BACKGROUND\nSeveral randomized clinical trials in chronic myeloid leukemia (CML) have reported better patient survival with interferon alfa (IFN alpha) than with standard chemotherapeutic agents, such as busulfan or hydroxyurea. However, the size and persistence of this survival benefit is uncertain. Our aim was to assess these reliably, both overall and in particular patient subgroups.\n\n\nMETHODS\nWe collaborated in a worldwide overview of all clinical trials in which patients with CML were randomly assigned to receive either IFN alpha as the main drug or standard chemotherapy. Trials were identified by electronic and hand searching of the medical literature and databases and by personal contact. Individual patient data were available for each of 1554 patients who had been randomly assigned to treatment in seven trials (German, Italian, British, French, Japanese, and \"Benelux\"). Intention-to-treat stratified logrank survival analyses were performed, reporting two-sided P values.\n\n\nRESULTS\nAlmost all of the patients in these trials had disease with the Philadelphia chromosome abnormality. Among those who did, the regimens that involved IFN alpha produced a statistically significantly better survival than those involving either hydroxyurea (P = .001) or busulfan (P = .00007) alone. The 5-year survival rates were 57% with IFN alpha and 42% with chemotherapy, with an absolute difference of 15% (standard deviation = 3%; P<.00001). There were no trials or subgroups of patients in which the treatment difference was statistically significantly different from the average.\n\n\nCONCLUSION\nFor patients with Philadelphia chromosome-positive chronic myeloid leukemia, the inclusion of IFN alpha in the therapeutic regimen produced substantially better 5-year survival than standard chemotherapy alone.

Interferon alfa versus chemotherapy for chronic myeloid leukemia: A meta-analysis of seven randomized trials

Impact of blood collection devices on clinical chemistry assays.

INTRODUCAO: Os pacientes submetidos ao transplante de medula ossea (TMO) necessitam de um acesso venoso seguro para a infusao da medula ossea. A implantacao de um cateter venoso central e parte da terapeutica, sendo o de Hickman o mais utilizado atualmente; entretanto, sua presenca impoe riscos, sendo a infeccao, o mais preocupante. OBJETIVO: Revisao integrativa da literatura, que teve como objetivo buscar e avaliar as evidencias sobre os cuidados de enfermagem relacionados ao cateter de Hickman. METODO: Para a selecao dos artigos utilizamos as bases de dados Lilacs, Medline, Cinahl e o periodico Bone Marrow Transplantation, e a amostra constituiu-se de 18 artigos. RESULTADOS: O curativo recomendado e o de poliuretano trocado a cada 7 dias. O metodo de coleta de sangue observado foi o de descarte, sendo que a dosagem de ciclosporina nao deve ser coletada da mesma via onde foi infundida. A reducao do numero de manipulacoes do cateter e considerada uma medida eficaz na prevencao e no controle de infeccao. CONSIDERACOES FINAIS: As evidencias extraidas dos estudos analisados podem auxiliar a implementacao de cuidados de enfermagem eficazes relacionados ao cateter de Hickman.

https://acta-ape.org/wp-content/uploads/articles_xml/1982-0194-ape-S0103-21002005000300008/1982-0194-ape-S0103-21002005000300008.pdf

O cuidado de enfermagem e o cateter de Hickman: a busca de evidências

Background: Patients submitted to Bone Marrow Transplantation (BMT) need a safe venous access for the infusion of bone marrow. The implantation of a central venous catheter is a part of therapy, with Hickman’s catheter as the most commonly used type; however, its presence entails risks, the most preoccupying of which is infection. Objective: Integrative literature review aimed to look for and evaluate evidence on nursing care related to Hickman’s catheter. Method: Articles were selected from the Lilacs, Medline and Cinahl databases and from the journal Bone Marrow Transplantation. The sample consisted of 18 articles. Results: Polyurethane dressings are recommended, to be changed every 7 days. The observed blood collection method was through discarding, in which the cyclosporine dose should not be collected from the same pathway it was infused in. Reducing the number of catheter manipulations is considered an efficient measure for infection prevention and control. Conclusion: The evidence taken from the studies that were analyzed can be of help in the implementation of efficient nursing care related to Hickman’s catheter.

Nursing care and Hickman's catheter: the search for evidence El cuidado de enfermeria y el catéter Hickman: la búquela de evidencias O cuidado de enfermagem e o cateter de Hickman: a busca de evidências*

Background Our objective was to compare the accuracy of drug levels in blood samples obtained from central venous catheters with those from peripheral blood samples taken to monitor various drug levels. Methods Pediatric patients with central venous catheters receiving aminoglycosides, vancomycin, or cyclosporine had central and peripheral blood samples obtained within 5 minutes of each other and analyzed simultaneously. We ascertained how well blood levels from central venous catheters compared with those from peripheral blood (the criterion standard). Results There were no clinically significant differences between central and peripheral values for amikacin, gentamicin, tobramycin, and vancomycin (both peaks and troughs). Preliminary data indicated that oral cyclosporine can be monitored via central venous catheter. In contrast, there was poor agreement between peripheral and central values when cyclosporine was administered by IV. Conclusions Amikacin, gentamicin, tobramycin, vancomycin, and probably oral cyclosporine can be monitored accurately via central venous catheter. In contrast, IV cyclosporine should be monitored via peripheral blood.

Central venous catheters versus peripheral veins for sampling blood levels of commonly used drugs

In order to assess the suspected influence of indwelling lines on the measurement of cyclosporine (CSA) blood levels, we evaluated CSA concentrations in samples drawn simultaneously from both silicone catheter lumens and peripheral veins of eight bone marrow transplant recipients. Blood samples were obtained at 30 min or 6-12 h after discontinuation of intravenous CSA. CSA concentrations were determined in whole blood by specific monoclonal antibody assay. Mean CSA levels from the lumen used for CSA administration were significantly higher than those from samples drawn from the second lumen (i.e., not used for CSA infusion) or peripheral vein. This difference, obtained when the infusion had been interrupted for 30 min, was still the case 6-12 h after discontinuation of CSA infusion. No difference was found between samples obtained from the second lumen and peripheral vein. These observations suggest that CSA might be adsorbed or bound by the silicon catheter and, thus, CSA blood level measurements may be misleading. The second lumen of the catheter or a peripheral vein should be used for accurate monitoring of CSA concentrations.

Monitoring of cyclosporine blood levels from central venous lines: a misleading assay?

Alte dosi di vp16 e tbi come regime di condizionamento per un secondo trapianto di midollo osseo allogenico

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Monitoring of cyclosporine blood levels from central venous lines: a misleading assay?

Alte dosi di vp16 e tbi come regime di condizionamento per un secondo trapianto di midollo osseo allogenico