This study estimates the cost of an average blood transfusion of 2 units to be 546.12 pounds sterling. It should be noted that significant indirect costs, such as those incurred by patients, their carers and societal costs, have not been considered. Against the background of finite blood resources and other factors such as patient quality of life, blood transfusion may not represent the best choice for patient care. Alternative treatments should be considered.

IL-8 but not SDF1-alpha mRNA expression was associated with inflammation in UC. This suggests that IL-8 may play a more important role in inflammatory bowel disease than does SDF1-alpha.

No abstract

Introduction Autologous hematopoietic stem cell transplantation (AHSCT) with anti-thymocyte globulin (ATG) conditioning as treatment of active multiple sclerosis (MS) is rapidly increasing across Europe (EBMT registry data 2017). Clinically significant Epstein-Barr virus reactivation (EBV-R) following AHSCT with ATG for severe autoimmune conditions is an underrecognized complication relative to T-cell deplete transplants performed for hematological diseases. This retrospective study reports EBV-R associated significant clinical sequelae in MS patients undergoing AHSCT with rabbit ATG. Methods Retrospective data were analyzed for 36 consecutive MS-AHSCT patients at Kings College Hospital, London. All patients routinely underwent weekly EBV DNA polymerase chain reaction monitoring and serum electrophoresis for monoclonal gammopathy (MG or M-protein). EBV-R with rising Epstein-Barr viral load, M-protein, and associated clinical sequelae were captured from clinical records. Results All patients had evidence of rising EBV DNA-emia, including 7 who were lost to long-term follow-up, with a number of them developing high EBV viral load and associated lymphoproliferative disorder (LPD). Nearly 72% (n = 18/29) developed de novo MG, some with significant neurological consequences with high M-protein and EBV-R. Six patients required anti-CD20 therapy (rituximab) with complete resolution of EBV related symptoms. Receiver operating characteristics estimated a peak EBV viremia of >500 000 DNA copies/mL correlated with high sensitivity (85.5%) and specificity (82.5%) (area under the curve: 0.87; P = .004) in predicting EBV-R related significant clinical events. Conclusion Symptomatic EBV reactivation increases risk of neurological sequelae and LPD in MS-AHSCT. We recommend regular monitoring for EBV and serum electrophoresis for MG in MS patients in the first 3 months post-AHSCT.

Background: EPO for management of chemotherapy-associated anaemia in patients with cancer is recommended by international guidelines. However, the variable response rate to EPO limits its effective deployment. In the UK, a ‘predictive factor testing service (PFTS)’ (supported by Roche) ascribes a low, moderate or high probability of response to EPO therapy - based on a two step holostic evaluation: (i) the state of erythropoiesis (serum EPO in relation to Haemoglobin concentration [Hb]; reticulocyte count and %); (ii) the need for IV iron to support erythropoiesis (MCH, reticulocyte Hb and serum ferritin). Aims: To assess the utility of the PFTS and iron supplementation in improving response rates to EPO used for chemotherapy-induced anaemia. Patients and methods: an ASH/ASCO based-guideline for EPO therapy was developed. The criteria were: patients with CLL, myeloma and NHL (excluding diffuse large B-cell NHL); Hb < 10 g/dl; on chemotherapy; a moderate or high PFTS score. EPO dose: 30,000 units s.c. once weekly, increased to 60,000 at 4 weeks if there was no response (NR: Hb increase of < 1g/dl over baseline). EPO was stopped at 8 weeks if NR. Minor (MiR) and major (MaR) responses were defined as: Hb increase of 1 - 2 and > 2 g/dl, respectively. Iron dose: iron sucrose (Venofer) 200mg IV weekly for 3 doses, repeated as indicated. Two successive 6-month, prospective audits (I and II) were performed, which differed only in that audit II, in addition to the PFTS score, also took into account the recommendation for IV iron supplementation. We retrospectively audited a 6-month period preceding the guideline introduction and analysed Hb response and red blood cell transfusion (RBC TX) of those patients who would have been eligible for EPO. Results: Prospective audit (I) - 12 patients received EPO; 8 (66%) responded. Hb levels and RBC Tx are shown in table 1. Prospective audit (II) - 25 patients qualified for EPO; 23 patients (92%) responded, with 17 MaR. Hb levels and RBC Tx are shown in table 1. Iron supplementation: Nine patients received IV iron. Seven patients received IV iron from week 0 and all responded; one patient from week 4, who converted from NR to MaR; and one patient received IV iron at week 8, but failed to maintain a MiR. Thus, 8/9 patients given IV iron responded (7 MaR) and 5 had EPO dose reductions. EPO dosage: Overall, there was a dose reduction of EPO in 8 patients, and a dose increase in 4 (2 responses achieved). The average EPO dose was 340,000 units/patient. The 6-month retrospective audit data is also shown in table 1. Conclusion: an holistic approach, using readily available laboratory parameters, to assess erythropoietic status and the need for IV iron supplementation has increased the response rate to EPO from 66 to 92%. The limited data presented here suggests similar response rates can be achieved in cancer as in renal use of EPO. This approach to targeted EPO therapy warrants further investigation and validation. Hb and RBC Tx outcomes both with and without EPO Patients (n) Mean Hb weeks 0 /4 /8 /12 Responders Mean Hb weeks 0 /4 /8 Non responders Total RBC Tx (units /patient) #: patients who would have been eligible for EPO ; *: mean Hb at each visit; Retro. Audit: retrospective audit ; Prosp. Audit: prospective audit; R: responders ; NR: non responders Retro. Audit 17# 8.0* 5.5 Prosp. Audit - I (R) 8 8.6 /10.3 /− /− 1.1 Prosp. Audit – I (NR) 4 8.9 /8.3 /− 6.0 Prosp. Audit – II (R) 23 9.5 /10.5 /11.6 /11.8 0.8 Prosp. Audit – II (NR) 2 8.9 /8.6 /7.6 4.5