Pharmacokinetics of oral fluconazole when used for prophylaxis in bone marrow transplant recipients

The pharmacokinetics of fluconazole was investigated in 20 bone marrow transplant patients following oral administration of 200 mg of this drug. Blood samples were collected from each patient at different time intervals within 48 h after the first dose, and fluconazole was measured in plasma by high-performance liquid chromatography with UV detection. Urine was collected from 14 of these patients and analyzed similarly. The plasma concentration-time data exhibited the characteristics of the one-compartment model with first-order absorption quite well. The means +/- standard deviations of half-lives for absorption and elimination, peak concentration, time to peak, mean residence time, apparent volumes of distribution, area under the curve, and apparent oral clearance observed in these patients were 2.84 +/- 1.34 h, 19.94 +/- 18.7 h, 4.45 +/- 1.86 microg/ml, 8.34 +/- 5.97 h, 39.57 +/- 20.5 h, 0.874 +/- 0.48 liter/kg, 156.0 +/- 60.6 microg x h/ml, and 0.0256 +/- 0.0138 liter/h x kg, respectively. The amount of fluconazole excreted in urine in 24 h was 67.1 +/- 83 mg, which represents 33.55% +/- 41.6% of the dose administered. Patients who developed hemorrhagic cystitis excreted significantly (P < or = 0.0094) more fluconazole in 24 h than did those who did not.

Expression of IL-12 and IL-13 mRNA in asthma and their modulation in response to steroid therapy

Interleukin-12 (IL-12) and IL-13 are two recently characterized cytokines which play an important role in the induction of T helper cell type 1 (Th1-) and Th2-like cells, respectively. Using the technique of in situ hybridization, we have investigated the expression of these cytokines in bronchial biopsies from nine allergic asthmatics and nine normal control subjects. To determine the effect of steroid therapy on the expression of IL-12 and IL-13 in asthma, the numbers of cells expressing these cytokine mRNA before and after a 1-wk course of oral prednisone in six steroid-sensitive (SS) and five steroid-resistant (SR) moderately severe asthmatics were also examined. There was an increased number of IL-13, and a decreased number of IL-12 mRNA positive cells in asthmatic subjects compared with normal control subjects (p < 0.001). After steroid treatment, the increase in FEV1 values observed in SS asthmatics was accompanied by a significant decrease in cells expressing IL-13 mRNA (p < 0.05) and an increase in the numbers of cells expressing IL-12 mRNA (p < 0.05). In contrast, steroid therapy in SR asthmatics was not associated with significant changes in IL-12 and IL-13 mRNA expression. Thus, allergic asthma is associated with a downregulation of IL-12 mRNA expression and an upregulation of IL-13 mRNA expression. These results suggest an in vivo role for IL-12 and IL-13 in modulating allergic responses and support the notion that the clinical effects of glucocorticoids are at least partially mediated through the modulation of cytokine production.

Effectiveness of the leukotriene receptor antagonist zafirlukast for mild-to-moderate asthma. A randomized, double-blind, placebo-controlled trial

BACKGROUND

The increasing costs of managing asthma are due in part to the introduction of new medications, such as leukotriene receptor antagonists. These antagonists interfere with the action of leukotrienes, which are implicated in bronchoconstriction and the formation of airway edema in patients with asthma. Leukotriene receptor antagonists must be shown to be clinically and economically effective for their clinical use to be justified.

OBJECTIVE

To assess the clinical and economic effectiveness of zafirlukast, a leukotriene receptor antagonist, in patients with mild-to-moderate asthma who might benefit from regular anti-inflammatory therapy.

DESIGN

Randomized, double-blind, multicenter, placebo-controlled trial.

SETTING

28 outpatient clinics.

PATIENTS

146 patients with mild-to-moderate asthma who were 12 years of age or older, had not smoked cigarettes in the previous 6 months, had a smoking history of less than 10 pack-years, had an FEV1 at least 55% of the predicted value with no upper limit, had demonstrated bronchial hyperresponsiveness, and were symptomatic during the 7-day run-in period. All patients were seen every 2 to 3 weeks for 13 weeks.

INTERVENTION

103 patients received zafirlukast (20 mg twice daily), and 43 patients received placebo (twice daily). All patients received inhaled beta-agonists as needed.

MEASUREMENTS

Data were obtained from medical examinations, patient questionnaires, and daily diaries. The clinical effectiveness outcomes were days per month without asthma symptoms, limitation of activity, use of beta-agonists, sleep disturbance, and episodes of asthma (the latter was a composite measure made up of the first four outcomes plus the occurrence of adverse events). The economic effectiveness outcomes were frequency and type of unscheduled health care contacts, use of beta-agonist inhalers, consumption of nonasthma medications, and days of absence from work or school.

RESULTS

The zafirlukast group had 89% more days without symptoms (adjusted rates, 7.0 compared with 3.7 days per month; P = 0.03), 89% more days without use of beta-agonists (adjusted rates, 11.3 compared with 6.0 days per month; P = 0.001), and 98% more days without episodes of asthma (adjusted rates, 10.1 compared with 5.1 days per month; P = 0.003). They also had 55% (95% CI, 19% to 74%) fewer health care contacts (18.5 compared with 40.7 per 100 per month; P = 0.007) and 55% (CI, 3% to 79%) fewer days of absence from work or school (15.6 compared with 35.0 per 100 per month; P = 0.04). They used 17% fewer canisters of inhaled beta-agonists (P = 0.17) and 19% less nonasthma medication (P < 0.2).

CONCLUSIONS

A daily regimen of zafirlukast added to as-needed inhaled beta-agonists is more effective than beta-agonists alone in treating mild-to-moderate asthma. The clinical and economic effectiveness of zafirlukast, a potential alternative to inhaled corticosteroids, provides further impetus to use regular "preventive" therapy in patients with mild-to-moderate asthma.

Assessing asthma management from interviews of patients and family physicians

Directed self-care is recommended in asthma. Adequate patient education and follow-up are nevertheless necessary to optimize outcomes. We compared the agreement between detailed information on asthma history and management, collected from the patient and the family physician, to validate the files of physicians and to assess patients' knowledge, attitude, and behavior concerning asthma. A sample of 54 asthma patients were interviewed in detail about use of medications and self-care practice; 36 family physicians (FPs) were interviewed concerning asthma therapy, history, and attitudes of the same patients. Forty-eight percent of the patients expressed negative attitudes toward inhaled corticosteroids, for reasons of safety or lack of efficacy. Less than 20% of the patients made regular use of a peak flow meter. Eighty-three percent of the patients usually obtained prescriptions for asthma therapy from their FP, but on average, only 40% of these prescriptions were provided during visits specific to asthma. FPs were not optimally informed of actual treatments and outcomes and had poor perception of patients' attitudes toward treatment. Nonetheless, in about 30% of the patients, FPs identified risk factors for adverse outcome, such as depression and family conflicts. A majority of interviewed patients had a negative perception of anti-inflammatory therapy, specifically relating to issues of safety and efficacy. Peak flow meters were seldom used and therapy was commonly prescribed outside visits specific to asthma. Despite being centrally involved in the care of asthma patients, FP did not optimally assess therapy and outcomes. The findings suggest suboptimal education and health status in this asthma population.

Engraftment failure following bone marrow transplantation in children with thalassemia major using busulfan and cyclophosphamide conditioning

Thirteen children older than 3 years of age with beta-thalassemia major underwent allogeneic bone marrow transplantation (BMT) from a full human leukocyte antigen (HLA) matched sibling donor in a single institution. These patients received busulfan (Bu). 16 mg/kg followed by cyclophosphamide (Cy) 200 mg/kg for conditioning. Eight of the 13 patients (Group 1) engrafted and have a median age of 13 years (range 5-15 years). The five patients (Group 2) who failed to engraft have a median age of 6 years (range 3-8 years). The association with the following factors was found to be statistically significant: age (older in Group 1), duration of nadir of white blood count (WBC) of < or = .1 x 10(9)/L (longer in Group 1), and the dose of Bu administered to each patient calculated on the basis of body surface area (higher dose in Group 1). The high rate of engraftment failure (5 out of 13) may be related to the suboptimal systemic exposure of Bu in younger children leading to inadequate bone marrow ablation when the standard dose of 16 mg/kg is used.

Actual use of inhaled corticosteroids and risk of hospitalisation: a case-control study

BACKGROUND

The relationship between therapy and adverse outcome in asthma is debated especially for naturally occurring situations. This is due in part to insufficient information regarding actual use of medications.

OBJECTIVE

This study was conducted to clarify the relationship between actual intake of anti-asthma drugs and asthma hospitalisation, considered as an outcome.

METHODS

A case-control study was performed. Patients hospitalised for an asthma exacerbation were matched to community controls identified in surrounding general practices. Patients were questioned to identify prior use of anti-asthma medications, level of use of inhaled corticosteroids and attitude towards therapy.

RESULTS

Twenty-three cases and 31 matched controls were interviewed. Cases tended to have more severe asthma than controls, as judged by more frequent use of oral corticosteroids. Cases tended to make more frequent use of oral xanthines and inhaled anticholinergics, but the proportion of patients using inhaled beta 2-adrenoceptor agonists and inhaled corticosteroids was similar in both groups. Use of lower doses of inhaled corticosteroids was associated with an increased risk of hospitalisation, while higher dosage was associated with decreased risk. Cases and controls differed as to their answers to a questionnaire concerning attitudes: cases expressed less interest in optimal usage of inhaled corticosteroids than controls; they also expressed more confidence in inhaled beta 2-agonists. When both risks were combined, overconfidence in beta 2-agonists and suboptimal use of inhaled steroids, the relationship with hospitalisation was significant (OR 5.5, 95% CI 1.1; 26.1).

CONCLUSION

The results suggest that patients' attitudes to inhaled corticosteroids and actual consumption of these medications are directly related to adverse outcome in asthma.

Bone marrow transplantation in patients with Fanconi anemia: experience with cyclophosphamide and total body irradiation conditioning regimen

Eleven patients with Fanconi anemia (FA) underwent bone marrow transplantation (BMT) between March 1985 and May 1990 in a single institution. Ten patients received bone marrow from healthy full human leukocyte antigen (HLA) matched siblings and one patient from her father (one antigen mismatch). Ten patients were conditioned with cyclophosphamide (Cy) at a dose of 5 mg/kg per day for 4 days followed by total body irradiation (TBI) for a total of 600 cGy over 3 days. Six of the 11 patients are alive and have normal reconstitution of their bone marrow. Median follow-up was 72 months (range 42-84). Three of the 10 patients who received Cy and TBI (two HLA compatible, one antigen mismatch) had graft failure. Five patients developed at least grade III acute graft-versus-host disease (GVHD). The rates of graft failure and GVHD are, however, still significantly high. Modification of the conditioning regimen and GVHD prophylaxis is needed to improve the outcome.

Confounding by indication and channeling over time: the risks of beta 2-agonists

A previously published nested case-control study, the Saskatchewan Asthma Epidemiologic Project (SAEP) spanning 1980-1987, investigated the risk of fatal or near fatal asthma and found different risks for two inhaled beta 2-agonists, fenoterol and salbutamol. The authors assessed whether this comparison was confounded by indication because of channeling of inhaled fenoterol to more severely afflicted asthmatics. Using three subcohorts selected from a cohort of 12,301 asthmatics assembled from the computerized databases of Saskatchewan Health and followed over 7 years, the authors studied two forms of channeling and investigated whether greater asthma severity and less well-controlled disease were associated with preferential prescribing of a first prescription of inhaled fenoterol, as opposed to inhaled salbutamol, and whether they were associated with the likelihood of a switch from inhaled salbutamol to fenoterol as well as a switch from inhaled fenoterol to salbutamol. The authors found that the initial choice between fenoterol and salbutamol was independent of the severity of the asthma and disease control, but that preferential prescribing of fenoterol occurred among users of salbutamol who showed signs of increased severity or uncontrolled asthma. The switch from inhaled fenoterol to salbutamol was, however, minimally related to asthma severity. They conclude that the comparison between inhaled fenoterol and salbutamol in the SAEP may have been biased by indication. This study demonstrates that long-term information on medication use is essential to ensure that the results of such case-control studies are not biased by indication.

Bronchodilators and acute cardiac death

Bronchodilators used in the treatment of airway disease have been shown to have a variety of cardiac effects that may contribute to the occurrence of life-threatening events such as cardiac arrhythmias and cardiac arrest. We investigated whether theophylline and beta-agonists were associated with cardiovascular mortality among a cohort of subjects prescribed antiasthma medications. We used a population-based cohort of 12,301 subjects aged 5 to 54 yr, formed from health-insurance data bases from Saskatchewan, Canada, and spanning the period 1978 to 1987. Within this cohort, we identified all 30 deaths from cardiovascular causes in which acute asthma did not appear to be a contributing factor. We identified all asthma and cardiovascular drugs dispensed to these subjects shortly before their deaths and compared this therapy to that dispensed to a random sample of 4,080 person-time controls. After adjustment for age and the prior use of cardiac drugs, the rate of cardiovascular death was greater in users of theophylline, with a rate ratio (RR) of 2.7 (95% Cl:1.2 to 6.1), and in users of beta-agonists taken orally or by nebulizer (RR = 2.4; 95% Cl:1.0 to 5.4), but not in users of beta-agonists administered by metered-dose inhaler (RR = 1.2; 95% Cl:0.5 to 2.7). The great majority of cardiovascular deaths occurred among subjects with clinical or pathologic evidence of potentially lethal conditions. These results suggest that the use of theophylline and of beta-agonists administered orally or by nebulization should be avoided in subjects with significant cardiac disease or at high risk for such disease, especially acute coronary insufficiency and congestive cardiomyopathy. On the other hand, the use of beta-agonists administered by metered-dose inhalers (MDIs) was not associated with an increased risk of cardiovascular death.

Splenic irradiation before bone marrow transplantation for chronic myeloid leukaemia. Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

A total of 229 patients with chronic myeloid leukaemia (CML) in chronic phase were randomized between 1986 and 1990 to receive or not receive additional splenic irradiation as part of their conditioning prior to bone marrow transplantation (BMT). Both groups, 115 patients with and 114 patients without splenic irradiation, were very similar regarding distribution of age, sex, donor/recipient sex combination, conditioning, graft-versus-host disease (GvHD) prevention method and blood counts at diagnosis or prior to transplant. 135 patients (59%) are alive as of October 1995 with a minimum follow-up of 5 years. 52 patients have relapsed (23%), 26 patients in the irradiated, 26 patients in the non-irradiated group (n.s.) with a relapse incidence at 6 years of 28%. The main risk factor for relapse was T-cell depletion as the method for GvHD prevention, and an elevated basophil count in the peripheral blood prior to transplant. Relapse incidence between patients with or without splenic irradiation was no different in patients at high risk for relapse, e.g. patients transplanted with T-cell-depleted marrows (P = n.s.) and in patients with low risk for relapse, e.g. patients transplanted with non-T-cell-depleted transplants and basophil counts < 3% prior to transplant (P = n.s.). However, relapse incidence differed significantly in patients with non-T-cell-depleted transplants and high basophil counts (> 3% basophils in peripheral blood). In this patient group, relapse incidence was 11% at 6 years with splenic irradiation but 32% in the non-irradiated group (P = 0.05). Transplant-related mortality was similar whether patients received splenic irradiation or not. This study suggests an advantage in splenic irradiation prior to transplantation for CML in this subgroup of patients and illustrates the need for tailored therapy.

Recommendations for reducing the effect of grain dust on the lungs. Canadian Thoracic Society Standards Committee

OBJECTIVE

To assess the appropriateness of the current Canadian standards for exposure to grain dust in the workplace.

OPTIONS

The current permissible exposure limit of 10 mg of total grain dust per cubic metre of air (expressed as mg/m3) as an 8-hour time-weighted average exposure, or a lower permissible exposure limit.

OUTCOMES

Acute symptoms of grain-dust exposure, such as cough, phlegm production, wheezing and dyspnea, similar chronic symptoms, and spirometric deficits revealing obstructive or restrictive disease.

EVIDENCE

Articles published from 1924 to December 1993 were identified from Index Medicus and the bibliographies of pertinent articles. Subsequent articles published from 1994 (when the recommendations were approved by the Canadian Thoracic Society Standards Committee) to June 1996 were retrieved through a search of MEDLINE, and modification of the recommendations was not found to be necessary. Studies of interest were those that linked measurements of total grain dust levels to the development of acute and chronic respiratory symptoms and changes in lung function in exposed workers. Papers on the effects of grain dust on workers in feed mills were not included because other nutrients such as animal products may have been added to the grain. Unpublished reports (e.g., to Labour Canada) were included as sources of information.

VALUES

A high value was placed on minimizing the biological harm that grain dust has on the lungs of grain workers.

BENEFITS, HARMS AND COSTS

A permissible exposure limit of 5 mg/m3 would control the short-term effects of exposure to grain dust on workers. Evidence is insufficient to determine what level is needed to prevent long-term effects. The economic implications of implementing a lower permissible exposure limit have not been evaluated.

RECOMMENDATIONS

The current Canadian standards for grain-dust exposure should be reviewed by Labour Canada and the grain industry. A permissible exposure level of 5 mg/m3 is recommended to control short-term effects. Further measurements that link the levels of exposure to respiratory health effects in workers across Canada should be collected to establish an exposure-response relation and possible regional differences in the effects of grain dust.

VALIDATION

There has been no external review of these recommendations. However, the American Conference of Governmental Industrial Hygienists has recommended an 8-hour average exposure limit of 4 mg/m3 for wheat, oats and barley.

A potential role for Elf-1 in terminal transferase gene regulation

The terminal deoxynucleotidyltransferase (TdT) gene represents an attractive model for the analysis of gene regulation during an early phase of lymphocyte development. In previous studies, we identified a DNA element, termed D', which is essential for TdT promoter activity in immature lymphocytes, and two classes of D'-binding factors, Ikaros proteins and Ets proteins. Here, we report a detailed mutant analysis of the D' element which suggests that an Ets protein, rather than an Ikaros protein, activates TdT transcription. Since multiple Ets proteins are expressed in developing lymphocytes and are capable of binding to the D' element, DNA affinity chromatography was used to determine if one of the Ets proteins might bind to the D' element with a uniquely high affinity, thereby implicating that protein as a potential TdT activator. Indeed, one binding activity was greatly enriched in the high-salt eluates from a D' affinity column. Peptide microsequencing revealed that the enriched protein was Elf-1. Immunoblot analyses confirmed that in nuclear extracts, Elf-1 has a significantly higher affinity for the D' sequence than does another Ets protein, Ets-1. Transactivation and expression studies support the hypothesis that Elf-1 activates TdT transcription in immature T and B cells. Finally, a D' mutation which selectively reduces Elf-1 binding, but not the binding of other Ets proteins, was found to greatly reduce TdT promoter activity. Although Elf-1 previously had been implicated in the inducible activation of genes in mature T and B cells, our results suggest that it also plays an important role in regulating genes during an early phase of lymphocyte development.

[Ultrasonography: a complement to sialography in recurrent chronic childhood parotitis]

The objective of this research is to compare the ultrasonographic (USG) and sialographic contributions for the diagnosis of Recurrent Parotitis in Childhood (RPC). Bilateral USG of the parotid gland was performed among 16 children with RPC and 16 healthy children. The image of the normal parotid glands was compared with the image of the parotid gland with RPC. A pathologic USG pattern for RPC was obtained which consisted in a homogeneous, micronodular parenchyme with a diffuse increase density, sometimes with multiples hypoechogenous areas, that were considered solid hypoechogenous nodules suggesting inflammatory nodes. A glandular contour finely granulated was described with normal peri-parotidareas and with aponeurotic-muscular planes. Then 16 USG of the parotid gland of the children with RPC were compared with 16 Sialography previous obtained. The possibilities of diagnosis of the disease with both techniques was not different (p > 0.05). When the clinic was correlated with the USG it was possible to obtain parameters of severity of the glandular damage and to visualise the degree of changes of the parenchyma of each child with RPC. In some cases, bilateral damage was observed in children with clinical unilateral symptoms. The USG was performed in children in the acute phase of disease, visualising the microabscess in the gland and confirming the previous diagnosis. Finally, it was possible to conclude the utility of USG in the study of the disease. Being a not invasive exam, harmless, unpainfully echography, was easily accepted by the child. Also, we obtain information not only about the diagnosis of the disease, but also about the severity, prognosis, treatment and follow-up of the infant patients.

Interleukin-13 and interleukin-4 are coexpressed in atopic asthma

Interleukin-4 (IL-4) is an important cytokine in the allergic inflammation associated with atopic asthma. Interleukin-13 shares many of the biological effects of IL-4, and the evidence suggests that the expression of these two cytokine genes may be coregulated. We have investigated the expression of IL-13 and IL-4 mRNA in the bronchial mucosa of nine stable atopic asthmatics and 10 normal controls, characterized the major cellular source of IL-13 mRNA, and examined the colocalization of IL-13 and IL-4 mRNA. Endobronchial biopsies were obtained and examined for IL-13 and IL-4 mRNA using radiolabeled in situ hybridization. The number of positive cells per millimeter of basement membrane for both IL-13 and IL-4 mRNA was increased significantly in the bronchial mucosa of atopic asthmatics compared to normal controls (p < .001). In the atopic asthmatics, the expression of IL-13 was significantly greater than that for IL-4 (p < .01). In these subjects, 90% of the IL-13 mRNA-positive cells were CD3-positive T cells. Furthermore, although 100% of IL-4-positive cells also expressed IL-13 mRNA, only 60% of IL-13-positive cells also expressed IL-4. These results demonstrate that, in mild atopic asthma, IL-13 and IL-4 are coexpressed and that the upregulation of IL-13 expression is greater than that of IL-4. Our data support the role of IL-13 in the allergic inflammation present in atopic asthma.

Antiallergic and antitussive medications: extent of use and relationship to asthma exacerbations

BACKGROUND

Asthma patients are frequently exposed to antiallergic and antitussive medications, in addition to their respiratory treatment. These medications interfere with inflammatory pathways common to all atopic diseases and could affect asthma.

OBJECTIVES

To investigate associations between antiallergic and antitussive medications and the occurrence of asthma exacerbations and to assess the extent of use of these medications in asthma.

METHODS

Regular users of anti-asthma medications were identified in a drug dispensing database. A base-cohort of asthma patients was identified using age and exposure criteria. A nested case-control study was performed within the base-cohort: the outcome was defined as a new dispensing of oral corticosteroids and matched cases and controls were compared regarding exposure to antiallergic medications. Odds ratios (OR) were computed by conditional logistic regression and adjustment incorporated markers for asthma severity.

RESULTS

680 asthma patients were followed in the base-cohort for an average duration of 1390 days. Antitussives, antihistamines and nasal corticosteroids were used by respectively 40, 30 and 13 per cent of the asthma population. Among the patients, 134 cases were pair matched with controls. In these pairs, antitussives showed a significant association with asthma exacerbations, with an OR of 3.1. The association had borderline significance for antihistamines and was not significant for nasal corticosteroids. The results were not modified by adjustment for disease severity.

CONCLUSIONS

This study confirms that antitussives and antihistamines are commonly used by asthmatics and indicates that both classes are associated with increased occurrence of asthma exacerbations; assessing causality from present data is, however, difficult. Nasal corticosteroids are used less often and are not associated with the outcome. Antihistamine and antitussive medications should be more thoroughly investigated in asthma patients.

Effect of passive smoking on the development of respiratory symptoms in young adults: an 8-year longitudinal study

The evidence of an association between passive smoking and occurrence of respiratory symptoms is relatively strong in children, whereas studies conducted in adult populations have provided inconsistent results. The objective of the present study was to examine the relations between exposure to environmental tobacco smoke (ETS) and development of respiratory symptoms in young adults during a study period of 8 years, with emphasis on the evaluation of potential dose-response pattern of the relations. The study population consisted of 117 "never smokers," who were 15 to 40 years of age at the time of initial examination, when they answered a standardized questionnaire on respiratory health, and who were reexamined 8 years later. ETS exposure at home and at work during the study period was recorded at the 8-year examination with a structured questionnaire. The symptoms studied as outcomes included wheezing, dyspnea, cough, and phlegm production. The relations between ETS exposure and development of respiratory symptoms were studied in multivariate logistic regression models controlling for age, gender, atopy, and the presence of other respiratory symptoms. Cumulative incidences of the respiratory symptoms, except of phlegm production, were consistently greater among subjects exposed to ETS compared with the reference group. A significant dose-related increase in the risk of developing dyspnea was observed in relation to ETS exposure, with an OR of 2.37 for an average exposure of 10 cigarettes/day (95% confidence interval, 1.25-4.51). The risk of developing other respiratory symptoms, apart from phlegm, was also related to ETS exposure, but these relations did not achieve statistical significance. The results provide evidence of adverse respiratory effects of ETS exposure in the home and office work environments in young adults. These findings emphasize the need for effective measures in the prevention of involuntary smoking during young adulthood.

Allogeneic bone marrow transplant is not better than autologous transplant for patients with relapsed Hodgkin's disease. European Group for Blood and Bone Marrow Transplantation

PURPOSE

To compare the results achieved with myeloablative therapy followed by either allogeneic bone marrow transplantation (alloBMT) or autologous bone marrow transplantation (ABMT) for patients with Hodgkin's disease (HD).

PATIENTS AND METHODS

Of more than 1,200 patients with HD reported to the European Bone Marrow Transplantation (EBMT) registry, 49 underwent alloBMT. Of these, 45 with sufficient data were matched to 45 patients who underwent ABMT. The matching criteria were sex, age at time of transplantation, stage of disease at diagnosis, bone marrow involvement at diagnosis and at transplantation, year of transplantation, disease status at time of transplantation, time from diagnosis to transplantation, and conditioning regimen with or without total-body irradiation (TBI).

RESULTS

The 4-year actuarial probabilities of survival, progression-free survival (PFS), relapse, and non-relapse mortality were 25%, 15%, 61%, and 48% and 37%, 24%, 61%, and 27% after alloBMT and ABMT, respectively. The toxic death rate at 4 years was significantly higher for alloBMT patients (P = .04). For patients with sensitive disease at the time of transplantation, the 4-year actuarial probability of survival was 30% after alloBMT and 64% after ABMT (P = .007). This difference is mainly due to a higher transplant-related mortality rate after alloBMT (65% v 12%, P = .005). Acute graft-versus-host disease (aGVHD) > or = grade II was associated with a significantly lower risk of relapse, but also with a lower overall survival (OS) rate.

CONCLUSION

Based on this study, alloBMT from a human leukocyte antigen (HLA)-identical sibling donor does not appear to offer any advantage when compared with ABMT. A graft-versus-Hodgkin effect is associated with > or = grade II aGVHD, but its positive effect on relapse is largely offset by its toxicity. In most circumstances, alloBMT cannot be recommended for patients with HD.