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  • 1
    Language: English
    In: Annals of hematology, 2020-02, Vol.99 (2), p.331-341
    Description: G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] 〈 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p 〈 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.
    Subject(s): Autografts ; Filgrastim - adverse effects ; Prospective Studies ; Multiple Myeloma - mortality ; Humans ; Middle Aged ; Polyethylene Glycols - adverse effects ; Male ; Filgrastim - administration & dosage ; Polyethylene Glycols - administration & dosage ; Stem Cell Transplantation ; Melphalan - administration & dosage ; Multiple Myeloma - therapy ; Melphalan - adverse effects ; Sex Factors ; Female ; Aged ; Medical research ; Chemotherapy ; Multiple myeloma ; Stem cells ; Medicine, Experimental ; Transplantation ; Comparative analysis ; Cancer ; Transplants & implants ; Neutrophils ; Index Medicus
    ISSN: 0939-5555
    E-ISSN: 1432-0584
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 2
    Language: English
    In: Cancer medicine (Malden, MA), 2020-12, Vol.9 (23), p.8735-8746
    Description: Background The neutrophil to lymphocyte ratio (NLR) and the lymphocyte to monocyte ratio (LMR) can reflect both the myeloid dysfunction and T‐cell immune suppression and have prognostic significance. Methods In 771 newly diagnosed advanced‐stage Hodgkin Lymphoma (HL) patients we evaluated the baseline values of NLR and LMR as predictors of clinical outcome. According to the multicenter prospective phase II GITIL‐HD0607 trial, all patients received two ABVD courses and if PET‐2 negative received four additional ABVD cycles while if PET‐2‐positive patients were randomized to either BEACOPP escalated (Be) plus BEACOPP baseline (Bb) (4 + 4 courses) or Be + Bb (4 + 4) and Rituximab. PET scans were centrally reviewed by an expert panel by Blinded Independent Central Review. Results Higher NLR and lower LMR were associated with a PET‐2 positivity and failure to achieve long‐term disease control, respectively. By univariate and multivariate analysis, large nodal mass (〉7 cm), IPS ≥ 3, NLR 〉 6 were strong independent predictors of early PET‐2 response after ABVD. Only NLR 〉 6 and IPS ≥ 3 were strong independent predictors of outcome at diagnosis; however, when PET‐2 status was added, only PET‐2‐positive status and IPS ≥ 3 were independent predictors of PFS. Focusing on PET‐2‐negative patients, those with NLR 〉 6 had an inferior 3‐year PFS compared to patients with NLR ≤ 6 (84% vs 89% months, P = .03). Conclusion In advanced‐stage HL patients treated with a PET‐2‐driven strategy, IPS ≥ 3 and NLR 〉 6 are independent predictors of outcome at diagnosis while the presence of large nodal mass, IPS ≥ 3, and NLR 〉 6 at diagnosis are independent predictors of early ABVD response. In the setting of newly diagnosed advanced‐stage HL patients, the presence of large nodal mass, IPS ≥ 3, and NLR 〉 6 at diagnosis are independent predictors of early ABVD response. IPS ≥ 3 and NLR 〉 6 are also useful predictors of outcome in PET‐2‐negative patients.
    Subject(s): hodgkin lymphoma ; neutrophil to lymphocyte ratio ; PET‐2 ; biomarkers ; Neutrophils ; Rituximab ; Multivariate analysis ; Disease control ; Blood ; Monocytes ; Lymphocytes ; Biopsy ; Medical prognosis ; Monoclonal antibodies ; Diagnosis ; Targeted cancer therapy ; Hodgkin's disease ; Index Medicus
    ISSN: 2045-7634
    E-ISSN: 2045-7634
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: EBSCOhost EJS
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 3
    Language: English
    In: The New England journal of medicine, 2016-01-07, Vol.374 (1), p.43-53
    Description: Antilymphocyte globulin (ATG) added to the conditioning regimen before allogeneic hematopoietic stem-cell transplantation resulted in a lower rate of chronic graft-versus-host disease at 2 years than the rate without ATG (32% vs. 68%), with no apparent increased risk of relapse. Chronic graft-versus-host disease (GVHD) is a major complication of allogeneic stem-cell transplantation that results in later illness and death and a reduction in quality of life. 1 , 2 Risk factors for chronic GVHD are the use of peripheral blood as a source of stem cells, a history of acute GVHD, and the use of donated stem cells with high numbers of T cells. 3 – 7 In a meta-analysis, the Stem Cell Trialists’ Collaborative Group reported an incidence of extensive chronic GVHD of 47% after peripheral-blood stem-cell transplantation from an HLA-identical sibling. 4 In 2012, more than 70% of the stem-cell transplantations performed in . . .
    Subject(s): Graft vs Host Disease - epidemiology ; Prospective Studies ; Humans ; Immunosuppressive Agents - therapeutic use ; Middle Aged ; Proportional Hazards Models ; Child, Preschool ; Male ; Survival Rate ; Transplantation, Homologous ; Incidence ; Young Adult ; Disease-Free Survival ; Graft vs Host Disease - mortality ; Adolescent ; Antilymphocyte Serum - therapeutic use ; Adult ; Female ; Graft vs Host Disease - prevention & control ; T-Lymphocytes - immunology ; Child ; Chronic Disease ; Prevention ; Treatment outcome ; Graft versus host reaction ; Immunoglobulins ; Dosage and administration ; Analysis ; Graft-versus-host reaction ; Transplants & implants ; Leukemia ; Stem cell transplantation ; Lymphocytes T ; Preventive medicine ; Hemopoiesis ; Globulins ; Risk assessment ; Peripheral blood ; Stem cells ; Bone marrow ; Histocompatibility antigen HLA ; Index Medicus ; Abridged Index Medicus
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Single Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 4
    Language: English
    In: Blood, 2009, Vol.114 (3), p.709-718
    Description: We previously reported that patients with fibrotic, chronic graft-versus-host disease (cGVHD) have antibodies activating the platelet-derived growth factor receptor pathway. Because this pathway can be inhibited by imatinib, we performed a pilot study including 19 patients with refractory cGVHD, given imatinib at a starting dose of 100 mg per day. All patients had active cGVHD with measurable involvement of skin or other districts and had previously failed at least 2 treatment lines. Patient median age was 29 years (range, 10-62 years), and median duration of cGvHD was 37 months (range, 4-107 months). The organs involved were skin (n = 17), lung (n = 11), and bowel (n = 5); 15 patients had sicca syndrome. Imatinib-related, grade 3 to 4 toxicity included fluid retention, infections, and anemia. Imatinib was discontinued in 8 patients: in 3 because of toxicity and in 5 because of lack of response (n = 3) or relapse of malignancy (n = 2). Overall response rate at 6 months was 79%, with 7 complete remissions (CRs) and 8 partial remissions (PRs). With a median follow-up of 17 months, 16 patients are alive, 14 still in CR or PR. The 18-month probability of overall survival is 84%. This study suggests that imatinib is a promising treatment for patients with refractory fibrotic cGVHD.
    Subject(s): Hematologic and hematopoietic diseases ; Biological and medical sciences ; Medical sciences ; Piperazines - administration & dosage ; Graft vs Host Disease - complications ; Humans ; Middle Aged ; Male ; Piperazines - toxicity ; Pyrimidines - toxicity ; Graft vs Host Disease - mortality ; Adult ; Female ; Child ; Pyrimidines - administration & dosage ; Intestinal Diseases ; Skin Diseases ; Treatment Outcome ; Imatinib Mesylate ; Remission Induction ; Graft vs Host Disease - pathology ; Pilot Projects ; Graft vs Host Disease - drug therapy ; Adolescent ; Survival Analysis ; Benzamides ; Fibrosis - pathology ; Lung Diseases ; Salvage Therapy - methods ; Index Medicus ; Abridged Index Medicus
    ISSN: 0006-4971
    E-ISSN: 1528-0020
    Source: HighWire Press (Free Journals)
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: American Society of Hematology
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 5
    Language: English
    In: Journal of clinical oncology, 2018-02-10, Vol.36 (5), p.454-462
    Description: Purpose To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P 〈 .001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.
    Subject(s): Hodgkin Disease - diagnostic imaging ; Procarbazine - administration & dosage ; Cyclophosphamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Lymph Nodes - pathology ; Prospective Studies ; Hodgkin Disease - pathology ; Humans ; Middle Aged ; Male ; Vinblastine - administration & dosage ; Feasibility Studies ; Young Adult ; Hodgkin Disease - drug therapy ; Hodgkin Disease - mortality ; Vincristine - administration & dosage ; Adult ; Female ; Doxorubicin - administration & dosage ; Dacarbazine - administration & dosage ; Prednisone - administration & dosage ; Etoposide - administration & dosage ; Lymphatic Metastasis ; Bleomycin - administration & dosage ; Radiotherapy ; Positron Emission Tomography Computed Tomography ; Rituximab - administration & dosage ; Adolescent ; Survival Analysis ; Index Medicus
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: Blood, 2013-12-12, Vol.122 (25), p.4111-4118
    Description: Forty adults aged 28 to 73 years were entered into a prospective trial of imatinib for the treatment of steroid-refractory chronic graft-versus-host disease (SR-cGVHD). After 6 months, intention-to-treat (ITT) analysis of 39 patients who received the drug, regardless of the duration of treatment, revealed 14 partial responses (PR), 4 minor responses (MR) with relevant steroid sparing (46%) according to Couriel criteria, and 20 ≥ PR (51.3%), as per the National Institutes of Health (NIH) criteria and NIH severity score changes. The best responses were seen in the lungs, gut, and skin (35%, 50%, and 32%, respectively). After a median follow-up of 40 months, 28 patients were alive, with a 3-year overall survival (OS) and event-free survival of 72% and 46%, respectively. The 3-year OS was 94% for patients responding at 6 months and 58% for nonresponders according to NIH response, suggesting that these criteria represent a reliable tool for predicting OS after second-line treatment. Monitoring of anti-platelet-derived growth factor receptor (PDGF-R) antibodies showed a significant decrease in PDGF-R stimulatory activity in 7 responders, whereas it remained high in 4 nonresponders. This study confirms the efficacy of imatinib against SR-cGVHD and suggests that the response at 6 months significantly predicts long-term survival.
    Subject(s): Piperazines - administration & dosage ; Prednisolone - adverse effects ; Prednisolone - administration & dosage ; Prospective Studies ; Follow-Up Studies ; Lymphoproliferative Disorders ; Autoantibodies - blood ; Humans ; Middle Aged ; Male ; Protein Kinase Inhibitors - adverse effects ; Antineoplastic Agents, Hormonal - adverse effects ; Benzamides - administration & dosage ; Graft vs Host Disease - mortality ; Time Factors ; Receptors, Platelet-Derived Growth Factor - blood ; Adult ; Female ; Benzamides - adverse effects ; Severity of Illness Index ; Myeloproliferative Disorders - therapy ; Pyrimidines - administration & dosage ; Antineoplastic Agents, Hormonal - administration & dosage ; Hematopoietic Stem Cell Transplantation ; Survival Rate ; Graft vs Host Disease - blood ; Imatinib Mesylate ; Piperazines - adverse effects ; Disease-Free Survival ; Protein Kinase Inhibitors - administration & dosage ; Graft vs Host Disease - drug therapy ; Pyrimidines - adverse effects ; Monitoring, Physiologic - methods ; Aged ; Chronic Disease ; Myeloproliferative Disorders - mortality ; Index Medicus ; Abridged Index Medicus
    ISSN: 0006-4971
    E-ISSN: 1528-0020
    Source: HighWire Press (Free Journals)
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: American Society of Hematology
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 7
    Language: English
    In: Journal of clinical oncology, 2020-11-20, Vol.38 (33), p.3905-3913
    Description: To investigate the role of consolidation radiotherapy (cRT) in advanced-stage Hodgkin lymphoma (HL) presenting at baseline with a large nodal mass (LNM) in complete metabolic response after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy. Advanced-stage (IIB-IVB) HL patients, enrolled in the HD 0607 trial (Clinicaltrial.gov identifier NCT00795613), with both a negative PET after two (PET-2) and six (PET-6) ABVD cycles, who presented at baseline with an LNM, defined as a nodal mass with the largest diameter ≥ 5 cm, were prospectively randomly assigned to receive cRT over the LNM or no further treatment (NFT). Among 296 randomly assigned patients, the largest diameter of LNM at baseline was 5-7 cm in 101 (34%; subgroup A) and 8-10 cm in 96 (32%; subgroup B), whereas classic bulky (diameter 〉 10 cm) was detected in 99 (33%; subgroup C). Two hundred eighty patients (88%) showed a postchemotherapy RM. The median dose of cRT was 30.6 Gy (range, 24-36 Gy). After a median follow-up of 5.9 years (range, 0.5-10 years), the 6-year progression-free survival rate of patients who underwent cRT or NFT was, respectively, 91% (95% CI, 84% to 99%) and 95% (95% CI, 89% to 100%; = .62) in subgroup A; 98% (95% CI, 93% to 100%) and 90% (95% CI, 80% to 100%; = .24) in subgroup B; 89% (95% CI, 81% to 98%) and 86% (95% CI, 77% to 96%; = .53) in subgroup C (classic bulky). cRT could be safely omitted in patients with HL presenting with an LNM and a negative PET-2 and PET-6 scan, irrespective from the LNM size detected at baseline.
    Subject(s): Dacarbazine - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Lymph Nodes - pathology ; Prospective Studies ; Hodgkin Disease - metabolism ; Hodgkin Disease - pathology ; Humans ; Middle Aged ; Kaplan-Meier Estimate ; Male ; Bleomycin - administration & dosage ; Vinblastine - administration & dosage ; Young Adult ; Hodgkin Disease - radiotherapy ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Progression-Free Survival ; Adolescent ; Hodgkin Disease - drug therapy ; Adult ; Female ; Neoplasm Staging ; Doxorubicin - administration & dosage ; Index Medicus
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 8
    Language: English
    In: Hematological oncology, 2020-10, Vol.38 (4), p.501-508
    Description: Among patients with advanced‐stage classical Hodgkin lymphoma (cHL) receiving ABVD chemotherapy, PET performed after the first two treatment cycles (PET‐2) has prognostic value. However, 15% of patients with a negative PET‐2 will experience treatment failure. Here we prospectively evaluated serum thymus and activation‐regulated chemokine (TARC) levels, to improve risk assessment in patients treated according to HD0607 PET‐driven trial (#NCT00795613). In 266 patients with available serum samples, who have agreed to participate in a sub‐study for assessment of the role of TARC monitoring, serum TARC levels were measured at baseline and at time of PET‐2 by commercially available ELISA test kits. The primary end‐point was to evaluate the association between TARC after 2 ABVD cycles and PFS. Median TARC‐2 values were significantly higher in PET‐2‐positive patients compared to PET‐2‐negative patients (P = .001), and in patients with treatment failure compared to those in continuous CR (P = .01). The 4‐year PFS significantly differed between patients with TARC‐2 〉800 pg/mL vs ≤800 pg/mL (64% vs 86%, P = .0001). Moreover, among PET‐2‐negative patients, elevated TARC‐2 identified those with a worse prognosis (74% vs 89%; P = .01). In multivariable analysis, TARC‐2 〉800 pg/mL was a significant independent predictor of PFS in the whole study population (HR 2.39, P = .004) and among the PET‐2‐negative patients (HR 2.49, P = .02). In conclusion, our results indicate that TARC‐2 serum levels above 800 pg/mL suggest the need for a stringent follow‐up in PET‐2‐negative patients, and the evaluation of new drugs in PET‐2‐positive, who will likely fail to respond to intensification with escalated BEACOPP.
    Subject(s): TARC ; PET‐2 ; PET‐adapted strategy ; advanced stage ; biomarker ; Hodgkin lymphoma ; Index Medicus
    ISSN: 0278-0232
    E-ISSN: 1099-1069
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: Biology of blood and marrow transplantation, 2018-03, Vol.24 (3), p.608-613
    Description: •High-dose chemotherapy plus autologous stem cell transplantation (ASCT) is the standard approach in transplantation-eligible patients with newly diagnosed multiple myeloma.•Outpatient ASCT has proven to be feasible in terms of physical morbidity and mortality outcomes.•Little data exist on the impact on quality of life (QoL) of delivering this care in this manner.•The results of this observational study show that the use of outpatient care compared with standard transplantation care did not result in improved QoL during transplantation. Outpatient autologous stem cell transplantation (ASCT) has proven to be feasible in terms of physical morbidity and mortality outcomes, but little data exist on the impact of this procedure on quality of life (QoL). The purpose of this prospective, observational, longitudinal cohort study was to compare the effects of inpatient (n = 76) and outpatient (n = 64) modes of care on QoL in patients with multiple myeloma who underwent ASCT. Patients were treated according to their preference for the inpatient or outpatient model. QoL was assessed using the Functional Assessment of Cancer Therapy–Bone Marrow Transplantation (FACT-BMT) at baseline (7 days before ASCT; T1) and at days +7 (T2) and +30 (T3) after ASCT. Overall, inpatients achieved higher mean values at each time point (86.05 ± 15.54 at T1, 89.23 ± 19.19 at T2, and 87.96 ± 13.6 at T3) compared with outpatients (85.62 ± 14.51 at T1, 87.42 ± 23.41 at T2, and 83.98 ± 20.2 at T3), although the differences did not reach statistical significance. Inpatients showed higher mean scores than outpatients in physical well-being (7.67 ± 5.7, 15.44 ± 6.34, and 12.96 ± 6.03, respectively, versus 5.89 ± 4.33, 13.92 ± 7.05, and 8.84 ± 6.33, respectively; P 〈 .05). Mean scores on social/family well-being were significantly higher in the outpatient group compared with the inpatient group (22.93 ± 13.29, 21.14 ± 5.31, and 21.64 ± 4.58, respectively, versus 20.59 ± 3.79, 19.52 ± 5.12, and 20.01 ± 3.97, respectively; P = .003). There were no significant between-group differences with respect to functional well-being and emotional status. Among adults at a single institution undergoing ASCT for MM, the use of outpatient care compared with standard transplantation care did not result in improved QoL during transplantation. Further research is needed for replication and to assess longer-term outcomes and implications.
    Subject(s): Inpatient ; Outpatient ; ASCT ; Multiple myeloma ; Quality of life ; Autografts ; Humans ; Middle Aged ; Male ; Stem Cell Transplantation ; Inpatients ; Multiple Myeloma - therapy ; Outpatients ; Adolescent ; Quality of Life ; Adult ; Female ; Aged ; Index Medicus
    ISSN: 1083-8791
    E-ISSN: 1523-6536
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: Blood, 2009-10-22, Vol.114 (17), p.3719-3720
    Subject(s): Correspondence
    ISSN: 0006-4971
    E-ISSN: 1528-0020
    Source: HighWire Press (Free Journals)
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: American Society of Hematology
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