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3.
Biomed Pharmacother ; 138: 111425, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33756154

RESUMEN

Cardiovascular disease is one of the leading causes of mortality worldwide. Cardiac tissue engineering strategies focusing on biomaterial scaffolds incorporating cells and growth factors are emerging as highly promising for cardiac repair and regeneration. The use of stem cells within cardiac microengineered tissue constructs present an inherent ability to differentiate into cell types of the human heart. Stem cells derived from various tissues including bone marrow, dental pulp, adipose tissue and umbilical cord can be used for this purpose. Approaches ranging from stem cell injections, stem cell spheroids, cell encapsulation in a suitable hydrogel, use of prefabricated scaffold and bioprinting technology are at the forefront in the field of cardiac tissue engineering. The stem cell microenvironment plays a key role in the maintenance of stemness and/or differentiation into cardiac specific lineages. This review provides a detailed overview of the recent advances in microengineering of autologous stem cell-based tissue engineering platforms for the repair of damaged cardiac tissue. A particular emphasis is given to the roles played by the extracellular matrix (ECM) in regulating the physiological response of stem cells within cardiac tissue engineering platforms.


Asunto(s)
Microambiente Celular/fisiología , Cardiopatías/terapia , Trasplante de Células Madre Mesenquimatosas/métodos , Miocitos Cardíacos/trasplante , Ingeniería de Tejidos/métodos , Trasplante Autólogo/métodos , Animales , Cardiopatías/fisiopatología , Humanos , Trasplante de Células Madre Mesenquimatosas/tendencias , Células Madre Mesenquimatosas/fisiología , Miocitos Cardíacos/fisiología , Ingeniería de Tejidos/tendencias , Trasplante Autólogo/tendencias
4.
Ann Hematol ; 99(12): 2893-2901, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32572522

RESUMEN

The amount of infused CD34+ cells has been reported to be the strongest predictor of platelet recovery after autologous stem cell transplantation (ASCT). However, the timing of platelet recovery varies widely among patients even after the infusion of similar amounts of CD34+ cells. Therefore, we retrospectively assessed 99 patients who underwent their first ASCT for lymphoma or myeloma at our center. Thirteen patients (13%) did not achieve platelet engraftment, defined as a platelet count of at least 2.0 × 104/µL without transfusion, at day 28 after transplantation, whereas 58 of 60 patients (97%) who received at least 2.0 × 106/kg CD34+ cells achieved platelet engraftment within 28 days. Multivariate analysis identified the following significant risk factors for delayed platelet recovery: hemoglobin level and platelet count before stem cell harvest, body temperature of > 39 °C within 5 days after ASCT, and infusion of a small amount (< 2.0 × 106/kg) of CD34+ cells. In a subgroup analysis of 39 patients infused with < 2.0 × 106/kg CD34+ cells, a need for repeated apheresis for stem cell harvest and a body temperature of > 39 °C within 5 days after ASCT were identified as independent factors for delayed platelet recovery. In summary, platelet recovery following ASCT was affected by insufficient hematopoietic recovery at stem cell harvest, a need for repeated apheresis, and high fever early after ASCT, particularly when the amount of infused stem cells was insufficient.


Asunto(s)
Plaquetas/fisiología , Trasplante de Células Madre Hematopoyéticas/métodos , Linfoma/sangre , Linfoma/terapia , Mieloma Múltiple/sangre , Mieloma Múltiple/terapia , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Trasplante de Células Madre Hematopoyéticas/tendencias , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función/fisiología , Estudios Retrospectivos , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Adulto Joven
5.
Ann Hematol ; 99(6): 1331-1339, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32382775

RESUMEN

Autologous stem cell transplantation (ASCT) is the only curable therapy for multiple myeloma (MM), while its success primarily relies on mobilization to obtain sufficient hematopoietic stem/progenitor cells (HPC). Although the role of Pegfilgrastim (PEG), a novel PEGylated form of the recombinant G-CSF filgrastim (FIL), in mobilization has been demonstrated, it remains unclear whether this approach is cost-effective in MM treatment. Here, we performed a real-world analysis to evaluate the efficacy and cost of PEG for mobilization in a cohort of MM patients, of which 53% carried high-risk cytogenetic abnormalities. A total of 91 patients who received either a single dose of PEG (6 or 12 mg, n = 42) or multiple dosing of 10 µg/kg/day FIL (n = 49) after chemotherapy for HPC mobilization were included. The yield of MNCs and CD34+ cells per milliliter of blood collected via apheresis was significantly greater in the PEG group than that in the FIL group (P = 0.014 and P = 0.038). Mobilization with PEG yielded significantly higher median number of collected CD34+ cells than FIL (5.56 vs. 4.82 × 106/kg; P = 0.038). Moreover, the average time-to-recovery of leukocytes and platelets after transplantation was markedly shorter in the PEG group than that in the FIL group (leukocyte, 11.59 ± 1.98 vs 12.93 ± 2.83 days, P = 0.019; platelet, 12.86 ± 2.62 vs 14.80 ± 5.47, P = 0.085). However, the total cost of mobilization and apheresis using PEG or FIL was comparable (P = 0.486). Of note, mobilization with 12 mg PEG further shortened time-to-recovery of leukocytes (10.64 ± 0.51 vs. 12.04 ± 2.26 days, P = 0.05) and platelets (10.60 ± 2.89 vs. 13.33 ± 2.35 days, P = 0.031) compared with 6 mg PEG. Our results support a notion that PEG (especially 12 mg) combined with chemotherapy is a cost-effective and convenient regimen of mobilization, which might improve the outcome of ASCT in MM.


Asunto(s)
Filgrastim/uso terapéutico , Movilización de Célula Madre Hematopoyética/métodos , Trasplante de Células Madre Hematopoyéticas/métodos , Mieloma Múltiple/sangre , Mieloma Múltiple/terapia , Polietilenglicoles/uso terapéutico , Adulto , Anciano , Estudios de Cohortes , Análisis Costo-Beneficio , Femenino , Filgrastim/economía , Movilización de Célula Madre Hematopoyética/economía , Movilización de Célula Madre Hematopoyética/tendencias , Trasplante de Células Madre Hematopoyéticas/economía , Trasplante de Células Madre Hematopoyéticas/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/economía , Polietilenglicoles/economía , Trasplante Autólogo/economía , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Resultado del Tratamiento
6.
Cancer Immunol Immunother ; 69(5): 879-899, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32130453

RESUMEN

A better understanding of the complex interactions between the immune system and tumour cells from different origins has opened the possibility to design novel procedures of antitumoral immunotherapy. One of these novel approaches is based on the use of autologous or allogeneic natural killer (NK) cells to treat cancer. In the last decade, different strategies to activate NK cells and their use in adoptive NK cell-based therapy have been established. Although NK cells are often considered as a uniform cell population, several phenotypic and functionally distinct NK cells subsets exist in healthy individuals, that are differentially affected by ageing or by apparently innocuous viruses such as cytomegalovirus (CMV). In addition, further alterations in the expression of activating and inhibitory receptors are found in NK cells from cancer patients, likely because of their interaction with tumour cells. Thus, NK cells represent a promising strategy for adoptive immunotherapy of cancer already tested in phase 1/2 clinical trials. However, the existence of NK cell subpopulations expressing different patterns of activating and inhibitory receptors and different functional capacities, that can be found to be altered not only in cancer patients but also in healthy individuals stratified by age or CMV infection, makes necessary a personalized definition of the procedures used in the selection, expansion, and activation of the relevant NK cell subsets to be successfully used in NK cell-based immunotherapy.


Asunto(s)
Inmunoterapia Adoptiva/métodos , Células Asesinas Naturales/inmunología , Subgrupos Linfocitarios/inmunología , Neoplasias/inmunología , Ensayos Clínicos Fase I como Asunto , Ensayos Clínicos Fase II como Asunto , Humanos , Inmunoterapia Adoptiva/tendencias , Células Asesinas Naturales/trasplante , Subgrupos Linfocitarios/trasplante , Neoplasias/terapia , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Trasplante Homólogo/métodos , Trasplante Homólogo/tendencias
7.
Muscle Nerve ; 61(6): 726-739, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31883129

RESUMEN

Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.


Asunto(s)
Regeneración Nerviosa/fisiología , Traumatismos de los Nervios Periféricos/cirugía , Procedimientos de Cirugía Plástica/tendencias , Andamios del Tejido/tendencias , Trasplantes/trasplante , Animales , Humanos , Traumatismos de los Nervios Periféricos/fisiopatología , Procedimientos de Cirugía Plástica/métodos , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias
9.
Leuk Lymphoma ; 60(13): 3235-3243, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31185769

RESUMEN

To describe temporal trends in treatment among older adult (≥66 years) patients diagnosed with diffuse large B-cell lymphoma (DLBCL), we analyzed 18,058 DLBCL patients from the Surveillance, Epidemiology, and End Results linked Medicare (SEER-Medicare) database diagnosed between 2001 and 2013. Among 65% of patients receiving treatment after diagnosis, R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) was the most common frontline therapy, increasing with more recent treatment year: 51% (2001-2003) vs. 69% (2010-2014). Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) was uncommon in these Medicare patients. As the addition of rituximab increased over time, we also observed an improved survival rate over time. It is possible there is an association, but we cannot make this inference as effectiveness was not measured in this study. Overall survival estimates indicated that survival probabilities steadily improved in more recent years; however, 5-year survival was <40%, indicating the need for improved treatment options for older adult DLBCL patients.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/tendencias , Linfoma de Células B Grandes Difuso/terapia , Anciano , Anciano de 80 o más Años , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Humanos , Linfoma de Células B Grandes Difuso/mortalidad , Masculino , Medicare/estadística & datos numéricos , Prednisona/uso terapéutico , Estudios Retrospectivos , Rituximab/uso terapéutico , Programa de VERF/estadística & datos numéricos , Tasa de Supervivencia/tendencias , Factores de Tiempo , Trasplante Autólogo/estadística & datos numéricos , Trasplante Autólogo/tendencias , Trasplante Homólogo/estadística & datos numéricos , Trasplante Homólogo/tendencias , Resultado del Tratamiento , Estados Unidos/epidemiología , Vincristina/uso terapéutico
10.
Arthritis Res Ther ; 21(1): 106, 2019 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-31036055

RESUMEN

BACKGROUND: Autologous hematopoietic stem cell transplantation (aHSCT) is performed in patients with aggressive forms of systemic sclerosis (SSc). The profile of B cell reconstitution after aHSCT is not fully understood. The aim of this study was to investigate changes of B cell subsets and cytokine production of B cells in patients with SSc after aHSCT. METHODS: Peripheral blood of six patients with SSc was collected at defined intervals up to 16 months after aHSCT. Immunophenotyping was performed, and B cell function was determined by measuring cytokine secretion in supernatants of stimulated B cell cultures. RESULTS: Within 1 month after aHSCT, a peak in the percentage of CD38++/CD10+/IgD+ transitional B cells and CD38++/CD27++/IgD- plasmablasts was detected. Long-term changes persisted up to 14 months after aHSCT and showed an increased percentage of total B cells; the absolute B cell number did not change significantly. Within the B cell compartment, an increased CD27/IgD+ naïve B cell percentage was found whereas decreased percentages of CD27+/IgD+ pre-switched memory, CD27+/IgD- post-switched memory, and CD27-/IgD- double-negative B cells were seen after aHSCT. Cytokine secretion in B cell cultures showed significantly increased IL-10 concentrations 13 to 16 months after aHSCT. CONCLUSION: A changed composition of the B cell compartment is present for up to 14 months after aHSCT indicating positive persisting effects of aHSCT on B cell homeostasis. The cytokine secretion profile of B cells changes in the long term and shows an increased production of the immune regulatory cytokine IL-10 after aHSCT. These findings might promote the clinical improvements after aHSCT in SSc patients.


Asunto(s)
Subgrupos de Linfocitos B/inmunología , Citocinas/inmunología , Trasplante de Células Madre Hematopoyéticas/tendencias , Homeostasis/fisiología , Esclerodermia Sistémica/inmunología , Esclerodermia Sistémica/terapia , Adulto , Subgrupos de Linfocitos B/metabolismo , Linfocitos B/inmunología , Linfocitos B/metabolismo , Citocinas/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Esclerodermia Sistémica/sangre , Trasplante Autólogo/tendencias , Adulto Joven
11.
J Orthop Surg Res ; 14(1): 85, 2019 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-30898115

RESUMEN

OBJECTIVE: We compared autografts and allograft using partial and complete transphyseal anterior cruciate ligament (ACL) reconstruction techniques among skeletally immature individuals. METHODS: Male and females younger than 18 and 16 years old, respectively, diagnosed with ACL tear from April 2006 to March 2012 entered the study. One group had four-strand hamstring autograft, and the other had tibialis posterior allograft reconstruction. Those who had allografts either had hyper-laxity or recurvatum. RESULTS: Achieved mean (± SD) 2000 International Knee Documentation Committee subjective score was not statistically different (P = 0.385) between allograft (n = 13) (84.3 ± 3.2) and autograft groups (n = 18) (85.6 ± 4.4). Mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale Knee-Related Quality of Life at 2 years was 78.0 ± 7.2 and 75 ± 7.4 for allograft and autograft groups, respectively (p = 0.261). Mean 2-year KOOS subscale Sports and Recreation was 82.1 ± 5.8 and 84.8 ± 6.6 for allograft and autograft groups, respectively (p = 0.244). No patient reported instability, giving way, or locking of the knee. Pivot shift test was negative in all patients; however, a minor positive Lachman test was found in six cases (46%) within the allograft group and seven cases (39%) in the autograft group. One postoperative septic arthritis was documented in the autograft group. CONCLUSION: Considering existing concern that joint laxity and recurvatum are among the precursors of non-contact ACL injury in adolescents, bone-patellar-bone autografts are not applicable in this age group because of the open physis; furthermore, considering that hamstring autografts are insufficient (size thickness and stretchability), we recommend soft tissue allografts for ACL reconstruction in skeletally immature patients.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Autoinjertos/trasplante , Inestabilidad de la Articulación/diagnóstico por imagen , Adolescente , Lesiones del Ligamento Cruzado Anterior/epidemiología , Reconstrucción del Ligamento Cruzado Anterior/tendencias , Autoinjertos/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/epidemiología , Masculino , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/tendencias , Estudios Prospectivos , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Trasplante Homólogo/métodos , Trasplante Homólogo/tendencias
12.
J Orthop Surg Res ; 14(1): 87, 2019 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-30902098

RESUMEN

BACKGROUND: Recently, the AMADEUS (Area Measurement And DEpth Underlying Structures) grading system has been introduced to evaluate and grade osteochondral lesions prior to cartilage surgery. The AMADEUS score has not been connected to clinical data in order to test a potential clincial impact. PURPOSE: To examine the correlation between the AMADEUS score and preoperative patient-reported outcome measurements (PROMs). STUDY DESIGN: Case series METHODS: Patients treated with matrix-induced autologous chondrocyte implantation (MACI) were included in the study, unless exclusion criteria like BMI > 35, prior extensive meniscectomy or ongoing inflammatory arthritis were present. Preoperative magnetic resonance (MR) examinations were graded according to the standardized AMADEUS protocol. The final AMADEUS score was correlated with preoperative patient-reported outcome measurements (PROMs), including the IKDC (International Knee Documentation Committee), the Lysholm score, the Short-Form-12 (SF-12) score, and the Core Outcome Measures Index (COMI) score. RESULTS: A total of 50 patients with a mean age of 33.6 ± 11.5 years, a mean BMI of 25.1 ± 4.9, and a mean defect size of 2.3 ± 1.5 cm2 were included in the study. More severe cartilage defects, indicated by the AMADEUS grade (R = 0.35, p = 0.01) and the AMADEUS score (R = - 0.36, p = 0.01) as well as larger chondral defects (R = 0.32, p = 0.03) show a moderate correlation with the higher COMI scores. No correlative capacity was demonstrated for the AMADEUS score and the IKDC, Lysholm, and Tegner activity scores as well as for its subscales. CONCLUSION: There is a moderate correlation of the COMI and the AMADEUS score in patients treated with matrix-induced autologous chondrocyte implantation (MACI). All other patient-reported outcome measurement scores (PROMs) show no evidence of an association to the magnetic resonance-based AMADEUS score. CLINICAL RELEVANCE: The clinical and scientific implication of the COMI score as a PROM tool can be recommended when working with the AMADEUS score and patients undergoing MACI.


Asunto(s)
Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedades de los Cartílagos/cirugía , Condrocitos/trasplante , Medición de Resultados Informados por el Paciente , Cuidados Preoperatorios/métodos , Índice de Severidad de la Enfermedad , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/tendencias , Trasplante Autólogo/tendencias , Resultado del Tratamiento
13.
Zhonghua Shao Shang Za Zhi ; 35(3): 233-236, 2019 Mar 20.
Artículo en Chino | MEDLINE | ID: mdl-30897874

RESUMEN

Scars formed by various injuries can affect the appearance and psychology of patients. Therefore, more and more people pay attention to the prevention and treatment of scar. With the development of the autologous fat grafting, it has been gradually applied to the prevention and treatment of scar. At present, it has been confirmed by scholars that the autologous fat grafting could be an effective method to prevent and treat scar from basic research and clinical practice. At the same time, the deficiency of autologous fat grafting in the prevention and treatment of scar was also pointed out. This paper reviews the application, mechanism, and deficiency of autologous fat grafting in scar prevention and treatment.


Asunto(s)
Cicatriz/prevención & control , Cicatriz/cirugía , Procedimientos de Cirugía Plástica/métodos , Grasa Subcutánea/trasplante , Trasplante Autólogo/métodos , Tejido Adiposo , Cicatriz/complicaciones , Humanos , Trasplante Autólogo/tendencias
14.
Intern Med J ; 49(5): 598-606, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30411451

RESUMEN

BACKGROUND: The impact of changes in novel agent (NA) usage on the survival of multiple myeloma (MM) patients in real-world hospital settings is unclear. In New Zealand (NZ) in 2011, frontline bortezomib became available and thalidomide availability was expanded. AIM: This retrospective study analyses the impact these change had on the survival of MM patients treated at a NZ hospital. METHODS: Clinical and overall survival (OS) data were collected on MM patients who were treated at Christchurch Hospital during 2000-2009 (pre-cohort, n = 337) and 2011-2017 (post-cohort, n = 343). Outcomes were compared using pre-cohort data truncated at 2011. RESULTS: Patients in the post-cohort had significant increases (P < 0.001) in not only NA usage (85 vs 55%) and OS (median = 56 vs 44 months) but also the proportion (74 vs 49%) of young patients (age < 70) who received an autologous stem cell transplant (ASCT). Separate analysis of older patients demonstrated that those in the post-cohort had significantly longer OS (median OS 28 vs 17, P < 0.001) although 5-year relative survival remained less than 50%. Separate analysis of young patients demonstrated that those in the post-cohort had significantly increased initial OS with the survival curves converging at 5 years. Although ASCT-treated patients had similar OS in each cohort, their progression-free survival (PFS) was significantly increased in the post-cohort (median 40 vs 20 months, P < 0.0001). CONCLUSION: In the setting of a NZ hospital the increased availability of NA was associated with a significant improvement in both the OS of older patients and the PFS of ASCT patients.


Asunto(s)
Accesibilidad a los Servicios de Salud/tendencias , Trasplante de Células Madre Hematopoyéticas/tendencias , Hospitalización/tendencias , Mieloma Múltiple/epidemiología , Mieloma Múltiple/terapia , Supervivencia sin Progresión , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos Alquilantes/administración & dosificación , Bortezomib/administración & dosificación , Femenino , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Inmunosupresores/administración & dosificación , Quimioterapia de Inducción/métodos , Quimioterapia de Inducción/tendencias , Masculino , Melfalán/administración & dosificación , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Talidomida/administración & dosificación , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Resultado del Tratamiento
15.
World Neurosurg ; 122: 692-703.e2, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30414518

RESUMEN

BACKGROUND: Acellular nerve allografts (ANAs) have been established as promising alternatives to autologous nerve grafts, which represent the reference standard. Our research group recently performed a systematic review of reported cell-based-enriching methods for recellularization of ANAs. Recellularization results in consistent improvement of peripheral neuroregeneration compared with plain ANAs. We systematically reviewed the effects on nerve regeneration when ANA enrichment was obtained through biological, chemical, and physical modification instead of cells. METHODS: The PubMed, ScienceDirect, Medline, and Scopus databases were searched for reports of noncellular modification of ANAs, reported from January 2007 to December 2017. The inclusion criteria were English language, noncellular enrichment of ANAs in peripheral nerve regeneration, an in vivo study design, and postgrafting neuroregenerative outcomes assessment. The exclusion criteria were the central nervous system as the site of ANA application, nerve conduits, xenografts, case series, case reports, and reviews. RESULTS: Only animal studies were found to be eligible. We included 16 studies, which were analyzed regarding the animal model, decellularization method, graft-enriching mode, and neuroregenerative tests performed. CONCLUSIONS: Noncellular-based stimulation of ANAs demonstrated positive effects on recovery of nerve function compared with nerve grafting compared with plain ANAs. The neuroregenerative effect of autografting still appeared superior to ANAs, even with noncellular enrichment of ANAs. However, we found that in a few studies, modified ANAs closely approached or even outperformed autografts. Future research should include more preclinical investigations of this promising tool and clinical translation to increase the level of evidence available in the challenging field of peripheral nerve reconstruction.


Asunto(s)
Regeneración Nerviosa/fisiología , Procedimientos Neuroquirúrgicos/métodos , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/cirugía , Animales , Humanos , Procedimientos Neuroquirúrgicos/tendencias , Nervios Periféricos/patología , Nervios Periféricos/cirugía , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Trasplante Homólogo/métodos , Trasplante Homólogo/tendencias
16.
Intern Med J ; 49(7): 886-893, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30552793

RESUMEN

BACKGROUND: Hungry bone syndrome (HBS) is one of the most serious complications following parathyroidectomy for severe hyperparathyroidism. There is a lack of literature informing the treatment and risk factors for this condition and the ideal pre-operative strategy for prevention. AIMS: The primary aims were to examine the incidence of HBS with pre-operative calcitriol loading for 10 days and to determine the risk factors for HBS. The secondary aims were to determine the rate of intravenous calcium replacement in those with HBS and to assess whether cinacalcet removal has increased rates of parathyroidectomy in the end-stage kidney disease population. METHODS: We performed a retrospective study from 2011 to 2018 on 45 patients with end-stage kidney disease undergoing total parathyroidectomy with autotransplantation for severe hyperparathyroidism. This was based at the John Hunter and Newcastle Private Hospitals in New South Wales. RESULTS: 28.3% of patients with calcitriol loading undergoing parathyroidectomy fulfilled criteria for HBS. Pre-operative variables that were associated with HBS were elevated parathyroid hormone (P = 0.028) and longer duration of renal replacement therapy (P = 0.033). Rates of total parathyroidectomy were higher after the removal of calcimimetics from the Pharmaceutical Benefits Scheme (P = 0.0024). CONCLUSIONS: HBS remains a common complication of parathyroidectomy, even with prolonged high-dose calcitriol loading. This emphasises the need for further trials investigating other targeted therapies, such as bisphosphonates, to prevent HBS. Those most at risk of HBS are patients with high bone turnover and prolonged renal replacement therapy.


Asunto(s)
Calcitriol/administración & dosificación , Hormonas y Agentes Reguladores de Calcio/administración & dosificación , Hipocalcemia/prevención & control , Fallo Renal Crónico/cirugía , Paratiroidectomía/efectos adversos , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/epidemiología , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Paratiroidectomía/tendencias , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/tendencias
17.
BMC Cancer ; 18(1): 1008, 2018 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-30342509

RESUMEN

BACKGROUND: Renal impairment (RI) is a negative prognostic factor in Multiple Myeloma (MM) and affected patients are often excluded from autologous stem cell transplantation (ASCT). However, it remains unclear whether historically inferior outcome data still hold true. METHODS: From a total of 475 eligible MM patients who had undergone ASCT between 1998 and 2016, 374 were included in this multi-centric retrospective cohort study. Renal function was determined both at the time of MM diagnosis and ASCT by estimated glomerular filtration rate (eGFR according to the MDRD formula, RI defined as eGFR < 60 ml/min/1.73m2). Patients were categorized into 3 groups: A) no RI diagnosis and ASCT, B) RI at diagnosis with normalization before ASCT and C) RI both at the time of diagnosis and ASCT. Log-rank testing was used for overall and progression-free survival (OS, PFS) analysis. CONCLUSION: While severe RI at MM diagnosis confers a risk of shorter OS, MM progression after ASCT is not affected by any stage of renal failure. It can be concluded that ASCT can be safely carried out in MM patients with mild to moderate RI and should be pro-actively considered in those with severe RI. RESULTS: When comparing all groups, no difference in OS and PFS was found (p = 0.319 and p = 0.904). After further stratification according to the degree of RI at the time of diagnosis, an OS disadvantage was detected for patients with an eGFR < 45 ml/min/m2. PFS was not affected by any RI stage.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas/tendencias , Mieloma Múltiple/terapia , Insuficiencia Renal/terapia , Anciano , Estudios de Cohortes , Femenino , Tasa de Filtración Glomerular/fisiología , Trasplante de Células Madre Hematopoyéticas/métodos , Trasplante de Células Madre Hematopoyéticas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/mortalidad , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/mortalidad , Estudios Retrospectivos , Trasplante Autólogo/métodos , Trasplante Autólogo/mortalidad , Trasplante Autólogo/tendencias , Resultado del Tratamiento
18.
BMC Cancer ; 18(1): 994, 2018 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-30340548

RESUMEN

BACKGROUND: The number of patients requesting autologous breast reconstruction (ABR) after mastectomy for breast cancer has increased over the past decades. However, concern has been expressed about the oncological safety of ABR. The aim of our study was to assess the effect of ABR on distant relapse. METHODS: In this retrospective cohort study, data was analysed from patients who underwent mastectomy for invasive breast cancer in University Hospitals Leuven between 2000 and 2011. In total, 2326 consecutive patients were included, 485 who underwent mastectomy with ABR and 1841 who underwent mastectomy alone. The risk of relapse in both groups was calculated using a Cox proportional hazards analysis, adjusted for established prognostic factors. ABR was considered as a time-dependent variable. Additionally, the evolution of the risk over follow-up time was calculated. RESULTS: With a median follow-up of 68 months, 8% of patients in the reconstruction group developed distant metastases compared to 15% in the mastectomy alone group (univariate HR 0.70, 95% CI 0.50-0.97, p = 0.0323). However, after adjustment for potential confounding factors in a Cox multivariable analysis, the risk of distant relapse was no longer significantly different between groups (multivariate HR 0.82, 95% CI 0.55-1.22, p = 0.3301). Moreover, the risk of metastasis after reconstruction was not time-dependent. CONCLUSIONS: These findings suggest that there is no effect of ABR on distant relapse rate and thus that ABR is an oncological safe procedure. The rate of local recurrence was too low to make any significant conclusions.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Mamoplastia/tendencias , Mastectomía/tendencias , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/efectos adversos , Mamoplastia/métodos , Mastectomía/efectos adversos , Mastectomía/métodos , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Estudios Prospectivos , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Resultado del Tratamiento , Adulto Joven
19.
J Natl Compr Canc Netw ; 16(9): 1092-1106, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30181421

RESUMEN

Patients with relapsed or refractory (R/R) cancers have a poor prognosis and limited treatment options. The recent approval of 2 chimeric antigen receptor (CAR) autologous T-cell products for R/R B-cell acute lymphoblastic leukemia and non-Hodgkin's lymphoma treatment is setting the stage for what is possible in other diseases. However, there are important factors that must be considered, including patient selection, toxicity management, and costs associated with CAR T-cell therapy. To begin to address these issues, NCCN organized a task force consisting of a multidisciplinary panel of experts in oncology, cancer center administration, and health policy, which met for the first time in March 2018. This report describes the current state of CAR T-cell therapy and future strategies that should be considered as the application of this novel immunotherapy expands and evolves.


Asunto(s)
Inmunoterapia Adoptiva/métodos , Recurrencia Local de Neoplasia/terapia , Neoplasias/terapia , Comités Consultivos , Instituciones Oncológicas/organización & administración , Resistencia a Antineoplásicos/inmunología , Política de Salud , Humanos , Inmunoterapia Adoptiva/efectos adversos , Inmunoterapia Adoptiva/tendencias , Comunicación Interdisciplinaria , Oncología Médica/organización & administración , Recurrencia Local de Neoplasia/inmunología , Neoplasias/inmunología , Receptores Quiméricos de Antígenos/inmunología , Sociedades Médicas/organización & administración , Linfocitos T/inmunología , Linfocitos T/trasplante , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplante Autólogo/tendencias , Estados Unidos
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