Meta-analyses of the efficacy of pharmacotherapies and sublingual allergy immunotherapy tablets for allergic rhinitis in adults and children

BACKGROUND

Treatment options for seasonal and perennial allergic rhinitis (SAR/PAR) include pharmacotherapies and allergy immunotherapy. These meta-analyses evaluated the efficacy of pharmacotherapies and sublingual immunotherapy tablets (SLIT-tablets) versus placebo on nasal symptoms associated with SAR and PAR.

METHODS

Randomized, double-blind, placebo-controlled trials were identified from systematic PubMED/EMBASE searches through 7/18/2019 (PROSPERO protocol CRD42018105632). The primary outcome was mean numerical difference in total nasal symptom score (TNSS; 0-12) between active treatment and placebo at the end of the assessment period. Random-effects meta-analyses estimated the mean difference for each medication group weighted by the inverse of the trial variance. Publication bias assessments and sensitivity analyses were conducted.

RESULTS

Rescue symptom-relieving pharmacotherapy was prohibited in most pharmacotherapy trials but was allowed in all SLIT-tablet trials. For adult/adolescent SAR, the mean numerical difference (95% CI) in TNSS versus placebo was: intranasal corticosteroids (INCS)=1.38 (1.18, 1.58; 39 trials); combination intranasal antihistamine/INCS=1.34 (1.15, 1.54; 4 trials); intranasal antihistamines=0.72 (0.56, 0.89; 13 trials); oral antihistamine=0.62 (0.35, 0.90; 18 trials); SLIT-tablets=0.57 (0.41, 0.73; 4 trials); and montelukast=0.48 (0.36, 0.60; 10 trials). For adult/adolescent PAR, mean difference in TNSS versus placebo (95% CI) was: INCS=0.82 (0.66, 0.97; 14 trials); SLIT-tablets=0.65 (0.42, 0.88; 3 trials); and oral antihistamine=0.27 (0.11, 0.42; 3 trials). The number of eligible trials limited meta-analyses for pediatric SAR/PAR.

CONCLUSIONS

All treatments significantly improved nasal symptoms versus placebo. SLIT-tablets provided improvement in TNSS despite access to rescue symptom-relieving pharmacotherapy. Extensive trial heterogeneity and strong indications of publication bias preclude the comparison of treatment effects among treatment classes.

Acute hepatitis C in a contemporary US cohort: modes of acquisition and factors influencing viral clearance

BACKGROUND

Acute hepatitis C virus (HCV) infection is often asymptomatic; thus, its epidemiology and natural history are difficult to define.

METHODS

Acute HCV infection was identified on the basis of HCV seroconversion within 1 year (n=45), new anti-HCV seropositivity with clinical acute hepatitis (n=21), or HCV strain sequencing after an iatrogenic exposure (n=1). Risk factors were assessed with a baseline questionnaire, and participants were followed up prospectively with serial measurement of viral loads.

RESULTS

Of 67 persons with acute HCV infection, most were asymptomatic (64%) and injection drug users (66%). Thirteen had an unknown mode of transmission; of these, 11 reported high-risk sexual behavior. Ten acquired acute HCV infection within 3 months of an iatrogenic exposure; 3 had confirmed iatrogenic infection, and 4 had no other risk factors identified. The spontaneous viral clearance rate after 6 months of infection was 18% (95% confidence interval, 11%-31%). The rate of viral clearance varied significantly by sex (34% vs. 3% for women vs. men; P<.001).

CONCLUSIONS

High-risk sexual or iatrogenic exposures may be important contemporary risk factors for HCV infection. The spontaneous viral clearance rate (18%) in this contemporary study was similar to that reported for past studies of transfusion-associated HCV infection. Women were more likely to clear acute HCV infection than men.

Thermal Detection of Embedded Tumors Using Infrared Imaging

Breast cancer is the most common cancer among women. Thermography, also known as thermal or infrared imaging, is a procedure to determine if an abnormality is present in the breast tissue temperature distribution. This abnormality in temperature distribution might indicate the presence of an embedded tumor. Although thermography is currently used to indicate the presence of an abnormality, there are no standard procedures to interpret these and determine the location of an embedded tumor. This research is a first step towards this direction. It explores the relationship between the characteristics (location and power) of an embedded heat source and the resulting temperature distribution on the surface. Experiments were conducted using a resistance heater that was embedded in agar in order to simulate the heat produced by a tumor in the biological tissue. The resulting temperature distribution on the surface was imaged using an infrared camera. In order to estimate the location and heat generation rate of the source from these temperature distributions, a genetic algorithm was used as the estimation method. The genetic algorithm utilizes a finite difference scheme for the direct solution of the Pennes bioheat equation. It was determined that a genetic algorithm based approach is well suited for the estimation problem since both the depth and the heat generation rate of the heat source were accurately predicted.

Attitudes toward blood donation incentives in the United States: implications for donor recruitment

BACKGROUND

The potential effectiveness of various donation incentive programs may vary by demographics, first-time or repeat status, and collection site.

STUDY DESIGN AND METHODS

Attitudes toward future incentives were obtained from a 1998 anonymous survey sent to 92,581 US blood donors. Responses (encouraged, discouraged, no difference) to incentives were compared within demographic groups, donations sites, and between first-time and repeat community whole-blood (WB) donors using chi-square tests and logistic regressions adjusted for sample design.

RESULTS

Incentives most likely to encourage donation return among all 45,588 WB respondents were blood credits (61%), cholesterol screening (61%), and prostate-specific antigen (PSA) screening (73% of men). Younger donors (< or = 25 years old) were 4 to 5 times more likely to be encouraged to donate if offered compensatory incentives (tickets to events, discounts or lottery and/or raffle tickets), gifts, or a token of appreciation than were those donors older than 55. This age effect influenced positive attitudes toward incentives in first-time donors and in donors giving at schools, universities, or military sites. Among all donors, up to 7 to 9 percent reported they would be discouraged to return if offered compensatory incentives.

CONCLUSIONS

Blood credits and cholesterol and PSA screening would be well received at all donation sites. Gifts, compensatory incentives, and tokens of appreciation appeal more to younger donors. These data may allow blood centers to optimize recruitment by tailoring limited incentive resources more effectively.

Ethnic differences in erythrocyte catechol-O-methyltransferase activity in black and white Americans

Catechol-O-methyltransferase (COMT) catalyzes the O-methylation of catecholamine and catechol drugs such as levodopa and methyldopa. Human COMT activity is inherited as an autosomal co-dominant trait; approximately 25% of white individuals have low activity consistent with homozygosity for a low activity allele, about 50% have intermediate activity (i.e., heterozygous genotype) and 25% have high activity. COMT activity has not been characterized in African-Americans or other black populations. To investigate potential ethnic and gender differences in COMT, we measured erythrocyte COMT activity in 195 unrelated black and 202 unrelated white healthy individuals living in the Southeast United States. Overall, the black population had significantly higher COMT activity than the white population (median 15.7 vs. 11.4 U/ml of packed red blood cell volume; P < .001). Maximum likelihood estimation of COMT activity distribution identified significant ethnic differences, with high activity in 23% of whites and 55% of blacks, intermediate activity in 50% of whites and 38% of blacks and low activity in 27% of whites and 7% of blacks. No greater differences in COMT activity were observed in either ethnic group. We conclude that red blood cell COMT activity is significantly higher in black subjects than white subjects. Hardy-Weinberg estimates indicate that this ethnic difference is due to a higher frequency of high activity COMT alleles in blacks vs. whites (0.74 vs. 0.48).

Thiopurine methyltransferase activity in American white subjects and black subjects

BACKGROUND

Thiopurine methyltransferase (TPMT) is a cytoplasmic enzyme that preferentially catalyzes the S-methylation of aromatic and heterocyclic sulfhydryl compounds, including 6-mercaptopurine. TPMT exhibits genetic polymorphism in white populations, with 89% of individuals having high TPMT activity, 11% having intermediate activity, and one in 300 having extremely low or absent activity. TPMT activity is inversely correlated with formation of active 6-mercaptopurine metabolites (thioguanine nucleotides), thereby influencing 6-mercaptopurine toxicity and efficacy.

METHODS

To investigate ethnic and gender differences in TPMT, we measured erythrocyte TPMT activity in 209 white healthy subjects and 196 black healthy subjects (202 women and 303 men).

RESULTS

The black population had lower TPMT activity than the white population (median, 14.4 versus 16.8 units/ml packed erythrocytes; p < 0.001). Maximum likelihood estimation of TPMT activity distribution identified 91.9% and 93.9% with high activity and 7.7% and 6.1% with intermediate activity in the white and black groups, respectively.

CONCLUSIONS

These data indicate that TPMT activity is similarly polymorphic in American black subjects and white subjects, although median TPMT activity is approximately 17% lower in black subjects.

Genetic basis for a lower prevalence of deficient CYP2D6 oxidative drug metabolism phenotypes in black Americans

Debrisoquin hydroxylase (CYP2D6) is a cytochrome P450 enzyme that catalyzes the metabolism of > 30 commonly prescribed medications. Deficiency in CYP2D6 activity, inherited as an autosomal recessive trait, was found to be significantly less common in American blacks (1.9%) than whites (7.7%). To determine the genetic basis for this difference, inactivating CYP2D6 mutations were assessed by allele-specific PCR amplification and RFLP analyses of genomic DNA from 126 unrelated whites and 127 unrelated blacks. Blacks had a twofold lower frequency (8.5 versus 23%, P = 0.001) of the CYP2D6(B) mutation (point mutation at intron 3/exon 4 splice site), while complete deletion of the CYP2D6 gene (5.5% blacks, 2.4% whites), and the CYP2D6(A) mutation (single nucleotide deletion in exon 5; 0.24% blacks, 1.4% whites) were not different between the two groups. The prevalence of heterozygous genotypes was significantly lower in blacks (25 versus 42% of extensive metabolizers, P = 0.009), consistent with the observed prevalence of the deficient trait in blacks and whites. We conclude that the same CYP2D6 mutations lead to a loss of functional expression in blacks and whites, but American blacks have a lower prevalence of the deficient trait due to a lower frequency of the CYP2D6(B) mutation. This could explain racial differences in drug effects and disease risk.

Design and preliminary evaluation of an expert system for platelet request evaluation

In spite of growing awareness of the potential risks associated with transfusion, the number of platelet units transfused in the United States continues to increase each year. There is a growing interest in ensuring that all transfusions are administered for appropriate reasons. Prospective review of requests for transfusions has been used to accomplish this goal. Although successful in reducing the number of inappropriate transfusions, this review method requires great time commitments by blood bank personnel and physicians. A knowledge-based system (ESPRE) that aids hospital blood bank personnel in the review of requests for platelet transfusions has been developed. The system automatically obtains most of the required patient data via a direct link to the hospital's main laboratory computers. The system generates a printed report that includes a list of patient-specific data, a list of the conditions for which a transfusion would be appropriate for the particular patient (given the clinical condition), and the conclusions drawn by the system. During a preliminary clinical evaluation of ESPRE, 73 randomly selected platelet transfusion requests were evaluated for approval by laboratory personnel and ESPRE. Overall, ESPRE would have approved 71 of the requests and laboratory staff would have approved 72. Forty-four percent of the requests would have been approved for the same reasons given by the staff. There were only three disagreements on final approval between ESPRE and blood bank personnel. This computerized expert system is a promising approach to the prospective review of all platelet transfusions.

ESPRE--expert system for platelet request evaluation

The expert system for platelet request evaluation (ESPRE) is being developed to support independent learning and decision making regarding the use of platelet transfusions while physicians are actively engaged in clinical practice. The knowledge of transfusion medicine incorporated in ESPRE has been largely gathered from blood bank physicians responsible for determining the appropriateness of blood product administration. Knowledge acquisition methods have included structured and unstructured interviews with protocol analysis using real and fabricated transfusion cases and critiques of an expert system prototype's conclusions. For knowledge representation, ESPRE uses frames with embedded production rules to provide processing efficiency and facilitate knowledge base development. ESPRE automatically acquires key laboratory findings from a laboratory information system. Systems such as ESPRE require careful evaluation and, if proven effective and accurate, present to laboratorians a new tool for delivering high-quality and individually adapted health care.

ESPRE: a knowledge-based system to support platelet transfusion decisions

ESPRE is a knowledge-based system which aids in the review of requests for platelet transfusions in the hospital blood bank. It is a microcomputer-based decision support system written in LISP and utilizes a hybrid frame and rule architecture. By automatically obtaining most of the required patient data directly from the hospital's main laboratory computers via a direct link, very little keyboard entry is required. Assessment of time trends computed from the data constitutes an important aspect of this system. To aid the blood bank personnel in deciding on the appropriateness of the requested transfusion, the system provides an explanatory report which includes a list of patient-specific data, a list of the conditions for which a transfusion would be appropriate for the particular patient (given the clinical condition), and the conclusions drawn by the system. In an early clinical evaluation of ESPRE, out of a random sample of 75 platelet transfusion requests, there were only three disagreements between ESPRE and blood bank personnel.

Effectiveness of a regional bone marrow donor program

Because many potential bone marrow transplant patients lack HLA-matched siblings, there is growing interest in carrying out transplantations using matched, unrelated volunteer donors. We developed a local registry of 2147 informed donors who consented to be listed in the Bone Marrow Donor Registry. This registry was used to carry out 420 donor searches for 351 patients. The initial computer search involved matching for HLA-A and HLA-B locus antigens only because most donors had not been typed for HLA-DR antigens. Depending on the degree of HLA-A and HLA-B antigen mismatching allowed, suitably matched (HLA-DR-identical, mixed lymphocyte culture nonreactive) donors were located for 6% to 16% of patients. This resulted in 13 bone marrow transplants. This study shows that a small, local bone marrow donor registry can locate donors for a few patients; however, a large network involving an expanded number of donors will be necessary to allow an extensive evaluation of unrelated bone marrow transplantation.

Platelet utilization in a university hospital

Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions.

Posttransfusion thrombocytopenia associated with passive transfusion of a platelet-specific antibody

A transfusion reaction in a 76-year-old man was followed by severe but transient thrombocytopenia after infusion of whole blood. A high-titer platelet-specific antibody (anti-PLA) was demonstrated in the plasma of the implicated unit and in the serum of the blood donor. In addition, three previous recipients of blood from the implicated donor had posttransfusion episodes of unexplained thrombocytopenia. These cases represent the first reported clinical examples of posttransfusion thrombocytopenia caused by passively transfused platelet-specific alloantibodies.

Conditioned saccharin aversions in rats as a result of cutaneous nicotine or intraperitoneal nicotine administered in divided doses

Nicotine base was used in a conditioned taste aversion (CTA) paradigm to avert male Sprague-Dawley rats to saccharin solution (0.1%, w/v). Experiments investigated different dose routes of nicotine administration and duration of action as determinants in nicotine-induced CTA. In Experiment 1 nicotine was injected intraperitoneally (IP) at doses of 0.5, 1.0, or 3.0 mg/kg 30 min after drinking saccharin solution. Using a two-bottle choice test, no CTA was observed, although all nicotine animals showed obvious symptoms of malaise including seizures in the highest dose group. Experiment 2 showed dose-related CTA when nicotine (10.0, 30.0, or 50.0 mg/kg) was cutaneously applied 30 min following saccharin drinking. Experiment 2B showed that the aversions were due to associative rather than nonassociative factors such as sensitization or enhanced neophobia. In Experiment 3, the following group treatments were begun 30 min after saccharin drinking to distribute identical total nicotine doses over an extended period of time: One IP injection of 2.0 mg/kg nicotine (in a saline vehicle) and four injections of saline solution, three injections of 0.67 mg/kg nicotine and two injections of saline, five injections of 0.40 mg/kg nicotine, or five injections of saline. All injections were spaced 30 min apart. Compared with saline-injected controls, CTA occurred in the rats receiving either three or five injections of nicotine but the group receiving one injection did not differ from the control group. There was no difference in CTA between the groups receiving three or five injections.

Automatic prediction of platelet utilization by time series analysis in a large tertiary care hospital

The authors investigated the potential of various time series models to aid in the prediction of platelet utilization patterns at the authors' institution. During a seven-week feasibility study, prediction accuracy of time series models was slightly inferior to that of an experienced platelet transfusion coordinator. The models that adjusted for day-of-the-week variability were superior to simpler models in a prospective evaluation over a three-month period. Conversion to a time series model for platelet utilization prediction has resulted in significant savings in personnel costs for management of platelet concentrate inventory in the blood bank. Outdate rates have been lower than those achieved by the platelet transfusion coordinator, with no sacrifice in availability occurring during the evaluation period.

Small lymphocytic lymphoma. Morphologic and immunologic progression

The large cell lymphoma (LCL) that occurs in patients with chronic lymphocytic leukemia (Richter's syndrome) has generally been shown to be of the same light chain type as the original chronic lymphocytic leukemia (CLL). The authors now report on a patient with diffuse well-differentiated lymphocytic lymphoma (WDL) of the kappa light chain type who in the course of his illness first had the blood picture of CLL and then developed malignant lymphoma of large cell ("histiocytic") type, which expressed lambda light chains. Despite an extensive multiparameter investigation, we could not determine with certainty whether the presence of two morphologically and immunologically different lymphomas represented proliferation of two distinctly separate clones or whether it represented clonal evolution of the disease with an alteration in immunoglobulin light chain associated genes. The results of the study, however, suggest that the development of lymphoma with expression of a different immunoglobulin light chain may not necessarily indicate the occurrence of a second primary. This study also illustrates the necessity for sequential lymph node biopsies to document progression of disease in patients with low-grade lymphoproliferative disorders and indicates that the immunologic phenotype of a B-cell neoplasm in a given patient should not be assumed to remain constant.

Platelet crossmatch tests using radiolabelled staphylococcal protein A or peroxidase anti-peroxidase in alloimmunized patients

Refractoriness to random-donor platelets as a result of alloimmunization remains a major problem in long-term platelet transfusion therapy despite the use of HLA-matched platelets. We have therefore studied the use of two methods for detection of platelet associated IgG as platelet crossmatch tests for the selection of platelet donors. These methods use radiolabelled staphylococcal protein A (125I-SPA) and peroxidase anti-peroxidase (PAP), respectively. One hundred and ten crossmatch tests using 125I-SPA were performed retrospectively in 18 alloimmunized patients. The results indicated that the predictive value of a positive or a negative test was 87%; the sensitivity was 73% and the specificity was 95%. Results with the PAP test were similar. The HLA types were known for 48 donor-recipient pairs. With few exceptions, there was a correlation between the results of the platelet crossmatch tests and the effectiveness of platelet transfusion regardless of the degree of HLA match. These results indicate that platelet crossmatch tests may be valuable even when closely HLA matched donors are not available. A large-scale prospective study is warranted, particularly in highly immunized patients.

Liquid Chromatographic Determination of Hydrocortisone in Bulk Drug Substance and Tablets: Collaborative Study

A normal phase liquid chromatographic (LC) method for determining the hydrocortisone content of bulk drug substance, tablet composites, and individual tablets was subjected to a collaborative study by 6 laboratories. The results showed a mean recovery of 98.5% for an authentic tablet formulation and reproducibility coefficients of variation of 0.97, 1.6, and 2.7% for bulk drug substance, tablet composites, and individual tablets, respectively. Infrared (IR) and thin layer chromatographic (TLC) identification tests, also included in the collaborative study, were satisfactory. The LC method for determining hydrocortisone in bulk drug substance, tablet composites, and individual tablets, with IR and TLC identification, has been adopted official first action.

Outcome of bone marrow transplantation in patients with extramedullary involvement of acute leukemia

Infiltration of extrahemopoietic tissue with leukemic cells was evaluated as a prognostic indicator in 18 patients with acute leukemia undergoing bone marrow transplantation. When compared to 107 patients who did not have extramedullary leukemia at any time prior to marrow grafting, the patients with leukemic invasion into organs outside the hemopoietic system had a significant increase of leukemic recurrence and a significant decrease in survival after marrow transplantation. Extramedullary leukemia may be a negative prognostic indicator for bone marrow transplantation candidates.

Eye-pressing by visually impaired children

Many children with severely impaired sight exhibit stereotyped mannerisms. Visual self-stimulation, e.g. eye-pressing and light-gazing, normally is restricted to the visually impaired; prolonged eye-pressing is the most common. This behaviour depends on onset of visual impairment, age, degree and quality of residual light, type of ocular abnormality, the presence of additional handicaps, and the activities in which the child is involved. Children with bilateral optic-nerve defects never press their eyes; those with retinal disorders tend to press vigorously. A possible physiological explanation is that self-stimulation occurs when the demand of the brain for meaningful visual information is not adequately met.

Application of postcolumn ionization in the high-performance liquid chromatographic analysis of butabarbital sodium elixir

A sensitive postcolumn ionization high-performance liquid chromatographic (HPLC) method for the quantitative determination of butabarbital sodium in butabarbital sodium elixir is described. The procedure employs a octadecylsilane column chemically bonded to porous silica microparticles. The mobile phase is a mixture of methanol and water (typically 35:65), adjusted to provide separation of butabarbital from two degradation compounds and other formulation ingredients. A buffer (pH 10) added between the column and detector provides for the primary ionization of the barbiturate necessary for optimum UV-detector sensitivity at approximately 240 nm. Determinations are made using the sodium salt; thus the need for extraction of the free base is eliminated. The procedure is linear over the 0.3-0.9-mg/ml concentration range of butabarbital sodium. Reproducibility values for 10 injections of a single reference standard range from 100.2 to 100.8% of theoretical with a mean of 100.5% and a coefficient of variation of 0.23%. An interlaboratory precision study for blind duplicates of one simulated product formulation and two commercial elixirs produced coefficients of variation of 1.4, 1.3, and 1.1%, respectively. Recovery determinations for the drug in simulated product formulations ranged from 98.4 to 99.0%, intralaboratory, and 97.7 to 102.2%, interlaboratory. The HPLC procedure is stability indicating with respect to two decomposition products.

Bone marrow ablation followed by allogeneic marrow grafting during first complete remission of acute nonlymphocytic leukemia

Of 33 patients who had undergone allogeneic bone marrow transplantation during first complete remission of acute nonlymphocytic leukemia, 21 patients have now been followed in continued complete remission for 6-64 mo (median greater than 18 mo) without maintenance chemotherapy. The median age of the surviving patients is 27 yr. Transplant-related complications occurring throughout the first year after marrow grafting were fatal in 7 patients, and leukemic recurrence led to the death of 5 patients. The actuarial long-term disease-free survival is 60% and the actuarial remission rate is 79%.

Successful second bone marrow transplantation in a patient with myositis ossificans progressiva and aplastic anemia

Bone marrow transplantation has become the treatment of choice for patients with severe aplastic anemia who are fortunate enough to have allogeneic sibling donors. As patients have been transplanted earlier in the course of their disease, significant improvements have been obtained in long-term survival. However, in patients who have been sensitized by previous blood product transfusions, graft rejection continues to be a significant problem and second transplants when performed are frequently unsuccessful. This case report deals with a patient with myositis ossificans progressiva (MOP) who developed severe idiopathic aplastic anemia. He rejected his first graft after 160 days. However, he was successfully reingrafted with marrow from the same donor using a different conditioning regimen.

Platelet transfusion therapy in an alloimmunized patient. The value of crossmatch procedures for donor selection

A 51-year-old patient with acute myelogenous leukemia, who was alloimmunized to platelets, failed to show adequate platelet increments after receiving transfusions of HLA grade A-identical platelets. Only platelets from an HLA grade B-matching donor gave high increments. Several crossmatching procedures were used to select platelet donors. A correlation was seen between in vitro tests and in vivo response. HLA typing has limitations in the selection of platelet-compatible donors.

Reversal of acute ("malignant") myelosclerosis by allogeneic bone marrow transplantation

A 28-yr-old woman with acute malignant myelosclerosis received, as primary treatment, ablative chemotherapy and total body radiation therapy followed by bone marrow transplantation from her histocompatible brother. The patient is now well more than 15 mo after bone marrow transplantation, with normal peripheral blood counts, a normal bone marrow, no evidence of graft-versus-host disease, and is on no therapy. In light of the poor results obtained with conventional chemotherapy in this disease, bone marrow transplantation may represent the treatment of choice for patients who have an appropriate donor.

Viability and function of platelet concentrates stored in CPD-adenine (CPDA-1)

The effective use of CPDA-1 as an anticoagulant in routine blood banking practice requires demonstration that platelet concentrates prepared in this solution meet both in vitro quality control standards and maintain posttransfusion viability and function after storage. In this study of 138 units of CPDA-1 platelet concentrates, the average platelet count was 8.0 +/- 0.2 x 10(10) with 81 per cent of the units having greater than 5.5 x 10(10) platelets. The mean poststorage pH was 6.68 +/- 0.03 and only four of the units had a pH of less than 6.0 (3%). Residual plasma volume averaged 75 +/- 1 ml. Platelet viability was determined in 16 normal volunteers by measuring survival of 51Cr-labeled autologous platelets after storage for 72 hours at 22 +/- 2 C. Platelet recovery averaged 50 +/- 4 per cent, while survival was 7.3 +/- 0.4 days for the 15 units with a pH above 6.0. Measurements of posttransfusion platelet viability and function were made in 12 paients with thrombocytopenia secondary to marrow failure. Their mean pretransfusion platelet count was 17,000 +/- 2,000/microliter, and their standardized template bleeding times were all greater than 30 minutes. Platelet recovery averaged 44 +/- 5 per cent and survival 3.3 +/- 0.5 days. In seven of the patients with the best posttransfusion increments, bleeding time was improved. Five patients with poor posttranfusion platelet increments showed no improvement in bleeding time with CPDA-1; two of these patients were also transfused with CPD platelets and had no response. Our studies indicate that platelet concentrates prepared in CPDA-1 meet in vitro quality control standards and after transfusion, maintain viability and function comparable to that of CPD collected platelets.

Bone-marrow ablation and allogeneic marrow transplantation in acute leukemia

Thirty-three patients with acute leukemia (15 with lymphoblastic leukemia and 18 with myeloblastic leukemia) were entered into a program of high-dose radiochemotherapy followed by allogeneic bone-marrow transplantation. These patients were in various clinical stages of disease. Of 10 in complete hematologic remission at the time of transplantation, seven were alive without maintenance therapy at the time of evaluation, eight to 35 months after grafting; one was in relapse. Of 11 who received transplants during partial remission, six were in remission without further treatment eight to 33 months after transplantation. In 12 the disease was refractory to chemotherapy when preparation for transplantation was started, and only one of them was alive and free of disease after 10 months. Recurrent leukemia, graft-versus-host disease, viral pneumonia, and early therapy-related toxicity were the major causes of failure. High-dose chemotherapy and total-body irradiation followed by allogeneic marrow transplantation performed during complete or partial remission can produce long-term remission of acute leukemia.