Summary:Transplant-related mortality (TRM) following allogeneic bone marrow transplantation (BMT) remains a major concern and early identification of patients at risk may be clinically relevant. In this study we describe a predictive score based on bilirubin and blood urea nitrogen (BUN) levels on day +7 after BMT. The patient population consisted of 309 consecutive patients who underwent BMT from sibling (n = 263) or unrelated donors (n = 46) for hematologic disorders between December 1990 and December 1996. Of 27 laboratory tests taken on day +7 after BMT, serum bilirubin (P = 0.02) and BUN (P = 0.007) were found to be independent predictors of TRM in multivariate analysis. The median levels of bilirubin (0.9 mg/dl) and of BUN (21 mg/dl) were then used as a cut-off and a score of 1 was given for values equal/greater than the median. There were 216 patients with scores 0-1 (low risk) on day +7 (bilirubin Ͻ0.9 and/or BUN Ͻ21) and 93 patients with score 2 (high risk) (bilirubin у0.9 and BUN у21): the latter had more grade III-IV acute graft-versus-host disease (P = 0.03), slower neutrophil (P = 0.02) and slower platelet engraftment (P = 0.002). The actuarial 5 year TRM is 22% for low risk vs 44% for high risk patients (P = 0.0003). For HLA-identical siblings TRM is 20% vs 35% (P = 0.01), for unrelated donors it is 20% vs 65% (P = 0.01). Day +7 score was highly predictive of TRM on multivariate analysis (hazard ratio 1.9, P Ͻ 0.01), after adjustment for year of transplant (P Ͻ 0.00001), unrelated vs sibling donors (P = 0.001), patient age (P = 0.01) and diagnosis (P = 0.01). These results were validated on an independent group of 82 allogeneic BMT recipients in a pediatric Unit who showed an actuarial TRM of 16% for low risk vs 46% for high risk patients (P = 0.002). This study suggests that it may be possible to identify patients with different risks of TRM on day +7 after BMT: high risk patients could be Allogeneic bone marrow transplantation (BMT) is associated with considerable morbidity and mortality, and several studies have addressed the issue of risk factors for major single complications such as interstitial pneumonitis, 1 acute GVHD 2,3 and graft rejection: 4 patient variables (older age), donor variables (older age, parous female donors for male recipients, degree of HLA matching) and transplant variables (longer interval from diagnosis to transplant, intensive regimens), are among these. A study from the Seattle group has looked at risk factors for veno-occlusive disease of the liver, another important complication of allogeneic BMT 5 and found that early increments in serum bilirubin level and body weight were highly predictive. Other studies have also addressed the impact of risk factors on post-BMT complications. [6][7][8][9][10] During the past decades we have improved our ability to prevent and/or treat such complications, and transplantrelated mortality (TRM) has been considerably reduced 11 and delayed: in our HLA-identical sibling program TRM was 39% before 1990 (385 patients) and occurred at a...

Summary:The purpose of this study was to assess the role of ABMT in children with ALL who are in 2nd CR after an early isolated CNS relapse. All children experiencing an isolated CNS relapse at 10 AIEOP centers (Associazione Italiana Emato-Oncologia Pediatrica) from 1986 to 1992 were eligible for this study. The series included 69 patients who relapsed within 3 years from diagnosis: 19 underwent ABMT, nine patients underwent ALLO-BMT from an HLA-identical sibling, and 41 received conventional chemotherapy (CHEMO). Statistical analysis was performed using a Cox's regression model, adjusting for the waiting time before transplantation and prognostic factors. The 5 years DFS was 56.3% (s.e. 12.3) for patients in the ABMT group. This compared favorably with the poor result (12.6% (s.e. 5.9) ) seen in the CHEMO group. The risk of failures was reduced by one-third in the ABMT group as compared to the CHEMO group in the multivariate analysis (P Ͻ 0.01). In the ALLO group four out of nine patients were in CCR 4-5 years post-transplant. This study suggests that ABMT may also represent a valuable therapeutic choice for patients lacking a matched familiar donor in 2nd CR after an early isolated CNS relapse. Keywords: childhood lymphoblastic leukemia; meningeal relapse; autologous marrow transplantation Isolated CNS relapse occurs in 5-10% of children with ALL treated with risk-directed therapy.1,2 In most experiences, patients who despite an adequate front-line CNS prophylaxis experience a meningeal relapse have a poor 3 Retreatment induces a second CR but due to further relapses the event-free-survival (EFS) is in the 20-30% range, with few exceptions.2-8 Successful treatment of CNS relapse must include CNS-directed and intensive systemic therapy. Major CNS problems have been described in long-term survivors after conventional retreatment. 9 The role of BMT in the therapeutic strategy of isolated CNS relapse has only recently been explored, with controversial results.7,10-12 Our study investigates the role of ABMT in a relatively large series of 60 children with ALL, who developed a first isolated CNS relapse early, ie within 3 years of diagnosis. Of these, 19 underwent ABMT, while 41 had chemotherapy only; we also include our limited experience on nine patients who had ALLO-BMT. This retrospective study has been based on the experience of all the AIEOP centers that considered ABMT as a therapeutic option for ALL children after an isolated CNS relapse from 1986 to 1992. The analytical method adopted here aimed to exclude any biases related to the retrospective nature of the study and the waiting time before transplantation. Patients and methods PatientsCNS relapse was defined as the presence in the cerebrospinal fluid of Ͼ5 mononuclear cells per microliter, morphologically identified as lymphoblasts on cytospinning. ABMT and, to a lesser degree, also ALLO-BMT, have been considered as a therapeutic option after an isolated CNS relapse at 10 AIEOP transplantation centers since 1986. From 1986 to 1993, 20 consecutive childre...

We have evaluated flu vaccine coverage and variables associated with the lack of vaccination in cirrhotic subjects with particular attention to the cirrhosis etiology. Cirrhotic subjects consecutively referring to eight Italian centers were prospectively enrolled for a 6‐month period in 2019. Subjects were asked if they had received a flu vaccine in the last 12 months. Multiple logistic regression analysis was performed to identify independent predictors of lack of vaccination. A total of 818 cases were recruited. The overall vaccine coverage was 39.6% (26.9% in those younger than 65 years and 51.9% in those older than 64 years; p < 0.001). Age < 65 years (odds ratio [OR] = 2.38; 95% confidence interval [CI] = 1.68–3.36), alcoholic etiology (OR = 2.40; 95% CI = 1.49–3.85), birth abroad (OR = 2.7; 95% CI = 1.10–6.61), and residence in South/Sardinia island (OR = 1.66; 95% CI = 1.14–2.42) all resulted independent predictors of the likelihood of lack of vaccination. The lack of information regarding the vaccine as the reason for no vaccination was reported by 71.4% of foreigners and by 34.7% of natives (p < 0.001). In conclusion, much work still should be done to improve coverage among groups at higher risk of lack of vaccination identified in this survey. The ongoing SARS‐CoV‐2 pandemic may represent one more alert for improving seasonal flu vaccine coverage to avoid further stress to the National Health System.

Hormonal abnormalities are quite common in chronic heart failure (CHF). The most studied hormonal axis in CHF is the impairment of Growth Hormone (GH)/Insulin Growth Factor-1(IGF-1), which in turn is defined either by a blunted response to GH stimulation test or low serum IGF-1 values.  Several independent groups reported that the presence of an abnormal GH/IGF-1 status in CHF is associated with a more severe disease, impaired functional capacity and reduced Survival rates. After the first encouraging results, double -blind controlled trials showed a neutral effect of the GH administration in patients. However, further studies reported positive results, when a GH-therapy is implemented only in those patients presenting a GH deficiency (replacement therapy).

Summary:Serum cholinesterase (CHE) has been reported to be a significant indicator of liver function and prognosis in patients with cirrhosis. On the other hand, liver complications are frequent following allogeneic stem cell transplantation (HSCT). We therefore tested whether CHE was predictive of graft-versus-host disease and outcome in HSCT recipients. We studied 689 patients receiving a HSCT from an HLA-identical sibling (SIB) (n = 511), an alternative donor (n = 173) or a syngeneic twin (n = 5). Acute graft-versus-host disease (GVHD) was scored as 0-I, II, III-IV in 325 (47%), 279 (41%), and 85 patients (12%) respectively; 190 (28%) patients died of transplant-related complications (TRM). On day −7 the median CHE serum level was comparable in patients who either survived or died of TRM (5900 IU/l). On day 0, serum CHE levels were respectively 2310 and 2120 IU/l (P = NS) indicating the impact of the conditioning regimen. On day +7 after HSCT, the median level for surviving patients was 2598 IU/l vs 2309 IU/l for patients who subsequently died (P = 0.0002), on day +21 CHE levels were respectively 3348 vs 2528 IU/l (P Ͻ 0.00001), on day +50, 3575 vs 2358 IU/l (P Ͻ 0.00001) and on day +100 4193 vs 2729 IU/l (P Ͻ 0.00001). CHE levels on day +50 strongly correlated with aGVHD (3803 vs 3070 vs 1933 IU/l for patients with GVHD grade 0-I, II, and III-IV, respectively (P Ͻ 0.00001) and relapse (3569 for patients relapsing vs 3115 IU/l for patients not relapsing, P = 0.0006). In conclusion, (1) serum cholinesterase is a simple and reliable marker of acute GVHD and transplant-related complications; and (2) high CHE levels on day +50 predict relapse. If confirmed, the latter patients may be elegible for early reduction of immunosuppressive therapy. Bone Marrow Transplantation (2001) 28, 1041-1045.