Summary:chemotherapy does not exceed 5-10%. Advanced age (median, 65 years), renal function impairment and hematoThis report summarizes 2 years experience in perpoietic stem cell compromise due to prolonged alkylating forming 336 autotransplant procedures in 251 consecuagent therapy have delayed evaluation of high-dose chemotive patients with multiple myeloma, using high-dose therapy in MM, an approach that has proven to be successmelphalan at 200 mg/m 2 in the context of a tandem ful in the management of lymphomas. 2 Pilot studies in the transplant program. A total of 91 patients received 118 early 1980s revealed that drug-resistance in advanced MM transplants as outpatients while the remaining 160 could be overcome by dose-escalation of alkylating patients received 218 transplants as inpatients. Outagents. 3,4 As a result, numerous clinical trials have patients were more often younger, with better stem cell employed autologous stem cells, as well as colony-stimulatproducts, normal serum albumin and ␤-2-microglobuing factors, to support myeloablative therapy for MM. 5-9 A lin levels as well as chemotherapy-sensitive disease comrandomized clinical trial by French investigators has shown pared to inpatients. There were no differences in hemaautotransplant to be superior to standard chemotherapy in topoietic recovery and non-hematologic toxicities the management of newly diagnosed symptomatic myeloma between outpatient and inpatient transplant recipients.patients. 10 In the interest of offering this promising treatPost-transplant febrile neutropenia and most other ment strategy to a larger MM patient population, outpatient post-transplant toxicities were managed successfully in transplants were initiated at our institution and their safety, an ambulatory setting. Although liberal criteria were efficacy, and cost-effectiveness were examined. developed for hospitalization of outpatients, including High-dose melphalan was chosen as cytoreductive regiclinical parameters as well as patient desire and men because of its relative lack of extra-medullary toxicity, physician/nurse judgment, only 21% of outpatients even at 200 mg/m 2 . 11,12 The initiation of outpatient transrequired admission after transplantation. Median hosplants required a high degree of proficiency on the part of pital stay for these outpatients was 9 days, while inpathe transplant team and an adequate outpatient nursing and tients were hospitalized for a median of 15 days (P ‫؍‬ pharmacy infrastructure to ensure continuity of care, even 0.0001). After adjusting for differences in disease and at weekends. Because only two outpatient autotransplant host features, our study showed outpatient management procedures could be accommodated per week, patient perresulted in significant financial savings due to lower formance status and preference, as well as third-party pharmacy (42%), hospitalization (50%) and insurance payments influenced whether or not a patient was pathology/laboratory charges (36%). We conclude that accepted for outpatient transplantation....

Changes in behaviour and cognitions mediate the change in CBT given to IBS patients. The results strengthen the validity of a theoretical model of CBT by confirming the interaction of cognitive, emotional and behavioural factors in IBS.

Summary:Chronic lymphocytic leukaemia is a condition which has a median age of 65 years but approximately 10% of patients are younger than 50. Fludarabine has been shown to produce better response rates than conventional single agent or combination chemotherapy but as yet no improved survival. We have treated a series of 10 patients presenting with de novo (six) or relapsed (four) chronic lymphocytic leukaemia (CLL) with fludarabine as cytoreduction treatment and consolidation of the response with CD34 selected peripheral blood stem cell transplantation using cyclophosphamide and total body irradiation (TBI) as conditioning therapy. We report here on the progenitor cell harvest characteristics and clinical and molecular responses to both fludarabine and high-dose consolidation. Our results indicate that at 3 months post transplant clinical remissions were induced in 10/10 patients and molecular responses in 7/8 (88%) evaluable patients. Molecular relapses occurred on long-term follow-up at 6, 9, 12 and 24 months post transplant but patients continued in clinical and haematological remission. Two patients have died from progressive disease and a third patient from aggressive high grade lymphoma. Median survival from the time of transplantation for the group overall was 22 months (range 6-45). There was no procedure-related mortality in the first 100 days. Keywords: autologous blood cell transplantation; molecular responses; multiple myeloma Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in people over 50 years old with a median age at presentation of 64 years. It is, however, being seen in an increasing number of patients under this age and data from the South East Thames Malignancy Register suggests that it has an incidence in the under 50s of approximately 1:350 000. Median overall survival varies according to stage but the range is extremely wide. However, the influence of the disease on survival is similar regardless of age. 1 Furthermore, although initial response rates are in the region of 80% median response duration is only 2 years. 2 Recently a new purine analogue, fludarabine, has been

Objective-To ascertain the views of primary care professionals about the current purpose, uses, potential, and workload implications ofthe statutory general practice annual report.Design-Postal questionnaire survey. Setting-General practices in the Northern region.Subjects-All practices in the region that were singlehanded, fundholding, non-fundholding and with more than five partners, and a one in three random sample of all non-fundholding practices (n=318).Results-263 practices responded (83%). The report took a median of 12 hours to produce (95% confidence interval 11 to 15 hours; interquartile range 7-35). The main perceived purpose of the report was to monitor practice activity (165 respondents; 63% (95% confidence interval 57% to 69%I.)), but 44 respondents (17%; 13% to 22%) produced it only because it was contractually required. Practices included statutory and non-statutory data in these reports and would have liked comparative practice activity information (155 respondents; 59%/) and "good ideas" (165 respondents; 63%) fed back to them. Respondents would have liked the annual report used to improve practice development planning (122 respondents; 46% (40/o to 520/)), to facilitate audit (115 respondents; 44%/ (38% to 50%/)), and to influence resource allocation (104 respondents; 40!/o (34% to 460/6)). One hundred and eighteen practices (45%; 39%/6 to 51%) would produce an annual report even if not contractually required.