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Steinerova K.,Hematologicko onkologicke Oddeleni FN Plzen | Houdova L.,NTIS Nove Technology pro Informacni Spolecnost | Jindra P.,Hematologicko onkologicke Oddeleni FN Plzen | Lysak D.,Hematologicko onkologicke Oddeleni FN Plzen | And 4 more authors.
Transfuze a Hematologie Dnes | Year: 2014

At the beginning of 2014 over 24 million of unrelated donors being listed in the registries worldwide and number of hematopoietic stem cell collections exceed 16 000 per year. In order to insure the quality of unrelated donor searches Quality Assurance Working Group at the World Marrow Donor Association defined global key performance indicators for bone marrow donor registries, which were retrospectively evaluated also within Czech National Marrow Donors Registry. The aim of the study was evaluate the performance of quality indicators, perform further analysis for those that do not meet the specified criteria and compare the observed result with published data. For the year 2013 three of the five analysed quality indicators were fulfilled: the rate of extended typing performed within two weeks of receipt of the request, the rate of donors available during work up examination and the rate of discrepant typing identified in the verification typing. Two quality indicators were not fulfilled: the rate of samples of the donors available during verification typing (79% in the CNMDR compared to 80% WMDA recommended) and the rate of samples sent for verification typing within two weeks from receipt of the request (64% in the CNMDR compared to 80% WMDA recommended). Due to this unfulfilled indicators reasons for the unavailability of the donors were analysed and the lack of contact was identified as the main reason. Looking at the detail we identified the risk group of donors with only contact address and phone number provided upon entry to the registry. On the contrary minimum of unavailable donors were in the group of donor with e-mail contact. Based on the findings of unfulfilled quality indicators further quality improvement objectives were defined for the future.

Dvorak P.,Ustav lekarske genetiky LF UK | Lysak D.,Hematologicko onkologicke oddeleni FN Plzen | Vokurka S.,Hematologicko onkologicke oddeleni FN Plzen | Vozobulova V.,Hematologicko onkologicke oddeleni FN Plzen
Onkologie (Czech Republic) | Year: 2014

Imatinib mesylate, the first tyrosine kinase inhibitor (TKI) approved for the treatment of chronic myeloid leukemia (CML), became the standard of care, induces durable responses and prolongs event-free survival and progression-free survival. However, if TKI therapy is required indefinitely, then this ongoing drug exposure raises its own problems. Long-term follow-up indicates that an increasing proportion of patients treated with TKI have prompt cytogenetic response and achieve reductions in BCR-ABL1 transcripts to a level that is undetectable by very sensitive molecular genetic methods. Observation of the stability of such responses over long follow-up suggests that such patients may be "functionally cured" of CML and thus potentially eligible for TKI therapy discontinuation. At present, therapy discontinuation in CML is not recommended in routine practice and is under active investigation in several clinical studies worldwide. Many questions remain regarding definition of "functional cure" in CML, which patients are most eligible for safe therapy discontinuation, and what management strategies are recommended post discontinuation, especially regarding subsequent molecular relapse.

Acute myeloid leukemia (AML) is disease of older age with the median of age at diagnosis 69 years. Unfortunately results of intensive treatment of patients older than 60 years with AML, thus patients with high-risk of AML development, are unsatisfactory. The reasons for this unsatisfactory results are higher risks of treatment-related mortality among older patients treated with intensive chemotherapy and biological characteristics of AML in older age with higher risk of AML resistance to intensive treatment and higher risk of AML relapse. According to published data reduced-intensity allogeneic transplantation as part of consolidation treatment and advancement in supportive care after transplantation can improve outcome of patients older than 60 years with AML. The limitation of this strategy is a fact that majority of older patients cannot undergo allogeneic transplantation due to unsatisfactory control of AML or due to diminished performance status which does not alow transplant procedure. New approaches to AML treatment and future improvements in transplant procedure could potentially increase the role of allogeneic transplantation in treatment of patients older than 60 years with AML.

PubMed | Hematologicko onkologicke oddeleni FN Plzen.
Type: Journal Article | Journal: Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti | Year: 2010

Bortezomib represents a novel biological and targeted treatment modality with excellent treatment results in multiple myeloma patients. Bortezomib has also been successfully used several times in heavily pre-treated patients with myeloma relapse or progression after allogeneic stem cell transplantation. Its immunomodulatory effect, mediated, for instance, through the selective apoptosis of alloreactive T-lymphocytes and inhibition of the nuclear factor kappa B, brings the potential of graft versus host disease management, while the immunological anti-tumour effect remains preserved. Apart from thrombocytopenia, neurotoxicity most likely potentiated by concomitant and long-term use of cyclosporine is the major side effect of the treatment. The impact and modulation of graft versus host disease remains controversial in clinical practice. Bortezomib is effective and feasible in the post-transplant setting.

PubMed | Hematologicko onkologicke oddeleni FN Plzen.
Type: Journal Article | Journal: Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti | Year: 2011

Melphalan is an important cytotoxic drug. The empirical practice of body surface area-based (BSA) dosing (mg/m2) of melphalan has been critically analyzed in several observations. BSA-based dosing leads to significant variability in doses administered per kilogram of body weight (mg/kg), contributes to increased oral toxicity and probably does not have any significant effect on treatment results within equally BSA (mg/m2) dosed melphalan regimens.

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