and the median time from diagnosis to transplantation was 10.1 months. All patients were classified as intermediate-2 or high risk based on the International Prognostic Scoring System (IPSS). Conditioning regimens were myeloablative in 5 and reduced-intensity in 6 patients. All patients achieved full donor chimerism, and post-transplantation bone marrow biopsies showed significant improvement of myelofibrosis in 3 patients. The transplant-related mortality at 100 days post transplantation was 9%. Four patients had grade III-IV acute graft-versus-host disease. Six patients died, and the causes of death were GVHD (n=3), infection (n=2) and secondary graft failure (n=1). The estimated overall survival at two years was 45.5%. Conclusions Allogeneic hematopoietic stem cell transplantation is effective in treating myelofibrosis and is associated with modest toxicity and post-transplantation complications. In order to improve the treatment outcome, we have to manage GVHD and infection more carefully.
Single Center
Center (category theory)
Cite
Citations (0)
The authors declare no conflict of interest.
Acute megakaryoblastic leukemia
Cite
Citations (0)
Seroma
Wound dehiscence
Incisional Hernia
Fat necrosis
Cite
Citations (15)
We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
Cite
Citations (8)
Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
Seroma
Bleed
Hernia Repair
Cite
Citations (40)
Objective To investigate the causes, the indications and operative procedures of reoperation for postoperative recurrence of hyperthyroidism. Method Clinical data of 34 cases of postoperative recurrence of hyperthyroidism received reoperation were analyzed retrospectively .Results The reoperative procedures including bilateral subtotal thyroidectomy in 29 cases, unilateral thyroidectomy in 5. All the 34 patients were cured by reoperation.The incidence of postoperative complication was 5.9%,which was not significantly different compared with primary operation treatment during the same time in our hospital.All the 34 case were followed up for 1～10 years,the results showed that all patients were alive well without recurrence or hypothyroidism .Conclusions Extension of the resected thyoid is not enough in the primary surgery is the main cause of postoperative recurrence of hyperthyroidism.Reoperation is the choise of therapy in selective patients with postoperative hyperthyroidsm recurrence .Careful intraoperative dissection can help to avoid injuries of recurrent nerve and parathyroid,and to prevent massive bleeding.
Cite
Citations (0)
Chylothorax
Cite
Citations (312)
The choice of alternative donor is a major issue in allogeneic hematopoietic stem cell transplantation (HSCT) for patients with primary myelofibrosis (PMF) without an HLA-matched related donor. We conducted this retrospective study using the Japanese national registry data for 224 PMF patients to compare the outcomes of first allogeneic HSCT from HLA-matched related donor bone marrow (Rtd-BM), HLA-matched related donor peripheral blood stem cells (Rtd-PB), HLA-matched unrelated donor bone marrow (UR-BM), unrelated umbilical cord blood (UR-UCB), and other hematopoietic stem cell grafts. Nonrelapse mortality (NRM) rates at 1 year after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantations were 16%, 36%, 30%, 41%, and 48%, respectively. Multivariate analysis identified UR-UCB transplantation, other transplantation, frequent RBC transfusion before transplantation, and frequent platelet (PLT) transfusion before transplantation as predictive of higher NRM. Relapse rates at 1 year after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantation were 14%, 17%, 11%, 14%, and 15%, respectively. No specific factor was associated with the incidence of relapse. Overall survival (OS) at 1 and 4 years after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantation were 81% and 71%, 58% and 52%, 61% and 46%, 48% and 27%, and 48% and 41%, respectively. Multivariate analysis identified older patient age, frequent RBC transfusion before transplantation, and frequent PLT transfusion before transplantation as predictive of lower OS. In conclusion, UR-UCB transplantation, as well as UR-BM transplantation, can be selected for PMF patients without an HLA-identical related donor. However, careful management is required for patients after UR-UCB transplantation because of the high NRM. Further studies including more patients after HLA-haploidentical related donor and HLA-mismatched unrelated donor transplantation would provide more valuable information for patients with PMF when making decisions regarding the choice of alternative donor.
Cite
Citations (21)
Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
Cite
Citations (57)