The prevalence of SIgAD and subnormal SIgA levels is increased in males. There exists a significant influence of gender, age and seasons on SIgA levels.
ObjectReports on spinal cord ependymoma in children are rare. The aim of this study was to evaluate the clinical spectrum, treatment, and outcome of children with primary ependymoma of the spinal cord who were registered in the database of the pediatric German brain tumor studies Hirntumor (HIT) '91 and HIT 2000.MethodsBetween 1991 and 2007, 29 patients (12 male and 17 female, median age at diagnosis 13.6 years) with primary spinal cord ependymoma (myxopapillary ependymoma WHO Grade I, II, and III tumors in 6, 17, and 6 patients, respectively) were identified. Four patients had neurofibromatosis Type 2.ResultsWith a median follow-up of 4.2 years (range 0.48–15 years), 28 patients (96.6%) were alive. Seven patients (24.1%) developed progressive disease or relapse, 2 after gross-total resection (GTR) and 5 after incomplete resection or biopsy. One patient with anaplastic ependymoma (WHO Grade III) died 65 months after diagnosis of disease progression. Primary adjuvant treatment (radiotherapy, chemotherapy, or both) was used in 8 (50%) of 16 patients following GTR and in 9 (82%) of 11 patients who underwent less than a GTR. Three additional patients were treated adjuvantly following progression. Estimated progression-free survival and overall survival rates at 5 years were 72.3% (95% CI 50%–86%) and 100%, respectively. Progression-free survival at 5 years is 84.4% (95% CI 50%–96%) for patients following GTR compared with 57.1% (95% CI 25%–69%) for patients who achieved a less than GTR (p = 0.088, log-rank test). A high relapse incidence (4 of 6) was observed among patients with myxopapillary ependymoma.ConclusionsGross-total resection is the mainstay of treatment for patients with primary spinal cord ependymoma and may be achieved in about 50% of the patients using modern surgical techniques. Primary adjuvant treatment was commonly used in children with spinal cord ependymoma irrespective of the extent of resection or tumor grade. The impact of adjuvant treatment on progression-free and overall survival has to be investigated in a prospective trial.
Screening for RAS in patients with >2 diseased coronary segments has a high diagnostic yield, which is even greater in the presence of a reduced GFR, diabetes mellitus, and elevated systolic blood pressure.
(P < 0AE01) compared with the BM group. The numbers of proven bacterial and viral infections were equally distributed between the three groups. In conclusion, recipients of allogeneic highly purified CD34 + PBSC or unmanipulated BM have higher lymphocyte subset counts at 6 months after transplantation than recipients of autologous CD34-selected PBSC. Infection rates and outcome, however, were not significantly different.Keywords: immune reconstitution, transplantation, purified blood stem cells, bone marrow, children. Lang et al, 2004). T-cell depletion of the graft, however, is known to impair T-cell reconstitution in the recipient, causing post-engraftment immunodeficiency and increased non-relapse mortality (Ochs et al, 1995;Davison et al, 2000).The aim of the present prospective study was to analyse and compare laboratory data of immunity in children receiving unmanipulated allogeneic BM or CD34-selected autologous or allogeneic PBSC.
Patients and methods
Patient characteristicsOver a 7-year period, 61 children were enrolled in this study after informed consent was obtained from parents. Eighteen patients died early after HSCT and could not be evaluated. Seven patients were lost to follow-up. Patients receiving autologous unselected PBSC (n ¼ 2), autologous PBSC + autologous BM (n ¼ 1) and unmanipulated UCB (n ¼ 2) were excluded. The remaining 31 patients (female: n ¼ 9, male: n ¼ 22) were diagnosed with severe aplastic anaemia . These patients underwent a total of 31 single HSCT and were studied with respect to immunological reconstitution. All 31 transplantations were grouped according to the different stem cell source used: autologous CD34-selected PBSC (group 1; n ¼ 10), allogeneic CD34-selected PBSC (group 2; n ¼ 12), and allogeneic unmanipulated BM (group 3; n ¼ 9) for statistical analysis.
Transplantation characteristicsTransplantation characteristics are depicted in Table I. As conditioning regimen patients received busulfan-based (n ¼ 13), total body irradiation (TBI)-based (n ¼ 4) or other high dose chemotherapy-based regimens (n ¼ 13). In one patient, a reduced intensity immunoablative conditioning regimen was used.
Graft manipulationAutologous PBSC were mobilised and harvested according to treatment protocols used. Allogeneic PBSC were mobilised by subcutaneous injection of granulocyte colony-stimulating factor (G-CSF, 5-10 lg/kg body weight/d) once daily for 5 consecutive days. Allogeneic and autologous PBSC were CD34-selected using the CD34 + Progenitor Cell Isolation Kit (Miltenyi Biotec, Bergisch Gladbach, Germany) applying a magnetic cell separation (MACS) technique using the Clini-MACS sorting device (Miltenyi Biotec) according to the manufacturer's instructions. The purity and recovery of the isolated CD34 + cells and the contamination with T-lymphocytes were assessed by flow cytometry. Autologous PBSC were frozen after dilution with a dimethylsulfoxide (DMSO) containing freezing solution using a computerised nitrogen freezer and stored at )193°C in the liquid phase of nitrogen until tran...
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