Autologous Stem Cell Transplantation In Multiple Myeloma

Background. Multiple myeloma (MM) is the second most common hematologic malignancy after lymphomas In Finland: the annual incidence of MM is approximately 200. For three decades the median survival remained at 3 to 4 years from diagnosis until high-dose melphalan treatment supported by autologous stem cell transplantation (ASCT) became the standard of care for newly diagnosed MM since the mid 1990’s and the median survival increased to 5 – 6 years. This study focuses on three important aspects of ASCT, namely 1) stem cell mobilization, 2) single vs. double ASCT as initial treatment, and 3) the role of minimal residual disease (MRD) for longterm outcome. Aim. The aim of this series of studies was to evaluate the outcomes of MM patients and the ASCT procedure at the Turku University Central Hospital, Finland. First, we tried to identify which factors predict unsuccessful mobilization of autologous stem cells. Second, we compared the use of short-acting granulocyte-colony stimulating factor (GCSF) with long-acting G-CSF as mobilization agents. Third, one and two successive ASCTs were compared in 100 patients with MM. Fourth, for patients in complete response (CR) after stem cell transplantation (SCT), patient-specific probes for quantitative allele-specific oligonucleotide polymerase-chain reaction (qASO-PCR) measurements were designed to evaluate MRD and its importance for long-term outcome. Results. The quantity of previous chemotherapy and previous interferon use were significant pre-mobilization factors that predicted mobilization failure, together with some factors related to mobilization therapy itself, such as duration and degree of cytopenias and occurrence of sepsis. Short-acting and long-acting G-CSF combined with chemotherapy were comparable as stem cells mobilizers. The progression free (PFS) and overall survival (OS) tended to be longer after double ASCT than after single ASCT with a median follow-up time of 4 years, but this difference disappeared as the follow-up time increased. qASO-PCR was a good and sensitive divider of the CR patients into two prognostic groups: MRD low/negative (≤ 0.01%) and MRD high (>0.01%) groups with a significant difference in PFS and suggestively also in OS. Conclusions. When the factors prediciting a poor outcome of stem cell mobilization prevail, it is possible to identify those patients who need specific efforts to maximize the mobilization efficacy. Long-acting pegfilgrastim is a practical and effective alternative to short-acting filgrastim for mobilization therapy. There is no need to perform double ASCT on all eligible patients. MRD assessment with qASO-PCR is a sensitive method for evaluation of the depth of the CR response and can be used to predict long-term outcome after ACST.

Yliopistohakijan päätöksentekoprosessi markkinointiviestinnän näkökulmasta

Tutkielman tavoitteena on selventää yliopistohakijan päätöksentekoprosessia. Jotta yliopistohakijan päätöksentekoon pystyttiin tarkemmin tutustumaan, selvitettiin informaationhakua hyödyllisien viestintäkanavien ja vaihtoehtojen vertailua tärkeiden valintakriteerien avuilla. Tutkielmassa tarkasteltiin myös sitoutuneisuutta ja subjektiivista tietotasoa, jotta hakijan viitekehystä pystyttiin tarkemmin ymmärtämään. Yliopistohakijoihin kohdistuvaa mainonnan tehokkuutta selvitettiin kolmen mainoksen avulla. Tutkielman empiirinen osa toteutettiin kvantitatiivisena internet -pohjaisena kyselytutkimuksena tilastollisin menetelmin. Otos (n=290) koostui valmennuskurssilla olevista opiskelijoista keväällä 2010. Vastausprosentiksi saatiin 33 %. Johtopäätöksenä voidaan todeta, että yliopistohakijan päätöksentekoprosessi on hyvin monimutkainen. Monimutkaisuutta prosessiin tuo useiden attribuuttien vaikuttavuus päätöksenteossa. Tutkielma on tuottanut viitekehyksen, jonka avulla voidaan havaita yliopistohakijalle tärkeät viestintäkanavat sekä valintakriteerit. Tutkielman avulla myös havaittiin, että yliopistohakijat ovat korkeasti sitoutuneita yliopistohakuun.

Towards a Strategic Sales Channel Partnership: A Case Study from the IT Services Industry

Strategic partnerships have become a key to competitive advantage and success in a dynamic, global business environment. Partnering provides a strategic response to complex offerings that need multiple sources of technology and knowledge, allowing companies to offer a wider range of services and solutions to meet their customers’ needs. Companies that collaborate with strategic partners in sales channels may significantly grow their business and improve their prospects of winning major contracts. As a consequence, companies are increasingly transforming their go-to-market strategies and sales channel structures to align with the need to create added value to customers together with a business partner. The research objective of this case study is to review and assess the success of an established sales channel partnership in IT services industry and to find ways how to develop it towards a strategic collaboration. The research consists of two main parts. The first part reviews the literature, concluding with the identification of the critical success factors for partnering. The second part sets out for the case findings, focusing on how the success of the established sales channel partnership is perceived by key executives within the partner organizations, and further what actions are required to make the sales channel partnership and joint go-to-market more strategic.