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PubMed1997

Productivity and quality improvements in health care through airboss mobile messaging services.

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks, and cross media delivery and notification. It provides seamless wide area access to patient data in a secure environment, thus providing a continuity of care from the hospital to home.

Home Care Services↗

PubMed1999

[Transfer possibilities of the mobile phases between different liquid chromatographic techniques for the analysis and isolation of compounds of biological matrices].

After the survey and characterisation of the solid/liquid chromatographic methods, the author summarized the features of overpressure layer chromatography; the disturbing zone and the multi-front effect as well as the elimination of their influence. In light of these effects, the strategy of the mobile phase transfer possibilities is demonstrated between the various analytical and preparative liquid chromatographic methods, with the OPLC playing a central role. The main point of this strategy is that the examination of biological matrices is always begun with unsaturated TLC chamber, in which the compounds to be separated are placed between the Rf values of 0.3 and 0.8. The optimized TLC mobile phase is transferred without changes to the OPLC technique where a prerun is applied. For separation of nonpolar compounds, the prerun can be performed with hexane; for separation of polar substances the prerun can be performed with any component of the mobile phase in which the components are unable to migrate. The selection of this solvent might be considered during optimization of the mobile phase. Using HPTLC chromatoplate and analytical OPLC technique, highly effective separation can be achieved. The scaling-up for the various preparative chromatographic systems can be performed on basis of the applied chromatographic circumstances. The dry-filled preparative (FC, LPLC, MPLC) columns can be equilibrated with the solvent used for the prerun in analytical OPLC, while in case of filling with slurry technique, the slurry has to be prepared using the same solvent as was used for the prerun of OPLC. The air bubbles can be eliminated in both cases by pumping over the appropriate quantity of the solvent used for prerun, afterwards the preparative separation can be started with the optimized unsaturated TLC mobile phase. The author deals separately with the mobile phase transfer possibilities between the different analytical and preparative planar (OPLC and RPC with various chamber types) chromatographic techniques, where the saturation of the vapour phase is the determinant. The strategy is demonstrated through various plant extracts. The mobile phase transfer possibilities between the different solid-liquid chromatographic methods are summarized in comprehensive figures. Figure 13 demonstrates the direct transfer possibilities, different lines show those applicable with various methods: dotted line stands for off-line and thin line for on-line methods, while the ones marked with thick line ensure the transfer of the optimized mobile phase without change between different solid-liquid planar and column chromatographic techniques in case of both--off-line and on-line--procedures.

Chromatography, High Pressure Liquid↗

PubMed2001

Impaired mobility in older persons attending a geriatric assessment clinic: causes and management.

OBJECTIVES: To study the profile of older persons with impaired mobility. METHODS: A retrospective observational study that reviewed the case records of patients with impaired mobility at a geriatric assessment clinic. Data on mobility status, duration of decline in mobility, functional status, causes, intervention and short-term outcome (up to 16 weeks) were extracted and analysed. RESULTS: The study included 78 patients (42 males) with the median age of 78 years (61 to 96). About 80% had independent premorbid mobility. At presentation, this declined to 45%. Delayed consultations (more than 2 years) were found in 17% of patients. One third had associated decline in transfer, dressing, toileting or bathing, while 19% also had decline in feeding. In each patient, cause(s), many which were potentially reversible, were identified to have contributed to the immobility. More than one cause was identified in half of the patients. Interventions were prescribed in 88% of these patients. Short-term follow-up (median 7 weeks) showed that 21 had an improvement, 35 had the same and 8 had decline in mobility. There was a significant trend towards better outcome when patient presented early during their course of decline in mobility (p=0.005, linear by linear association = 0.013). CONCLUSION: Impaired mobility is a common pathway for many diseases, and is associated with significant functional decline. With proper evaluation, the offending causes can be identified. Early consultation is important for the application of appropriate intervention and can result in better outcome.

Activities of Daily Living↗

PubMed2003

Effect of environmental setting on mobility methods of children with cerebral palsy.

The aim of this study was to: (1) describe the usual mobility methods of children with cerebral palsy (CP) at home, school, and outdoors or in the community and (2) examine whether children with CP are more dependent on adult assistance for mobility in certain settings. The participants were a stratified random sample of 636 children with CP (355 males and 281 females; 2 to 12 years of age, mean 6.8 years SD 2.7), receiving rehabilitation services in Ontario, Canada. Children were grouped by age and Gross Motor Function Classification System (GMFCS) level. Among the five levels of the GMFCS, there were 185 children classified at level I, 81 children at level II, 113 children at level III, 132 children at level IV, and 125 children at level V. Information on children's usual mobility was obtained by parent report. The results of logistic regression indicated that compared with the school setting, children were more dependent on adult assistance for mobility when outdoors/in the community and less dependent at home. The majority of children aged from 4 to 12 years at levels III to V used wheelchair mobility at school and outdoors or in the community, however, only a small percentage self-propelled their wheelchair or used powered mobility. Of the children aged 4 to 12 years at level V, 39% were carried at home. The findings suggest that environmental setting is an important consideration for assessment and intervention to improve mobility of children with CP. For children who do not walk, attention should be given to the needs of caregivers and factors that are important for successful powered mobility.

Activities of Daily Living↗

PubMed2002

Influence of organic acids on the mobility of heavy metals in soil amended with some insecticides.

The mobility (Rf value) of some heavy metals, such as: Co, Zn, Ag, Cu, and Pb was measured through soil amended with some insecticides, such as: endosulfan, chlorpyrifos, dimethoate and methyl demeton using distilled water, formic, acetic and oxalic acids as mobile phase. The enhancement in the mobility of metal ions in all the amended soils formic, acetic and oxalic acids as mobile phase. The enhancement in the mobility of metal ions in all the amended soils followed the order: Co > Zn > Ag > Cu > Pb. On the otherhand the mobility followed the order: endosulfan > chlorpyrifos > dimethoate > methyl dementon for the amended insecticides and the order: formic > acetic > oxalic acids for the mobile phase in natural as well as amended soils. Mobility of ions increased upto a concentration of 0.25 mg 100 g-1 of soils thereafter it was decreased in all the systems. The results have been explained on the basis of the nature of heavy metals, insecticides, organic acids and the solubilities of the salts formed in the soil-insecticide-amended systems.

Chlorpyrifos↗

PubMed2004

Association of mobile phone radiation with fatigue, headache, dizziness, tension and sleep disturbance in Saudi population.

OBJECTIVE: The widespread use of mobile phones has been increased over the past decade; they are now an essential part of business, commerce and society. The use of mobile phones can cause health problems. Therefore, the aim of the present study is to investigate the association of using mobile phones with fatigue, headache, dizziness, tension and sleep disturbance in the Saudi population and provide health and social awareness in using these devices. METHODS: This study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the year 2002 to 2003. In the present study, a total of 437 subjects (55.1% male and 39.9% female) were invited, they have and had been using mobile phones. A questionnaire was distributed regarding detailed history and association of mobile phones with health hazards. RESULTS: The results of the present study showed an association between the use of mobile phones and health hazards. The overall mean percentage for these clinical findings in all groups were headache (21.6%), sleep disturbance (4.%), tension (3.9%), fatigue (3%) and dizziness (2.4%). CONCLUSION: Based on the results of the present study, we conclude that the use of mobile phones is a risk factor for health hazards and suggest that long term or excessive use of mobile phones should be avoided by health promotion activities such as group discussions, public presentations and through electronic and print media sources.

Adolescent↗

PubMedDate not supplied

Reliability of first ray position and mobility measurements in experienced and inexperienced examiners.

CONTEXT: Neither reliability nor validity data exist for the Root method of clinically assessing first ray position or mobility by experienced and inexperienced examiners. OBJECTIVE: To determine intrarater and interrater reliability for first ray position and mobility measurements in experienced and inexperienced examiners. DESIGN: Single-blind prospective reliability study. SETTING: Physical therapy clinic. PATIENTS OR OTHER PARTICIPANTS: Four examiners, 2 experienced and 2 inexperienced, obtained first ray position and mobility measurements. Both feet of 36 subjects (14 males, 22 females) were measured. INTERVENTION(S): Each examiner evaluated first ray position and mobility for each of the subjects' feet on 2 separate occasions using the manual assessment techniques described by Root. MAIN OUTCOME MEASURE(S): First ray position (normal, plantar flexed, dorsiflexed) and mobility (normal, hypermobile, hypomobile) decisions were made. RESULTS: We calculated kappa correlation coefficients for intrarater and interrater reliability. For position, intrarater and interrater reliability ranged from .03 to .27 for all examiners, experienced and inexperienced. For mobility, intrarater and interrater reliability ranged from .02 to .26 for experienced, inexperienced, and experienced/inexperienced. The percentage agreement (P(O)) values for all examiners were less than 58%. For individual values for position, intrarater and interrater reliability ranged from .00 to .26. For individual values for mobility, intrarater and interrater reliability ranged from .00 to .26. The P(O) values for all examiners were less than 50%. CONCLUSIONS: Clinical experience was not associated with higher kappa coefficients or P(O) values when examiners assessed first ray position or mobility. Clinicians should acknowledge the poor reliability of first ray measurements, especially when making treatment decisions. Finally, a validity study to compare the Root techniques with a gold standard is warranted.

Journal Article↗

PubMed2006

Mobile phone and young people. A survey pilot study to explore the controversial aspects of a new social phenomenon.

AIM: Aim of this paper is to report the results of a pilot study as a part of a program addressed to health promotion and to improve the culture of sustainability in the school. METHODS: A 15-items structured questionnaire was administered to 1 011 students (aged 9-18 years) in order to explore the entity of the phenomenon of mobile telephony among the young and qualitatively esteem the level of exposure to the potential adverse health and social effects of such dominant form of electronically mediate communication. This preliminary information was then deepened by in-group interviews focused to clarify the cultural basis of the phenomenon. RESULTS: The survey-study confirmed that the penetration of mobile telephony among the young matches with the national trend: 96% of 14-18-teens own at least one mobile phone; 22% of them own multiple mobile phones. In addition, most of them use mobile phone all the day; a third makes calls over 6 minutes long; half is poorly informed about the potential health risks related to ''electromagnetic pollution''. CONCLUSIONS: Despite the most perceive mobile phone like something noxious, only 23% holds it far from body; a very small percentage uses a hands-free kit. Most declared to suffer from a sort of addiction towards mobile phone. In the light of a growing literature and of a supposed more vulnerability of children and adolescents towards toxicants than adults, we believe that health and school operators should inform parents and the young about the possible risks linked to the abuse of technology and promote a more critic and responsible approach to mobile phone.

Adolescent↗

PubMed2006

Early mobilization after aortic valve surgery.

In recent years, the focus in peri-operative care of cardiac patients has shifted from trying to create a stress-free environment to hasten the recovery of patients by providing early extubation, early mobilization, and enteral nutrition. Fast-track cardiac surgery has therefore made a paradigm shift in postoperative care. However, evidence on the safety of early postoperative mobilization in high-risk groups like aortic valve replacement surgery is lacking. Physiological evidence from controlled studies in patients undergoing aortic valve replacement (AVR) showed that heart rate increases and stroke volume falls with maintenance of cardiac output. However, the increase of 50% to 60% of oxygen consumption during mobilization is covered by increased oxygen extraction, resulting in marked mixed venous oxygen desaturation. These physiological changes during postoperative mobilization were also seen in CABG patients. The mobilization pattern was also maintained on the second day after surgery. No serious side effects were observed in the controlled trials of mobilization of AVR patients after cardiac surgery. Over a 13-year period, we have mobilized more than 1200 AVR patients. No serious situations have occurred during or in direct connection to mobilization.

Aortic Valve Insufficiency↗

PubMed1991

[The role of stem cell mobilization in the scope of autologous blood stem cell transplantation].

It is widely believed that hemopoietic stem cells have to be mobilized from extravascular sites into the circulation to guarantee a sufficient and safe blood stem cell autograft. The question of using mobilized or non-mobilized stem cells for transplantation purposes addresses the quality of hemopoietic engraftment rather than its feasibility. Two aspects are of clinical relevance: 1. The increment of peripheral cell concentration per time, and 2. shortening the duration of total aplasia following myeloablation and stem cell transplantation. When comparing the various stem cell mobilization techniques the CFU-GM yield per apheresis was highest during rh GM-CSF application (250 micrograms/m2/day continuous i.v. infusion), whereas the MNC yield was not greatly affected. More severe side effects were seen during rh GM-CSF infusion: One patient experienced an axillary phlebothrombosis. In a series of 15 advanced stage Hodgkin's lymphoma patients the reconstitutive ability of the various stem cell autografts, whether chemotherapy-, cytokine-, or non-mobilized, did not vary. Particularly in acute leukemias, mobilization of hemopoietic precursor cells does not necessarily exclude a concomitant mobilization of clonogenic tumor cells, and, therefore, the probability of disease-free survival after ABSCT might be lower when using mobilized stem cells for transplant.

Blood Component Transfusion↗

PubMed1989

Ca2(+)-mobilizing hormones stimulate Ca2+ efflux from hepatocytes.

Treatment of hepatocytes with 2,5-di-(tert-butyl)-1,4-benzohydroquinone (tBuBHQ), a novel mobilizer of the inositol 1,4,5-trisphosphate-sensitive Ca2+ pool, produces a sustained elevation of [Ca2+]i (Kass, G. E. N., Duddy, S. K., and Orrenius, S. (1989) J. Biol. Chem. 264, 15192-15198). Exposure of hepatocytes to the Ca2(+)-mobilizing hormones, vasopressin, angiotensin II, or ATP following [Ca2+]i elevation by tBuBHQ produced a rapid return of [Ca2+]i to basal or near basal levels. Release of the inositol 1,4,5-trisphosphate-sensitive Ca2+ pool by tBuBHQ following pretreatment with vasopressin or angiotensin II resulted in a [Ca2+]i transient and not the sustained [Ca2+]i elevation observed in the absence of the Ca2(+)-mobilizing hormones. The G-protein activator, NaF plus AlCl3, mimicked both effects of the Ca2(+)-mobilizing hormones on [Ca2+]i. The mechanism for Ca2+ removal from the cytosol by Ca2(+)-mobilizing hormones did not involve cyclic nucleotides nor did it require protein kinase C activation or cyclo- and lipoxygenase-dependent metabolites of arachidonic acid. Furthermore, the hormone-mediated decrease in [Ca2+]i did not involve the pertussis toxin-sensitive Gi-protein. Removal of the tBuBHQ-mobilized Ca2+ from the cytosol of hepatocytes by Ca2(+)-mobilizing hormones was mediated by stimulation of a Ca2+ efflux pathway. Thus, in addition to initiating [Ca2+]i transients by releasing Ca2+ from the inositol 1,4,5-trisphosphate-sensitive Ca2+ store and stimulating Ca2+ influx, Ca2(+)-mobilizing hormones also regulate the termination of the [Ca2+]i transient by stimulating a Ca2+ efflux pathway.

Animals↗

PubMed1988

Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment?

The need to assess functions such as mobility in elderly patients is increasingly recognized. Lacking other methods, clinicians may rely on the standard neuromuscular examination to evaluate mobility. Therefore, we checked the sensitivity of the neuromuscular examination for identifying mobility problems by comparing relevant neuromuscular findings with performance during four routine mobility maneuvers: (1) getting up from a chair, (2) sitting down, (3) turning while walking, and (4) raising the feet while walking. The subjects investigated were 336 elderly persons living in the community. Many subjects who performed poorly during mobility maneuvers did not have the corresponding neuromuscular abnormalities. For example, although hip and knee flexion are needed to sit down safely, abnormal hip flexion was found in only 15% and abnormal knee flexion in only 30% of the subjects who had difficulty sitting down. The relationship between neuromuscular findings and functional mobility was not predictable enough to rely on neuromuscular findings for identifying mobility problems. Therefore, a simple assessment that reproduces routine daily mobility maneuvers should be developed for use in the clinical care of elderly patients.

Activities of Daily Living↗

PubMed1978

Feasibility of early mobilization after acute myocardial infarction.

The purpose of the study was to determine the proportion of patients with acute myocardial infarction (AMI) for whom an early programme of mobilization, independent of sex and age was possible, and the main reasons for delay of mobilization. Mobilization according to the programme (sitting on day 2 and standing on day 3) succeeded for 49% of the 241 patients alive and conscious after the 1st day, and there were no significant difference with regard to age and sex. The main reasons for delayed mobilization were prolonged chest pain, conduction disturbances and pulmonary oedema. Discharge on day 10 was feasible for 58% of the 241 patients alive and conscious after the 1st day. The mean hospital stay of the patients discharged later than that was 17.3 days. The reasons for the delayed discharge were delayed mobilization, chest pain persisting while in the ward, reinfarction, social, and other reasons. Early programmed mobilization was thus feasible for almost half the patients, and mobilization had been started in over 90% of the patients by the 5th day. Nevertheless, the remarkably high proportion of readmissions (13.3% of all discharged patients) and reinfarctions (6.9%) within the 30 days following discharge may indicate disadvantages in the early mobilization of some patients.

Acute Disease↗

PubMed1995

Peripheral blood progenitor cells mobilized by recombinant human granulocyte colony-stimulating factor plus recombinant rat stem cell factor contain long-term engrafting cells capable of cellular proliferation for more than two years as shown by serial transplantation in mice.

Mobilized peripheral blood progenitor cells (PBPC) have been shown to provide rapid engraftment in patients given high-dose chemotherapy. PBPC contain cells with long-term engraftment potential as shown in animal models. In this study we have further analyzed mobilized PBPC for their ability to support serial transplantation of irradiated mice. Transplantation of recombinant human granulocyte colony-stimulating factor (rhG-CSF) plus recombinant rat stem cell factor (rrSCF) mobilized PBPC resulted in 98% donor engraftment of primary recipients at 12 to 14 months post-transplantation. Bone marrow (BM) cells from these primary recipients were harvested and transplanted into secondary recipients. At 6 months posttransplantation, all surviving secondary recipients had donor engraftment. Polymerase chain reaction (PCR) analysis showed greater than 90% male cells in spleens, thymuses, and lymph nodes. Myeloid colonies from BM cells of secondary recipients demonstrated granulocyte/macrophage colony-forming cells (GM-CFC) of male origin in all animals. In comparison, transplantation of rhG-CSF mobilized PBPC resulted in decreased male engraftment in secondary recipients. BM cells from secondary recipients, who originally received PBPC mobilized by the combination of rrSCF and rhG-CSF, were further passaged to tertiary female recipients. At 6 months posttransplantation, 90% of animals had male-derived hematopoiesis by whole-blood PCR analysis. These data showed that PBPC mobilized with rhG-CSF plus rrSCF contained cells that are transplantable and able to maintain hematopoiesis for more than 26 months, suggesting that the mobilized long-term reconstituting stem cells (LTRC) have extensive proliferative potential and resemble those that reside in the BM. In addition, the data demonstrated increased mobilization of LTRC with rhG-CSF plus rrSCF compared to rhG-CSF alone.

Animals↗

PubMed1995

A clinical method for measuring segmental flexion mobility in the cervico-thoracic spine and a model for classification.

Pain and limitation of spinal mobility are symptoms frequently reported by patients. Many methods have been used to assess the total range of mobility in the different parts of the spine, but there is no method for clinical examination of segmental mobility. The aim of this study was to describe such a technique concerning of segmental flexion mobility in the cervico-thoracic spine, C7-T5, and to present a model for classification of mobility. The results of this study show that the relative flexion mobility examined, according to the Cervico-Thoracic-Ratio technique (CTR), may become a valuable complement to conventional methods of assessing mobility in the cervical spine. The normalized CTR values are less influenced by the individual factors age, body weight, height and number of years at work and the classification model presented makes functional analysis of segmental flexion mobility in the cervico-junction and upper thoracic spine more substantial.

Adult↗

PubMed1995

Long-term cultures to evaluate engraftment potential of CD34+ cells from peripheral blood after mobilization by chemotherapy with and without GM-CSF.

In this study we used a long-term culture system to evaluate engraftment potential of human peripheral blood (PB) cells mobilized by chemotherapy (CT) associated or not with granulocyte-macrophage colony-stimulating factor (GM-CSF). In six patients who underwent blood cell transplantation, PB CD34+ cells were cultured after mobilization and were compared to CD34+ cells in steady state from PB and bone marrow (BM). Qualitative differences were shown between PBC samples obtained after CT with and without GM-CSF. Despite similar CFU-GM counts at culture initiation, GM-CSF-mobilized CD34+ cells might contain a lower proportion of primitive stem cells, as suggested by the significant decrease in CFU-GM numbers produced beyond week 5 compared to CT-mobilized CD34+ cells (p = 0.033). Likewise, the percentage of CFU-GM produced beyond week 5 in relation to initial input was significantly lower than steady-state PB (p = 0.039) and than CT-mobilized CD34+ cells (p = 0.033). However, this CFU-GM production with GM-CSF-mobilized PB CD34+ cells was not different from cultures with BMC CD34+ cells. These results suggest that GM-CSF can mobilize CFU-GM in the blood mainly by differentiation at the expense of the primitive stem cell compartment. It appears valuable to define clearly for each mobilizing procedure a particular threshold of CFU-GM which reflects sufficient numbers of primitive stem cells to ensure long-term engraftment.

Adolescent↗

PubMed1996

Potentiation of granulocyte colony-stimulating factor-induced mobilization of circulating progenitor cells by seven-day pretreatment with interleukin-3.

Granulocyte colony-stimulating factor (G-CSF) as a single agent is increasingly used for the mobilization of peripheral blood progenitor cells (PBPCs) for stem cell transplantation. In patients with perturbed hematopoiesis the mobilizing capacity of G-CSF alone may be inadequate. We have shown in rhesus monkeys that interleukin-3 (IL-3) pretreatment markedly potentiated the increase in PBPC numbers by subsequent administration of granulocyte/macrophage-CSF (GM-CSF). Here we studied the effect of IL-3 pretreatment on G-CSF-induced mobilization of PBPCs in 6 patients with Hodgkin's disease (n = 5) or non-Hodgkin's lymphoma (n = 1) who had low progenitor cell numbers because of previous chemotherapy. Patients were treated in cycle 1 with G-CSF at a dose of 5 microgram/kg/d for 5 days and, after a treatment-free interval, received cycle 2 consisting of 5 microgram/kg/d of IL-3 for 7 days followed by G-CSF again at a dose of 5 microgram/kg/d for 5 days. G-CSF alone increased the mean number of circulating colony-forming units-GM (CFU-GM) by 21-fold, the number of burst-forming units-erythroid (BFU-E) by 9-fold, and the number of CFU-mix by 24-fold over pretreatment values. Treatment with 5 microgram/kg/d of IL-3 for 7 days did not mobilize by itself but significantly potentiated G-CSF-induced mobilization of all progenitor cell types leading to a 56-, 15-, and 46-fold increase over baseline of CFU-GM, BFU-E, and CFU-mix numbers, respectively. In 2 patients in whom leukapheresis was performed after G-CSF alone the target number of 2 x 10(6)/kg CD34+ cells was not reached. However, leukapheresis after the IL-3/G-CSF combination obtained > or =2 x 10(6)/kg CD34+ cells in 3 of 6 patients, including both patients who had inadequate collection after G-CSF alone. In one patient adequate function of mobilized progenitors could be shown by the demonstration of rapid trilineage engraftment after infusion of progenitors after myeloablative chemotherapy. Seven-day pretreatment with IL-3 may be a useful mean to augment mobilization of circulating progenitors by G-CSF. The combination of IL-3 and G-CSF seems to allow the procurement of sufficient numbers of PBPCs in some patients who cannot be mobilized adequately by G-CSF alone.

Adult↗

PubMedDate not supplied

[Mobilization of peripheral blood stem cells with conventional chemotherapy].

Autologous peripheral blood progenitor cells (PBPC) rescue after high-dose chemotherapy has been used progressively as a form of treatment in some solid and hematologic tumors. This increasing use can be explained by both advantages of PBPC rescue over bone marrow rescue (decrease in the duration of marrow aplasia, reduction of platelet transfusions, earlier discharge from hospital, potential use in patients with inadequate bone marrow reserve) and the low number of aphereses (one or two) needed to collect a sufficient number of progenitor cells for autografting. High-dose chemotherapy is likely to be increasingly used after the results of two recently reported studies in which treatment with high-dose compared with standard-dose chemotherapy increases overall survival in metastatic breast cancer patients and relapsed lymphoma patients. After the initial use of unselected mobilizing regimens regardless of the patient characteristics and the tumor type, now it seems more useful to optimize this approach. Mobilization of PBPC can be obtained by several approaches. Moderate or high doses of single agent alone (e.g. cyclophosphamide 4-7 g/m2) or some hematopoietic growth factors alone (e.g. G-CSF, GM-CSF) have been proven to be adequate mobilizing agents. However, the use of hematopoietic growth factors alone may disadvantageously delay the start of an effective chemotherapy. An efficient mobilizing regimen requires the use of both chemotherapy and hematopoietic growth factors: the efficiency of mobilization was greater and with less side effects than chemotherapy alone. It was postulated that PBPC mobilization could be achieved only at hematopoietic recovery following myeloablative chemotherapy. Recently, it has been demonstrated that some standard-dose chemotherapy regimens associated with hematopoietic growth factors are efficient priming agents. We reported that standard-dose CEF chemotherapy plus filgrastim is a disease specific regimen (breast cancer) allowing PBPC mobilization without any relevant toxicity. The maximum release of PBPC has been observed at day 11. The optimal time for PBPC collection is predictable and aphereses can be guided by WBC counts. In conclusion, both standard and high dose chemotherapy are effective priming regimens. So presently a mobilizing regimen should be an effective disease specific chemotherapy program and should contain a hematopoletic growth factor. The choice between standard and high-dose chemotherapy can be based on patients characteristic and disease status.

Antineoplastic Agents↗