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M M Bortin

Publications and source records attributed to M M Bortin.

At least 37 records · Page 2Linked to original sources
PubMed1992

Increasing utilization of allogeneic bone marrow transplantation. Results of the 1988-1990 survey.

OBJECTIVE: To determine the pattern and frequency of allogeneic bone marrow transplantation from related and unrelated donors from 1988 to 1990. DESIGN AND SETTING: Survey of 342 institutions in 47 countries. MEASUREMENTS: Numbers of patients receiving bone marrow transplantation for specific disease categories at institutions with active allogeneic bone marrow transplant programs. MAIN RESULTS: Patients (14,745) received allogeneic bone marrow transplantation between 1988 and 1990; of these, 1153 (8%) were from unrelated donors. Reasons for transplantation were acute leukemia (47%), chronic myelogenous leukemia (27%), lymphoma and other malignancies (10%), severe aplastic anemia (9%), and other nonmalignant diseases (7%). The number of allogeneic bone marrow transplants per million persons differed among countries, averaging 7.7 per million in North America and 5.7 per million in western Europe. CONCLUSIONS: The use of allogeneic bone marrow transplantation continued to increase at a rate of more than 600 additional patients and 25 new transplant teams annually. This rise is due in part to increasing use of unrelated volunteers as donors. Resources allocated for transplants vary widely among countries.

Bone Marrow Transplantation↗
PubMed1992

Current status of allogeneic bone marrow transplantation.

Use of allogeneic bone marrow transplants continues to increase. During the 36-year period between 1955 and 1990, more than 33,000 patients received allogeneic bone marrow transplants; more than 45% of these were performed during the 3 years 1988-1990. Transplants are effective therapy for leukemia and other hematologic diseases. It is widely considered that transplants are the treatment of choice for aplastic anemia and chronic myelogenous leukemia, those who fail conventional therapy for acute leukemia and a variety of genetic, metabolic and immune deficiency disorders. Successful application of bone marrow transplantation is limited by complications such as graft failure, graft versus host disease GVHD and interstitial pneumonia and, until recently, the requirement for an HLA-identical sibling donor. In the past few years, an increasing number of transplants were performed using unrelated or HLA-partially matched related donors with some success. Development of post-transplant complications can often be predicted by risk factor assessment. In this report, current data from the IBMTR are summarized and several risk factors affecting outcome identified.

Anemia, Aplastic↗
PubMed1992

Report from the International Bone Marrow Transplant Registry.

The number of allogeneic BMTs performed worldwide continues to increase. In addition, the characteristics of patients, donors, and selected treatments are changing. In BMT for leukemia during the 1980s there was a marked increase in transplants for early disease, the use of unrelated donors, and utilization of preparative regimens without radiation. Although treatment-related mortality declined during this period, there was only a modest decrease in relapse rates, indicating the need for more effective antileukemia strategies. The IBMTR collects data from many centers, and, as a consequence, it is uniquely suited to examine clinical situations in which patient accrual at a single institution would be insufficient for a study to be performed. In such analyses, BMT was shown to be an effective treatment for Ph1-positive ALL. Patients tended to have earlier relapses and lower probabilities of LFS than Ph1-negative ALL but the differences were not statistically significant. BMT was also shown to be effective in patients with acute leukemia failing to ever go into remission, most of whom would die within the first 6 months following diagnosis. The IBMTR is a premier example of international scientific collaboration. Its success is a consequence of the desire of investigators throughout the world to combine their clinical data for statistical analysis in order to accelerate and improve patient care.

Adolescent↗
PubMed1992

Progress report from the International Bone Marrow Transplant Registry.

The International Bone Marrow Transplant Registry receives and analyses detailed information contributed by more than 200 transplant teams worldwide. This collaborative research program has grown rapidly; there are now more than 15,000 cases in the database. This progress report summarizes the current status of bone marrow transplantation, the results of recent investigations and studies planned for the coming year.

Anemia, Aplastic↗
PubMed1992

Therapy decisions in leukemia.

Complex factors determine how physicians select between alternative therapies. We conducted a survey of 352 leukemia experts to determine consensus regarding optimal treatment for leukemia and to identify factors correlated with therapy decisions. The study evaluated both general treatment policies and recommendations for specific clinical situations. Responses of chemotherapy, allotransplant and autotransplant experts were compared. Although responses of these groups were similar for general treatment policies, recommendations for specific cases differed substantially. Interestingly, responses of the three groups to some clinical situations also differed from conclusions of several published studies examining these issues. These data suggest that experts may discount published results in favor of personal experiences, perceptions of the best treatment strategy (based on published data or not) or available resources.

Adult↗
PubMed1992

Progress in allogeneic bone marrow transplantation for acute lymphoblastic leukemia in the 1980's: a report from the IBMTR. The International Bone Marrow Transplant Registry.

Among patients with ALL and irrespective of disease state at transplant, highly significant improvements in treatment-related mortality, relapse and leukemia-free survival were observed during the 1980's. Although these results are encouraging, further reductions in treatment-related toxicity and posttransplant relapse are needed to achieve additional advances in the 1990's.

Bone Marrow Transplantation↗
PubMed1991

Use of a clinical data registry to evaluate medical technologies. Experience from the International Bone Marrow Transplant Registry.

We reviewed the 18 disease-specific evaluations that used the data base of the International Bone Marrow Transplant Registry to determine the effectiveness of alternative strategies for bone marrow transplant. We identify 17 treatment variables that physicians can control and report the associations between these variables and five clinical endpoints: stable engraftment, graft-versus-host disease, development of interstitial pneumonia, relapse, and disease-free survival. We also suggest policies to promote active participation in establishing and operating a registry.

Bone Marrow Transplantation↗
PubMed1990

Current status of allogeneic bone marrow transplantation.

Use of allogeneic BMTs continues to increase. During the 33-year period between 1955 and 1987, more than 20,000 patients received allogeneic BMTs; more than 50% of these were performed in the 3 years, 1985 through 1987. Transplants are effective therapy for leukemia and other hematologic diseases. They are the treatment of choice for aplastic anemia and chronic myelogenous leukemia, those who fail conventional therapy for acute leukemia, and a variety of immune deficiency disorders. Successful application of BMT is limited by complications such as graft failure, GvHD and interstitial pneumonia, and, until recently, the requirement for an HLA-identical sibling donor. In the past few years, an increasing number of transplants was performed using HLA partially matched related or unrelated donors, with some success. The development of posttransplant complications can often be predicted by risk factor assessment. In this report, current data from the IBMTR are summarized and several risk factors affecting outcome identified.

Anemia, Aplastic↗
PubMed1989

Increasing utilization of bone marrow transplantation. II. Results of the 1985-1987 survey.

The International Bone Marrow Transplant REgistry conducts periodic surveys to determine activity in the field of allogeneic and syngeneic bone marrow transplantation. Data were reported to the IBMTR by 258 institutions in 41 countries regarding their patients who received bone marrow transplants during the period 1985-1987. To the best of our knowledge, the data represent essentially all bone marrow transplants (exclusive of autologous transplants) performed in the past 3 years. A total of 10,887 patients received bone marrow transplants; 73% were for leukemia, 11% for other malignant diseases, 9% for severe aplastic anemia and related disorders, 3% for immune deficiency diseases, 2% for thalassemia major, and 2% for genetic, metabolic, and several other rare diseases. 161 (62%) of the 258 institutions performed fewer than one transplant per month. More than 50% of the patients were transplanted in 37 institutions. 46% of the world's bone marrow transplants were performed in North America, 42% in Western Europe, 5% in Asia, 3% in Australia and New Zealand, 2% in the Mideast and Africa, 1% in South and Central America, and 1% in Eastern Europe and the USSR. The data reflect continued growth in utilization of allogeneic and syngeneic bone marrow transplantation and quantify the annual increases in the number of patients receiving transplants.

Anemia, Aplastic↗
PubMed1989

Risk factors for interstitial pneumonia following bone marrow transplantation for severe aplastic anaemia.

Data from 547 patients with aplastic anaemia who received bone marrow transplants from HLA-identical siblings were analysed to determine factors associated with the risk of interstitial pneumonia (IPn). IPn developed in 92 patients (17%). 37% of cases were associated with cytomegalovirus infection and 22% with other organisms; in 41% of cases no organism was identified. The case fatality rate was 64%; the mortality rate due to IPn was 11%. In multivariate analysis, four factors were associated with an increased probability of interstitial pneumonia: use of methotrexate rather than cyclosporine after transplantation (relative risk, 2.8; P less than 0.0008); occurrence of moderate to severe acute graft-versus-host disease (relative risk, 2.2; P less than 0.002); inclusion of total body radiation in the pretransplant preparative regimen (relative risk 2.2, P less than 0.004); and patient age greater than 20 (relative risk 1.7, P less than 0.002). The probability of IPn ranged from 4% for patients with none of these adverse risk factors to 51% (relative risk of 13.4) for patients with all four. The incidence of IPn decreased significantly between 1978 and 1985, paralleling a decrease in the use of total body radiation pretransplant for immune suppression and methotrexate post-transplant for prophylaxis against graft-versus-host disease.

Adolescent↗
PubMed1989

Current status of bone marrow transplantation.

Utilization of bone marrow transplantation as a therapeutic modality continues to increase. More and more institutions are initiating bone marrow transplant programs. During the 33-year period between 1955 and 1987, more than 20,000 patients received allogeneic bone marrow transplants; more than 50% of these were performed in the 3 years, 1985-1987. Transplantation is an effective therapy for acute leukemia; in some instances it is the preferred treatment. In chronic myelogenous leukemia, severe aplastic anemia, and some genetic and immune deficiency diseases, bone marrow transplantation provides the only possibility for cure. Bone marrow transplantation is associated with serious problems such as graft-versus-host disease (GvHD), graft failure, interstitial pneumonitis and, until recently, the requirement for an HLA-identical sibling donor. In the past few years, an increasing number of transplants have been performed using HLA-partially matched related or unrelated donors with some success, the level of which is yet to be determined. The development of acute GvHD (8) and interstitial pneumonitis (9, 10) can often be predicted by risk factor assessment. Special precautions can then be taken for patients at high risk of these complications. In this report, current data from the International Bone Marrow Transplant Registry were summarized and several risk factors affecting outcome were identified.

Anemia, Aplastic↗
PubMed1989

Consensus among bone marrow transplanters for diagnosis, grading and treatment of chronic graft-versus-host disease. Committee of the International Bone Marrow Transplant Registry.

A questionnaire comprised of a series of clinical vignettes illustrating potential difficulties in diagnosis, grading and treatment of chronic graft-versus-host disease (GVHD) was completed by 65 bone marrow transplant physicians from 51 transplant centers worldwide. The concordance index (CI) for responses to each question was calculated using the formula CI = 2p-1, where p was the percentage agreement among respondents. Possible responses ranged from 0 (no agreement) to 1.00 (perfect agreement). Responses indicated moderate (CI = 0.55), high (CI = 0.88) and moderate (CI = 0.54) agreement among transplanters for diagnosis, grading and treatment of chronic GVHD, respectively. Disagreement was observed in (1) diagnosis of uncommon manifestations of chronic GVHD; (2) in interpretation of symptoms which occur less than 2 months after transplant; (3) in interpretation of persistent stable symptoms; and (4) in deciding whether to treat chronic GVHD limited to skin. The results point to potential problem areas in designing and interpreting clinical trials to prevent or treat chronic GVHD and highlight the need for improved diagnostic criteria.

Adolescent↗