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In addition buy discount kamagra effervescent on-line erectile dysfunction medication with high blood pressure, lower hemoglobin levels were tolerated in acting buy kamagra effervescent online now erectile dysfunction quality of life, bridging agents such as low-molecular-weight or standard larger patients, for whom this value was 1200. If elective cardiac catheterizations were done, they were Limiting phlebotomy for laboratory testing is important because this performed 3 weeks before surgery to allow recovery from procedure- is frequently a source of signiﬁcant blood loss, particularly in 8 related anemia when possible. For surgeries needed within 48 patients hospitalized in intensive care units (ICUs). In fact, it is hours of cardiac catheterization, a vascular closure device was estimated that ICU patients can lose up to 1% of their blood volume recommended to reduce blood loss. Acute coronary syndromes were each day from phlebotomy alone, which becomes signiﬁcant with 20 managed medically, followed by coronary artery stent placement. Pediatric or low-volume microtainer tubes Patients were evaluated for bleeding risk factors and advised to can be used to minimize the volume of blood needed for laboratory discontinue use of alcohol and medications or supplements associ- testing, although they need to be manually inserted into the ated with an increased bleeding. Before surgery, aspirin (3-5 days) laboratory instruments, which requires more effort by laboratory and clopidogrel (7 days) were withheld. Postoperative surgical patients with simple outcome measures, such as length of care included warming patients to normothermia and avoiding stay and mortality, without matched control groups for compari- hypertension. If tolerated hemodynamically, positive end-expira- son. Methods of blood conservation for “bloodless medicine” to a patient) were used to maintain euvolemia. Cryoprecipitate or recombinant Low-volume microtainers for phlebotomy factor VIIa was used for bleeding unless patients were undergoing Tolerating lower hemoglobin levels coronary artery bypass, in which case factor VII was avoided. A low Diagnosing and treating anemia or other cytopenias threshold was recommended for reexploration if surgical bleeding Methods relevant only to surgical patients was suspected. Phlebotomy was minimized with low-volume tubes Early diagnosis and treatment of preoperative anemia for laboratory blood testing, point of care testing, and in-line blood Intraoperative autologous blood salvage draw systems. Coagulation proﬁles were avoided unless patients Intraoperative autologous normovolemic hemodilution were suspected of active bleeding. Erythropoiesis-stimulating agents Meticulous surgical technique Perioperative antiﬁbrinolytics (tranexamic acid, epsilon aminocaproic (ESAs) were administered in some cases, although more speciﬁc 8 acid) details were not provided. The comorbidities in JW patients were New methods of electrocautery similar to a large 2012 study of cardiac surgery patients, except for 20 Topical sealants and hemostatic agents renal failure, which was less common in the bloodless patients. Avoiding perioperative hypothermia Nonetheless, the JW patients undergoing either elective or urgent Intentional moderate hypotension cardiac surgery had similar outcomes to historical controls. Even patients who accept blood products may not be consid- comparing concurrent, non-risk-adjusted pregnant women showed a ered surgical candidates if premorbid conditions are thought to be 44-fold greater maternal mortality for patients who refused ABT associated with unacceptable surgical risks. Therefore, future stud- compared with patients who accept ABT. Further studies are Our recommendations for bloodless medicine needed to determine whether the estimated increase in mortality is Based on prior reports and our experience thus far, we follow 5 relevant to a more diverse patient population. We request establishing a Bloodless Medicine and Surgery Program to care for that all surgical patients seeking bloodless care obtain a preopera- such patients at our institution, we reported a risk-adjusted, propen- tive complete blood count as soon as possible, preferably at least 4-8 sity-score-matched retrospective case-control study of clinical out- weeks before the surgery. We typically recommend oral iron (325 comes for hospitalized patients who did not accept ABT (bloodless mg ferrous sulfate; 2-3 doses/day as tolerated) and a multivitamin patients; n 294) compared with a control group of patients supplemented with B12 and folate after we identify a patient (control patients, n 1157). Each bloodless microcytic or normocytic anemia is present, iron studies are patient was matched by associated risks to 4 control patients to recommended (ferritin, transferrin saturation, total iron binding increase the sample size and power to detect differences. Risk capacity), whereas serum B12 and RBC folate are performed if assessment in both the bloodless and control patients were estimated RBCs are macrocytic. For patients with microcytosis, an elevated using 3 well-established indices, including the Charlson index RBC count, and minimally elevated RBC distribution width, a (which estimates risks based on comorbidities and other factors),23 hemoglobinopathy variant screen is recommended (hemoglobin the APR-DRG complexity score (which estimates disease sever- variant with quantitative hemoglobin A2 and F). For patients ity),24 and, for surgical patients, the American Society of Anesthesi- undergoing cardiac surgery, our typical goal is to increase the ologists classiﬁcation (which estimates operative risk based on hemoglobin to the 14-16 gm/dL range when possible based on a systemic disease). Surprisingly, overall mortality was lower in the 13-14 who are undergoing cardiac surgery after consultation with bloodless group (0. In addition, the mean Typically, standard erythropoietin ( 20 000-30 000 IU) is given 3 discharge hemoglobin concentrations were also similar in the times before scheduled surgeries (usually administered 2-3 times bloodless and control groups (10. Total and direct hospital costs were 12% smaller patients for whom a higher preoperative hemoglobin is (P. A caveat to this and other outpatient ESA therapy, standard erythropoietin (20 000-30 000 IU) studies comparing bloodless patients with controls, however, is that is generally given subcutaneously due to the ease of administration. To our knowledge, whether the procedures take longer dialysis (usually 3 times weekly). When possible, we favor intrave- has never been reported. We also consider antiﬁbrinolytic therapy nous administration because absorption is not an issue and there under certain circumstances for intraoperative or postoperative have been no reports of anti-erythropoietin antibodies after intrave- bleeding. We also consider the RCV and occasionally notiﬁed of patients who are not of the JW faith, but expected blood loss when estimating an acceptable preoperative who decline to accept ABTs. In addition, we receive consultations hemoglobin value. Ideally, we prefer bloodless patients undergoing from services that prefer to avoid blood transfusions in speciﬁc higher blood loss procedures to have an RCV correlate of 1200. Most patients are seen by at least considered to be anemia, insurance companies decline to cover one member of our team, which includes a patient coordinator (who the costs for preoperative erythropoietin therapy and therefore it is also a JW congregation elder), 2 nurse coordinators, our bloodless is not administered. A subset of patients are willing to pay on program director (an anesthesiologist), or our hematology consul- their own for erythropoietin therapy. Low-volume, pediatric phlebotomy tubes are always recom- mended and placed at the bedside for all patients. A sign is posted on We recommend that all surgical patients be evaluated for a bleeding the patient doors reminding nurses and phlebotomists to use diathesis by detailed histories and, when indicated, undergo further low-volume tubes. We routinely limit laboratory testing to essential laboratory testing. We also use an in-line reinfusion device (SafeSet) to screened for response to desmopressin. We also advise patients to eliminate blood wastage during sampling from arterial and central discontinue supplements associated with an increased bleeding risk. Intravenous iron is given for The ﬁnal preoperative dose of low-molecular-weight heparin is patients with more severe anemia that is unresponsive to oral iron or typically given 48 hours before surgery. For patients with severe anemia and Blood salvage is paramount to patient safety when ABT is not an ongoing blood loss, we frequently recommended both intravenous option during surgical procedures associated with moderate to high iron (iron sucrose, 200 mg IV daily for 3-5 days contiguously or 3 blood loss, and has been life-saving in some cases. If patients have a signiﬁcant intravascular space during surgery. Blood is suctioned from the infection, we attempt to limit or avoid iron therapy when possible surgical site into a device (or cell saver) that includes an anticoagu- given the potential risk of exacerbating infection with iron adminis- lated reservoir, after which the blood is ﬁltered, washed, and tration. The end therapy, the anticoagulation therapy is stopped if bleeding is product, however, consists of only RBCs and saline, because signiﬁcant and the beneﬁts of stopping therapy appeared to out- plasma, clotting factors (factors XII, XI, X, IX, VIII, V, II, I), weigh the risks.
Goldstein DJ cheap kamagra effervescent american express keppra impotence, Lu Y generic 100 mg kamagra effervescent mastercard smoking weed causes erectile dysfunction, Detke MJ, Wiltse C, Mallinckrodt C, Demitrack MA. Duloxetine in the treatment of depression: a double-blind placebo-controlled comparison with paroxetine. Efficacy comparison of escitalopram and citalopram in the treatment of major depressive disorder: Pooled analysis of placebo-controlled trials. Second-generation antidepressants 139 of 190 Final Update 5 Report Drug Effectiveness Review Project 354. A comparison of antidepressant response in younger and older women. Herrera-Guzmann I, Gudayol-FerrÃ© E, Herrera-GuzmÃ¡n D, Hinojosa-Calvo E, Herrera-Abarca JE, GuÃ rdia-Olmos J. Effects of selective serotonin reuptake and dual serotonergicâ€“noradrenergic reuptake treatments on memory and mental processing speed in patients with major depressive disorder. Herrera-Guzman I, Herrera-Abarca JE, Gudayol-Ferre E, et al. Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on attention and executive functions in patients with major depressive disorder. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. Escitalopram in the treatment of major depressive disorder: a meta-analysis. Treatment of major affective disorder with fluvoxamine. Efficacy of escitalopram in patients with severe depression: a pooled analysis. March JS, Kobak KA, Jefferson JW, Mazza J, Greist JH. A double-blind, placebo- controlled trial of fluvoxamine versus imipramine in outpatients with major depression. A meta-analysis of clinical trials comparing the serotonin (5HT)- 2 receptor antagonists trazodone and nefazodone with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. Papakostas GI, Montgomery SA, Thase ME, Katz JR, Krishen A, Tucker VL. Comparing the rapidity of response during treatment of major depressive disorder with bupropion and the SSRIs: a pooled survival analysis of 7 double-blind, randomized clinical trials. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: a meta-analysis of individual patient data from 10 double-blind, randomized clinical trials. A meta-analysis of clinical trials comparing mirtazapine with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. Venlafaxine XR demonstrates higher rates of sustained remission compared to fluoxetine, paroxetine or placebo. Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline. Comparative efficacy between venlafaxine and SSRIs: a pooled analysis of patients with depression. Second-generation antidepressants 140 of 190 Final Update 5 Report Drug Effectiveness Review Project 369. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. Thase ME, Clayton AH, Haight BR, Thompson AH, Modell JG, Johnston JA. A double- blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability. A randomized, double-blind, 24-week study comparing the efficacy and tolerability of mirtazapine and paroxetine in depressed patients in primary care. Serotonin selective reuptake inhibitors in child and adolescent psychopharmacology: a review of published experience. Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Carmody T, Mayes TL. Fluoxetine in child and adolescent depression: acute and maintenance treatment. Do children and adolescents have differential response rates in placebo-controlled trials of fluoxetine? A double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. Efficacy, safety, and tolerability of venlafaxine XR in generalized anxiety disorder. Analysis of the rate of improvement of specific psychic and somatic symptoms of general anxiety disorder during long-term treatment with venlafaxine ER. Estimation of symptom-free days in generalized anxiety disorder. Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-compulsive disorder: a meta-analysis. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Nair NP, Bakish D, Saxena B, Amin M, Schwartz G, West TE. Comparison of fluvoxamine, imipramine, and placebo in the treatment of outpatients with panic disorder. Second-generation antidepressants 141 of 190 Final Update 5 Report Drug Effectiveness Review Project 384. Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder: a randomized open label trial. Fluvoxamine in civilians with posttraumatic stress disorder. Treatment of posttraumatic stress disorder with nefazodone. De Boer M, Op den Velde W, Falger PJR, Hovens JE, De Groen JHM, Van Duijn H. Fluvoxamine treatment for chronic PTSD: a pilot study. Fluoxetine versus placebo in posttraumatic stress disorder.
Treatment is aimed at controlling the inflammation generic kamagra effervescent 100mg overnight delivery erectile dysfunction treatment home, maintaining remission order generic kamagra effervescent pills erectile dysfunction nclex questions, and 17 preventing complications. Mild disease may be controlled with 5-aminosalicylate drugs or antibiotics. If the disease is resistant to these interventions or is more severe, corticosteroids are frequently used. If symptoms persist despite steroids or if the disease flares on tapering the steroids, immunomodulatory agents (azathioprine, 6-mercaptopurine, and methotrexate) often are instituted. Biologics may be warranted in patients with moderate to severe active Crohn’s disease who have had inadequate response to conventional therapy or are sometimes used in a “top-down” approach before other therapies. In general, all available medical therapies are Targeted immune modulators 16 of 195 Final Update 3 Report Drug Effectiveness Review Project implemented before surgical therapy is considered, except in cases of catastrophic complications 17 such as acute colonic obstruction, massive hemorrhage, or bowel perforation. Ulcerative Colitis Ulcerative colitis is a chronic inflammatory bowel disease that is characterized by mucosal ulceration, rectal bleeding, diarrhea, and abdominal pain, and is limited to the colon and rectal areas, unlike Crohn’s disease which causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach. The most common symptoms of ulcerative colitis are abdominal pain and bloody 18 diarrhea. Clinical diagnosis is most accurately made with colonoscopy or sigmoidoscopy. Treatment is aimed at reducing and maintaining remission of symptoms and 19 inflammation and prevention complications. Distal disease, limited to the region below the descending colon, may be reached by topical treatments. Mild disease may be controlled with oral and/or topical 5-aminosalicylate drugs. If the disease is resistant to these interventions or is more severe, corticosteroids are frequently used. In addition, infliximab has been approved by the US Food and Drug Administration for treatment of moderate to severe ulcerative colitis and is recommended by the American College of Gastroenterologists for patients who are steroid 18 refractory or who are steroid dependent despite adequate therapy with thiopurines. Indications for surgery include excessive bleeding, perforation, carcinoma, and toxic colitis. Plaque Psoriasis Plaque psoriasis is a chronically recurring, debilitating inflammatory disease that affects the skin, scalp, and joints. It is characterized by erythrosquamous scaling lesions and ranges in severity from mild to severe. Patients with moderate to severe disease experienced significant 20 deterioration of quality of life. The exact pathogenesis of plaque psoriasis is still unknown, however pathophysiological evidence suggests that an overproduction of proinflammatory 21,22 cytokines plays an important role. In particular, tumor necrosis factor levels and interleukin- 12 and interleukin-23 levels are increased in psoriatic lesions compared with healthy skin. The severity of plaque psoriasis is most commonly classified based on the percentage of body surface area involved. Mild psoriasis is defined as affecting less than 5% of the body surface area; moderate psoriasis affects 5% to 10%; and severe psoriasis is defined as more than 20,23 10% of the body surface area affected. The goal of plaque psoriasis treatment is to gain control of the disease process, decrease 24 the percentage of body surface involved, and achieve and maintain long-term remission. Conventional therapy includes topical treatments (e. In addition, biologic agents such as adalimumab, alefacept, efalizumab, etanercept, infliximab, and ustekinumab have been approved by the US Food and Drug Administration for the treatment of moderate to severe plaque psoriasis. Targeted immune modulators 17 of 195 Final Update 3 Report Drug Effectiveness Review Project Purpose and Limitations of Systematic Reviews Systematic reviews, also called evidence reviews, are the foundation of evidence-based practice. They focus on the strength and limits of evidence from studies about the effectiveness of a clinical intervention. Systematic reviews begin with careful formulation of research questions. The goal is to select questions that are important to patients and clinicians then to examine how well the scientific literature answers those questions. Terms commonly used in systematic reviews, such as statistical terms, are provided in Appendix A and are defined as they apply to reports produced by the Drug Effectiveness Review Project. Systematic reviews emphasize the patient’s perspective in the choice of outcome measures used to answer research questions. Studies that measure health outcomes (events or conditions that the patient can feel, such as pain, functional status, and quality of life) are preferred over studies of intermediate outcomes (such as radiological progression). Reviews also emphasize measures that are easily interpreted in a clinical context. Specifically, measures of absolute risk or the probability of disease are preferred to measures such as relative risk. The difference in absolute risk between interventions depends on the number of events in each group, such that the difference (absolute risk reduction) is smaller when there are fewer events. In contrast, the difference in relative risk is fairly constant between groups with different baseline risk for the event, such that the difference (relative risk reduction) is similar across these groups. Relative risk reduction is often more impressive than absolute risk reduction. Another useful measure is the number needed to treat (or harm). The number needed to treat is the number of patients who would need to be treated with an intervention for one additional patient to benefit (experience a positive outcome or avoid a negative outcome). The absolute risk reduction is used to calculate the number needed to treat. Systematic reviews weigh the quality of the evidence, allowing a greater contribution from studies that meet high methodological standards and, thereby, reducing the likelihood of biased results. In general, for questions about the relative benefit of a drug, the results of well- executed randomized controlled trials are considered better evidence than results of cohort, case- control, and cross-sectional studies. In turn, these studies provide better evidence than uncontrolled trials and case series. For questions about tolerability and harms, observational study designs may provide important information that is not available from controlled trials. Within the hierarchy of observational studies, well-conducted cohort designs are preferred for assessing a common outcome. Case-control studies are preferred only when the outcome measure is rare and the study is well-conducted. Systematic reviews pay particular attention to whether results of efficacy studies can be generalized to broader applications. Efficacy studies provide the best information about how a drug performs in a controlled setting. These studies attempt to tightly control potential confounding factors and bias; however, for this reason the results of efficacy studies may not be applicable to many, and sometimes to most, patients seen in everyday practice. Most efficacy studies use strict eligibility criteria that may exclude patients based on their age, sex, adherence to treatment, or severity of illness. For many drug classes, including the antipsychotics, unstable or severely impaired patients are often excluded from trials.
Rigshospitalet generic kamagra effervescent 100 mg online erectile dysfunction drug therapy, Blegdamsvej 9 buy kamagra effervescent with a mastercard erectile dysfunction treatment in qatar, 2100 Copenhagen O, Den- 20. The safety and therapeutic mark; Phone: 45-51943994; Fax: 45 43262546; e-mail: effectiveness of human red cells stored at -80 degrees C for as long jakobmoerkeberg@hotmail. Changes in natural and administered recombinant hormones. Robinson N, Schattenberg L, Zorzoli M, Mangin P, Saugy M. Interview with former Tour de France winner Floyd (“epoetins”) and future erythropoiesis-stimulating treatments. USADA Report on for the separation and immunological detection of PEGylated Lance Armstrong. Thomas Frei used micro-doses and water to avoid microdoses of rhEPO with the MAIIA test. Proteins and peptides bound to long-circulating liposomes. The effect of cobalt on the production of Funded-Research-Projects/. Damsgaard R, Munch T, Morkeberg J, Mortensen SP, Gonzalez- 39. Effects of blood withdrawal and reinfusion on signaling at the consensus HRE. Simonsen LO, Brown AM, Harbak H, Kristensen BI, Bennekou anti-doping strategies. Current and upcoming erythropoi- supplementation: prediction of cobalt levels in whole blood and esis-stimulating agents, iron products, and other novel anemia urine using a biokinetic model. Sison1 and Patrick Brown1 1Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD A 6-month-old girl was diagnosed with acute lymphoblastic leukemia (ALL). She has completed induction therapy and is currently in ﬁrst complete remission (CR1). You are asked by your resident if hematopoietic stem cell transplantation (HSCT) would beneﬁt infants with acute leukemia. Advances in risk stratiﬁcation, intensiﬁcation of therapy, and institution. OS in their pediatric ALL and acute myeloid leukemia (AML). Cure rates now infants with ALL was 67% and 3 of the 4 patients who underwent approach 85% in pediatric ALL and 60% in pediatric AML. However, infants with ALL, especially those less than 6 months of Jacobsohn et al described 16 infants with ALL who underwent age at diagnosis and those with rearrangements of the MLL gene, allogeneic HSCT in CR1. Woolfrey et al reported a rearrangements are associated with intermediate to poor prognosis single-institution experience of autologous and allogeneic HSCT in in both ALL and AML. Eapen et al reviewed data from the Center for International recent trials have intensiﬁed therapy and several studies have Blood and Marrow Transplant Research and the New York Cord explored the use of HSCT in CR1 in infant ALL and AML. Blood Placental Program to compare survival in children 18 months or younger with ALL (n 146) or AML (n 121) receiving We performed a MEDLINE search for articles published between transplantations using a matched sibling donor versus an unrelated January 1998 and May 2013 to examine the evidence for the use of donor. Using the keywords “leukemia,” “hema- cantly different between the 2 groups. There were also no differ- topoietic stem cell transplantation,” and “infant” yielded 529 ences in recurrence, leukemia-free survival, or OS by type of results. After further limiting the search to those in the English leukemia. Chessels et al reported the results of the United Kingdom language, we found 485 results. We reviewed each abstract and Medical Research Council Infant 92 study, which enrolled 86 determined that 13 articles adequately addressed our question, from 14 infants with ALL. There were no differences in event-free survival which we included an additional 3 articles from the bibliographies. Comparing those with prospective studies) in our review (Table 1). MLL-R who received HSCT and those who received chemotherapy alone also showed no differences in EFS ( 35% at 3 years for both Pui et al performed a retrospective study of 497 children and young treatments). Isoyama et al reported the results of the Japanese adults with MLL-rearranged (MLL-R) ALL who were treated by 11 MLL96 study, which assigned 42 infants with MLL-R ALL to cooperative groups and single institutions in the United States and 6 chemotherapy followed by HSCT in CR1 if an HLA-matched donor Europe. After adjusting for initial WBC count, age, and time to transplantation, infants with t(4;11) who underwent any HSCT was available and 13 infants with non-MLL-R ALL to chemo- therapy alone. After a median posttransplantation follow-up reported 26 infants with acute leukemia (10 ALL, 15 AML, 1 period of 615 days, 11 of the 19 MLL-R transplanted patients and 5 bilineal) who underwent autologous or allogeneic HSCT at 7 of the 8 MLL-R chemotherapy patients remained in complete Spanish hospitals. Kosaka et al reported the results of the subsequent in CR1, the 5-year DFS was 71% for all infants and 50% for those Japanese MLL98 study that enrolled 54 infants with ALL with a with MLL-R leukemia. Sanders et al reviewed a single-institution speciﬁc goal of early HSCT (within 3-6 months of diagnosis) in infants with MLL rearrangements. Eleven of 14 patients with receiving transplantations in the Interfant-99 study, an international MLL-R ALL who received transplantations in CR1 were in remis- trial that enrolled 297 infants with MLL-R ALL. Summary of studies included in review Time Chemotherapy Study Disease period HSCT (n) (n) Findings Comments Pui (2002)6 Infant t(4;11) ALL 1983-1995 28 103 Chemotherapy EFS 23%, Retrospective study of 11 OS 33% cooperative groups and Pui (2003)7 HSCT EFS 18%, OS 25% single institutions Marco8 Infant ALL and AML 1990-1998 22 in CR1 None 5-y DFS for HSCT in CR1 71% Retrospective, multi-institution; for all infants, 50% for MLL-R 5-y DFS for ALL 56%; 5-y infants DFS for AML 73% Sanders9 Infant ALL 1982-2003 40 None 3-y DFS overall 42%; 3-y DFS Retrospective, single for HSCT in CR1 76% institution; 62. Subgroup response to prednisone/prednisolone or elevated WBC count. Biology, risk underwent HSCT and 47 infants received chemotherapy alone. The stratiﬁcation, and therapy of pediatric acute leukemias: an 5-year EFS rate was 48. Kawasaki et al reviewed 35 infants with AML treated by the protocol for infants younger than 1 year with acute lymphoblas- Japan Infant Leukemia Study Group. Novel prognostic subgroups in childhood 11q23/MLL-rearranged acute myeloid the report compared with 20 of the 26 patients who received leukemia: results of an international retrospective study. Klusmann et al reported the results of alloge- 2009;114(12):2489-2496. Five-year DFS in children under the and unique issues in hematopoietic cell transplantation for age of 2 who underwent HSCT was 53% compared with 46% in infant leukemia. Favorable tion was stratiﬁed by MLL status, those with MLL-R who underwent outcome in infants with AML after intensive ﬁrst- and second- HSCT had a signiﬁcant improvement in both DFS and OS (67% and line treatment: an AML-BFM study group report. Outcome of treatment in the combined results of 125 infants with AML treated on the childhood acute lymphoblastic leukaemia with rearrangements AML-BFM-98 and AML-BFM-2004 studies. EFS and OS in high-risk infants with or without MLL-R 7. Clinical heterogeneity was not signiﬁcantly different and OS in high-risk infants was in childhood acute lymphoblastic leukemia with 11q23 rear- similar to that of older high-risk children. High survival rate in infant Heterogeneity between the reviewed reports, including differences acute leukemia treated with early high-dose chemotherapy and in chemotherapy and transplantation preparative regimens, time to stem-cell support.