Home > Search Results

Results: 1 to 20 of 99

Clear

We reviewed the evidence about the effect of adding retinoic acid as part of a postconsolidation therapy after intensive chemotherapy (high‐dose chemotherapy) followed by autologous (from the same person) bone marrow transplantation (haematopoietic stem cell transplantation) in people with high‐risk neuroblastoma. A consolidation therapy tries to destroy possible remnant cancer cells after a preceding therapy has achieved the elimination of detectable tumour. A postconsolidation therapy is applied after that consolidation therapy. The addition of retinoic acid was compared to the same pretreatment but placebo (inactive) retinoic acid or no addition of retinoic acid for two primary and five secondary outcomes. The primary outcomes were overall survival (participants who did not die) and treatment‐related mortality (participants who died due to complications of the intervention). Secondary outcomes were progression‐free survival (the condition did not worsen), event‐free survival (staying free of any of a particular group of events), early and late toxicity (harmful effects), and health‐related quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 25, 2017

Women with breast cancer who have multiple positive lymph nodes when first diagnosed are at high risk of recurrence. Conventional chemotherapy has limited success and is unsafe in high doses as it damages the bone marrow. One treatment considered promising was to give women very high doses of chemotherapy followed by transplantation of stem cells to regenerate their bone marrow. Cochrane review authors examined the evidence, which is current to October 2015.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 20, 2016

Advanced or 'metastatic' breast cancer is cancer that has spread beyond the breast and underarm lymph nodes to other parts of the body. Although metastatic breast cancer is often responsive to conventional chemotherapy it does not provide a cure. The dose of chemotherapy that can be given to an individual is limited because it is unsafe in high doses and can seriously damage the bone marrow, creating high risk of serious infection. One treatment that was considered promising at the start of the 1990's was use of autograft, which involves transplantation of a woman's own bone marrow or peripheral stem cells to regenerate her bone marrow. Autografting allowed the administration of chemotherapy doses many times higher than could otherwise be used. This systematic review aimed to compare the evidence from randomised controlled trials comparing high dose chemotherapy with conventional chemotherapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 20, 2005

This review was undertaken to determine the best use of platelet transfusions for the prevention of bleeding in patients who have haematological disorders and are receiving intensive (myelosuppressive) chemotherapy or stem cell transplantation. The review aimed to look at three main topics. One, what is the evidence to indicate if platelet transfusions should be given to prevent bleeding as compared to a strategy aimed at transfusion when bleeding occurs? Second, if platelet transfusions are given to prevent bleeding, when should they be given, for example, at what level of platelet count when measured in a blood sample? Three, if platelet transfusions are given what platelet dose should be used? We are unable to answer the first question, however new data from two large studies should be available when this review is updated in approximately two years time. With regard to the second question, there is no evidence to suggest a change from the current practice of using a platelet count of 10 x 109/L to trigger the use of platelet transfusions to prevent bleeding. However, more research is required to clarify this issue. The final question can be answered. Using a lower platelet dose did not lead to an increased risk of bleeding and fewer platelets were required. The reduction in the number of platelets used should, theoretically, reduce the risk of adverse events although no true differences were seen in the studies. However, adverse events are uncommon and therefore a statistically significant difference may not be seen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 16, 2012

We evaluated the evidence about whether low‐dose platelet transfusions (platelet transfusions containing a lower number of platelets (1.1 x 1011/m2 ± 25%)) given to prevent bleeding in people with low platelet counts were as effective and safe as standard‐dose (2.2 x 1011/m2 ± 25%) or high‐dose platelet transfusions (platelet transfusions containing a larger number of platelets (4.4 x 1011/m2 ± 25%)) given regularly to prevent bleeding (prophylactically). Our target population was children and adults with blood cancers who were receiving intensive chemotherapy treatments or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 27, 2015

We evaluated the evidence about whether platelet transfusions given to prevent bleeding in people with lower platelet counts (for example 5 x 109/L or below) were as effective and safe as the current standard (10 x 109/L or below), or whether higher platelet count levels (20 x 109/L or below, 30 x 109/L or below, or 50 x 109/L or below) were safer than the current standard (10 x 109/L or below). Our target population was people with blood cancers (for example leukaemia, lymphoma, myeloma) who were receiving intensive (myelosuppressive) chemotherapy treatments or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 18, 2015

Multiple myeloma is a cancer of antibody‐producing cells in the bone marrow. It causes bone destruction and patients are usually at a higher risk for infections and renal damage. Autologous stem cell transplantation has been established as standard initial treatment for fit patients with symptomatic multiple myeloma. During autologous stem cell transplantation, blood‐forming stem cells are removed from the patient prior to intense chemotherapy and later given back to the same patient. The chemotherapy is aimed at killing tumour cells (the higher the dose the more tumour cells are killed) but also affects normal blood‐forming cells that are needed to fight infections, transport oxygen and control bleeding. By giving the patient back his or her own blood‐forming cells, the recovery from the chemotherapy is notably faster and better. Since it is unclear whether autologous stem cell transplantation as initial treatment of multiple myeloma should be performed once or twice, we systematically searched for publications addressing the question whether the acute toxicity of autologous stem cell transplantation is counterbalanced by a long‐term benefit for the patient. Several studies in which patients undergoing one treatment with autologous stem cell transplantation were compared to patients undergoing autologous stem cell transplantation twice were identified. Only five of 14 studies identified could be analysed in the present systematic review. We were interested in long‐term benefit for patients with respect to overall survival or so called event‐free survival, that is survival without disease progression. Quality of life and treatment‐related mortality should also be analysed in clinical studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2012

Patients with hematological malignancies are prone to infections due to defects in their immune system. One of the main defects is a reduction in the level of immunoglobulins. For many years, the notion was that administration of pooled immunoglobulins from healthy donors might reverse this defect. However, randomized controlled trials showed different results in terms of prolongation of survival, reduction of infections and side effects of treatments. We conducted a systematic review assessing the role of administration of immunoglobulins from healthy donors as prophylaxis in patients with hematological malignancies. Our review showed that in the context of bone marrow transplantation the administration of immunoglobulins did not have an effect on survival or other outcomes. On the other hand, in patients with lymphoproliferative disorders like chronic lymphocytic leukemia or multiple myeloma, it reduced substantially the rate of infections. Despite their high cost, prophylactic immunoglobulins might prove cost‐effective in this population.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 8, 2008

Stem cell transplantation is an important treatment option for individuals with blood cancers (haematological malignancies). During the procedure, blood‐forming (stem) cells, derived from the bone marrow, peripheral blood or umbilical cord blood of a healthy donor, are transplanted into a person with a blood cancer. The aim is to replenish the recipient's body with healthy cells after treatment with conditioning regimens such as chemotherapy or radiation (or both). Peripheral blood stem cells and bone marrow stem cells are the standard stem cell sources used in adults. The most successful transplantations occur when stem cells are transplanted from a healthy donor whose tissue is genetically compatible with that of the recipient (matched related donor). If no matched donor can be identified, it is possible to transplant cells from a matched unrelated donor or from donors carrying certain mismatches. In principle, the higher the degree of genetic mismatch, the higher the risk of severe transplant‐related complications, especially graft‐versus‐host disease (GvHD), in which a donor's white blood cells (T cells) attack the recipient's healthy tissues.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 20, 2014

Adults with cancer are prone to serious complications from influenza, more than healthy adults. The influenza vaccine protects against influenza and its complications. However, its effectiveness among cancer patients is unclear, as the immune dysfunction that accompanies cancer and as a result of chemotherapy might lower immune response to the vaccine. Cancer patients, therefore, do not have clear information on the importance, need and safety of the vaccine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 29, 2013

Critical limb ischaemia occurs when blood flow to the legs is reduced because of the worsening of peripheral arterial disease. Initially, patients experience cramping leg pain that limits walking (termed intermittent claudication), but over time some patients experience more severe symptoms including pain at rest, leg ulceration and gangrene. The available treatment options are very limited when the disease reaches this stage, especially when surgical or catheter revascularisation is not an option. A substantial proportion of these patients require amputation of the affected limb. A new therapy (mononuclear cell therapy using the patient’s own cells) offers the possibility of an alternative treatment for patients, by supplying cells that could stimulate the formation of stable capillary vessels to improve the blood flow in the affected limb. These cells can be obtained from the bone marrow or from peripheral blood following subcutaneous injections (of granulocyte colony‐stimulating factor) for five days. They are then treated in a laboratory and injected into the large muscle at the back of the lower leg.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 19, 2014

Despite the development of new treatment options, the prognosis of high‐risk neuroblastoma patients still remains poor; in more than half of patients the disease returns. Stem cell rescue replaces blood‐forming stem cells that were destroyed by high‐dose chemotherapy in order to recover the bone marrow. It is also known as myeloablative therapy and might improve the survival of these patients. A well‐informed decision on the use of myeloablative therapy in the treatment of children with high‐risk neuroblastoma should be based on high quality evidence of effectiveness for treating tumours and side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 5, 2015

Allogeneic haematopoietic (blood) stem cell transplantation (HSCT) is a potentially curative therapeutic option for a variety of malignant and some non‐malignant haematological (blood‐related) diseases. For this therapy, blood stem cells are transferred from a healthy person who has compatible tissue markers, so‐called human leukocyte antigen (HLA) markers, to a matched recipient. Even though the donor and the recipient are matched concerning these markers, immune cells that are part of the transferred cells ('the graft') are prone to recognise tissues of the recipient ('the host') as being to some extent incompatible or foreign, which then can induce inflammation ('graft‐versus‐host‐disease' or 'GVHD'). GVHD typically involves the skin, the gastrointestinal tract and the liver. GVHD is divided into acute and chronic forms based on the clinical features and the time of occurrence after transplantation. In order to prevent this potentially life‐threatening condition, reactive immune cells can be depleted in the recipient by administering antibodies which are directed against them. These antibodies are called anti‐thymocyte globulins (ATG) and are derived from animals which were immunised with human thymocytes or T‐cells. Different types of ATG have been used for decades to decrease the occurrence and severity of GVHD but they bear the risk of severe side effects such as increased infection rates or the risk of disease relapse. Also, severe side effects such as allergic reactions or serum sickness with shortness of breath and fever, blood coagulation disturbances or liver failure can harm the patient during the infusion of ATG. So far, no systematic analysis of the advantages and disadvantages of the use of ATG has been done.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 12, 2012

Corticosteroids are commonly used to treat acute and chronic graft‐versus‐host disease (GvHD) but their effect on length and quality of life of patients has not been studied systematically. In this systematic review, we tried to compare the effect of treatment regimens used for GvHD in the absence and presence of corticosteroids, or with different doses of corticosteroids. After searching relevant sources, we located only two studies that met our criteria to be included in the study. Their results are described in detail in the text of the review. In brief, these studies are in favor earlier remission and slightly better outcome in patients but more evidence is needed in this field.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

Hodgkin lymphoma (HL) is a malignancy of single lymph nodes, the lymphatic system, and might affect other additional organs. It is a relatively rare disease, accounting for two or three people per 100,000 every year in Western countries, but it is one of the most common cancers in young adults between 20 and 30 years of age. The second peak of the disease is after the age of 60 years. Treatment options for HL have improved since the 1980s, so that even patients in advanced stages may be cured with adequate therapy. Treatment approaches include chemotherapy, radiotherapy or chemotherapy combined with radiotherapy (combined‐modality treatment), of which the combined‐modality treatment is standard for most patients nowadays. Nevertheless, 15% to 20% of patients do not reach complete remission and have refractory disease or relapse. For these patients high‐dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) has become the optimal treatment option. However, the impact of this regimen on overall survival is still unclear. Therefore, we conducted a Cochrane Review on efficacy and safety of HDCT followed by ASCT in patients with primary refractory or relapsed HL. We searched several important medical databases (the Cochrane Central Register of Controlled Trials and MEDLINE) and summarised and analysed evidence from randomised controlled trials (RCTs). We identified three RCTs corresponding to our pre‐defined inclusion criteria treating 398 patients. We included two trials that compared HDCT followed by ASCT versus conventional chemotherapy alone, and one trial evaluating additional sequential HDCT (SHDCT) followed by ASCT against HDCT followed by ASCT.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 20, 2013

Blood stem cells used to be taken mainly from bone marrow, where they develop. Nowadays it is also possible to filter stem cells directly out of the bloodstream. Another method is to filter stem cells out of the umbilical cord blood of newborn babies.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 30, 2016

A restrictive transfusion policy involves giving a red blood cell transfusion if the oxygen‐carrying capacity of blood (haemoglobin) falls below a certain level. A liberal transfusion policy involves giving a red blood cell transfusion at a higher haemoglobin level.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 5, 2015

We evaluated the evidence about whether giving agents that can replace, or reduce platelet transfusion (artificial platelets, platelet‐poor plasma, fibrinogen concentrate, recombinant activated factor VII (rFVIIa), recombinant factor XIII (rFXIII), recombinant interleukin (rIL)6 or rIL11, desmopressin (DDAVP), thrombopoietin (TPO) mimetics or antifibrinolytic drugs), to people with a low platelet count prevents bleeding and whether these alternative agents are associated with side effects. Our target population was people with bone marrow disorders which prevent them from producing enough platelets. We excluded people undergoing intensive chemotherapy or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 31, 2016

Blood stem cells are collected from a donor in two ways: either through a bone marrow harvest (direct retrieval of the stem cells from the donor's hip bones, under general anaesthetic) or a peripheral blood stem cell collection (retrieval of stem cells using a blood cell separator machine, following a course of granulocyte colony stimulating factor (G‐CSF) injections). Both these methods of donation are common. Much research has explored which method of donation gives the best outcome to the patient, however there has not been a lot of research exploring these methods of donation from the donor's perspective. Such research is important if there is the possibility of long‐term adverse events for the donor. For example, the long‐term adverse events of G‐CSF are not known, but there is the suggestion of a correlation between G‐CSF and development of myelodysplastic syndrome (MDS). However, in many instances, donors are given a choice as to which method they would like to use to donate their stem cells. The aim of this review was to compare directly these two methods of blood stem cell donation from the donor's perspective, to understand the experiences of the donor. In this review, each donor was a sibling of the patient to whom they were donating blood stem cells.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 21, 2009

Kidney transplantation is the treatment of choice for most patients with end‐stage renal disease (ESRD). Strategies to increase donor organ availability and to prolong the transplanted kidney's survival have become priorities in kidney transplantation. This review aimed to evaluate the short and long‐term benefits and harms of sirolimus and everolimus (TOR‐I) when used in primary immunosuppressive regimens for kidney transplant recipients. Thirty three trials investigating the use of TOR‐I in four different settings were evaluated in this review. No differences in the hard‐end points of patient and graft survival were demonstrated for or against TOR‐I in any comparison. Generally surrogate endpoints for graft survival favour TOR‐I (lower risk of acute rejection and higher GFR) and surrogate endpoints for patient outcomes are worsened by TOR‐I (bone marrow suppression, lipid disturbance). Long‐term hard‐endpoint data from methodologically robust randomised trials are still needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 19, 2006

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...