Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®.

OBJECTIVES: Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE. MATERIAL AND METHODS: Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis. RESULTS: MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group. CONCLUSIONS: Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.

Sinus graft with safescraper: 5-year results.

PURPOSE: In the procedure of sinus floor elevation, autogenous bone, allogenic grafts, and several other bone substitutes are used. However, autogenous bone is still considered the gold standard. Donor sites for autogenous bone are generally the iliac crest, oral cavity, calvarium bone, and tibia. In this work the experience with the use of a Safescraper device for harvesting of autogenous bone is reported and a decision-making algorithm for grafting in sinus floor elevation procedures is proposed. MATERIALS AND METHODS: Forty sinus augmentation procedures were performed in 34 patients. All sinuses were filled with a mixture of autogenous bone and bovine hydroxyapatite. A Safescraper device was used to harvest autologous bone from the maxillary area. Platelet-rich plasma was used to sustain bone placement. Sixty-five dental implants were placed at 4 months with a flapless procedure. A clinical and radiological 5-year retrospective case series of a cohort is reported. RESULTS: In all cases new bone formation was confirmed radiologically and implant placement was performed successfully. Analysis of samples obtained by biopsy with histology and microcomputed tomography showed the presence of mature bone. Healing problems were observed in only 1 case. CONCLUSIONS: Sinus augmentation with bone grafts obtained from oral cavity with a bone scraper device has the advantage of providing autogenous bone without the need for an extra surgical approach. This procedure yields satisfactory results in bone formation, implant survival, and patient satisfaction. When combined with a flapless approach for implant placement, a decrease in the morbidity of the entire process is achieved.

GEMOX-R regimen is a highly effective salvage regimen in patients with refractory/relapsing diffuse large-cell lymphoma: a phase II study.

OBJECTIVES: The prognosis of old or immunocompromised patients with refractory or relapsing diffuse large-cell lymphoma (DLCL) is very poor as the current standard of salvage therapy with autologous stem cell transplantation (ASCT) is not feasible for most of them. New active regimens with an acceptable toxicity profile are needed. We aim to report the results of a phase II trial of the GEMOX-R regimen in DLCL. METHODS: A total of 32 patients received GEMOX-R regimen in 2-wk intervals if feasible or every 3 wk for a planned six to eight courses. RESULTS: Median age of the population was 69 yr. Forty-one percent of the patients were primary refractory and 59% after relapsing. At GEMOX-R, 75% of patients had a stage III-IV and an adjusted International Prognostic Index > 1 was observed in 69%. The response rate was 43% with 34% complete response. Neutropenia and thrombopenia grade III-IV were observed in 43% of the patients and neurotoxicity grade III-IV in 7% of cases. Median follow-up for alive patients was 13 months and the median survival was 9.1 months. At 12 months, the overall survival and progression-free survival were 41% and 29%, respectively. CONCLUSIONS: GEMOX-R is a new salvage regimen for DLCL with high activity and relatively safe toxicity profile, which can be offered to elderly patients not candidates of ASCT consolidation. The high efficacy of the regimen in this unfavorable population and also in immunocompromised situations warrant further investigation of this regimen in all salvage situations of this type of lymphomas.

Long-term hematological reconstitution and clinical evaluation of autologous peripheral blood stem cell transplantation after cryopreservation of cells with 5% and 10% dimethylsulfoxide at -80 degrees C in a mechanical freezer.

We report the long-term evaluation over 12 years of a simplified technique for stem-cell cryopreservation at -80 degrees C without rate-controlled freezing and with 5% (n=251) or 10% (n=47) DMSO as the sole cryoprotectant. Platelet recovery was greater in the 5% DMSO group while long-term hematological recovery did not differ. Factors influencing a faster hematological recovery were infusion of more than 2.7x10(6)/Kg of CD34+ cells, 10% DMSO cryopreservation and G-CSF. We confirm that the procedure is feasible with reduction in infusion-related toxicity from 60% using 5% DMSO. Differences in hematological reconstitution were not clinically significant if a minimum of 1.5x10(6)/Kg CD34+-cells were infused.

Pathogenic study of anti-CD20 infusion-related severe refractory shock in diffuse large B-cell lymphoma.

Although rituximab is an effective and safe therapy for B-cell lymphoid malignancies, a few cases of severe infusion-related reactions have been reported. Severe refractory distributive shock is an infrequent side-effect of treatment with rituximab and, to our knowledge, there are no reports describing its pathogenesis in a case of fatal outcome in detail. We present for the first time a case of fatal rituximab infusion-related refractory distributive shock in a patient with CD5+ diffuse large B-cell lymphoma (DLBCL) and analyse the pathogenic mechanisms involved. We have compared measurements obtained from the patient that experienced lethal refractory shock with the four subsequent DLBCL patients treated with rituximab, either at diagnosis or upon relapse, at our center. Serum cytokines [interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70] and complement components C3 and C4 were analysed, both pretreatment, and 3 h and 9 h after the onset of infusion. When compared with the control subjects, the potential risk factors for rituximab toxicity displayed by the patient that suffered refractory shock included C4 hypercomplementemia, IFN-gamma and IL-10 hypercytokinemia, as well as a high tumor burden. The refractory shock was distributive with most cytokines (IFN-gamma, TNF-alpha, IL-2, IL-4, IL-6 and IL-8) peaking 3 h after infusion and coinciding with the onset of the shock. Furthermore, the concentrations of IL-10 were persistently elevated. In conclusion, the cytokine pattern was similar to that observed in patients with rapid onset septic shock and serum cytokines reached levels markedly higher than previously described in other cases of severe rituximab infusion-related toxicity.

Gemcitabine and oxaliplatinum: an effective regimen in patients with refractory and relapsing Hodgkin lymphoma.

BACKGROUND: Most Hodgkin lymphomas (HL) can be cured with current strategies. However, one-third of the cases do not respond or relapse and need salvage regimens. We report the results of a retrospective study using the gemcitabine and oxaliplatinum (GemOx) regimen. METHODS: Patients who relapsed or failed to achieve complete response were eligible and received GemOx salvage therapy. To avoid selection bias and thus to overcome the retrospective nature of the study, all treated patients were included from the pharmacy database. RESULTS: Between 2003-2013, 24 HL patients - relapsing (number [n]=12) or refractory (n=12) - were included, receiving a total of 26 induction treatments with GemOx. Mean previous regimens were 2.38 (42% relapsing after autologous transplantation). Median follow-up was 37 months, and 71% responded (38% of patients achieved complete response). The factors related to better progression-free survival were: B symptoms; response to GemOx; and consolidation with stem cell transplantation. Grades 1 and 2 neurological toxicity was present in 17% of patients. Hematological toxicity was common, with grades 3 and 4 neutropenia (25%) and thrombocytopenia (34%) observed. Progression-free survival was better in patients consolidated with stem cell transplantation. The peripheral blood stem cell collection after GemOx was successful for all candidates. CONCLUSION: 1) The GemOx regimen is effective in relapsed or refractory HL with manageable toxicity. 2) No mobilization failures were observed. 3) Consolidation after response is needed. 4) Its efficacy and favorable toxicity profile might make multiple administrations possible in several recurrences in HL.