Effect of vitamin C on immune reconstitution after bone marrow transplantation.

BACKGROUND: Vitamin C is an essential nutrient for the adequate function and maturation of the immune system. In vitro studies show that the development, proliferation, and functioning of T cells requires vitamin C, especially for natural killer (NK) cells. Their deficiency during the acute phase post-transplantation could cause greater morbidity and mortality in these patients. A prospective clinical trial using high-dose vitamin C was performed to determine if vitamin C supplementation improves reconstitution of NK lymphocytes after hematopoietic stem cell transplantation (HSCT). MATERIALS AND METHODS: We enrolled 24 patients who underwent autologous HSCT for multiple myeloma and lymphoma. Patients were randomized to receive standard treatment or standard treatment plus 20 g vitamin C once daily (1 - 10 days) and 500 mg twice daily (11 - 100 days) after transplantation. RESULTS: NK and CD3+ lymphocytes showed an increase from days +30 to +100 only in the vitamin C-treated group. Patients in the vitamin C group had a lower frequency of infections. No severe adverse events were reported. CONCLUSION: Our results suggest that high-dose vitamin C supplementation is an effective and safe therapeutic option to decrease the frequency of infections and enhance immune reconstitution after HSCT.

Clinical effects of hydration, supplementary vitamins, and trace elements during end-of-life care for cancer patients.

Introduction: Introduction: current data regarding the decision on rehydration of patients with terminal-stage cancer remain controversial. Objective: the present study was to evaluate the effect of intravenous hydration and supplementary vitamins and trace elements on clinical symptoms and biochemical parameters in palliative cancer patients. Methods: a randomized clinical trial including 72 palliative cancer patients aged 18 years and older was performed at the National Cancer Institute in Mexico. Patients were divided into two groups: intervention and control, both receiving intravenous saline solution weekly for 4 weeks, but the former was also supplemented with vitamins and trace elements. Symptoms were assessed at baseline and 4 weeks after with the Edmonton Symptom Assessment Scale. Same measurements applied to biochemical parameters. Results: the mean age of the patients was 58.75 years. The most frequent cancer diagnoses were gastrointestinal (32 %). In the between-groups analysis significant improvements were found for the intervention group in anorexia (p = 0.024), pain (p = 0.030), chloride (p = 0.043), phosphorus (p = 0.001), potassium (p = 0.006), and total proteins (< 0.0001). Conclusion: we highlight the improvement in the control of most symptoms and some biochemical parameters in the intervention group receiving vitamins and oligoelements along with intravenous hydration. Further studies are needed.

Introducción: Introducción: los datos actuales sobre la decisión de rehidratación de pacientes con cáncer en fase terminal siguen siendo controvertidos. Objetivo: el presente estudio fue evaluar el efecto de la hidratación intravenosa y la suplementación con vitaminas y oligoelementos sobre los síntomas clínicos y parámetros bioquímicos en pacientes con cáncer paliativo. Métodos: en el Instituto Nacional del Cáncer de México se realizó un ensayo clínico aleatorizado que incluyó a 72 pacientes con cáncer paliativo de 18 años o más. Los pacientes se dividieron en dos grupos: intervención y control, ambos recibieron solución salina intravenosa semanalmente durante 4 semanas, pero el primero también se complementó con vitaminas y oligoelementos. Los síntomas se evaluaron al inicio del estudio y 4 semanas después con la escala de evaluación de síntomas de Edmonton. Mismas medidas aplicadas a los parámetros bioquímicos. Resultados: la edad media de los pacientes fue de 58,75 años. El diagnóstico de cáncer más frecuente fue el gastrointestinal (32 %). En el análisis entre grupos se encontraron mejoras significativas para el grupo de intervención en anorexia (p = 0,024), dolor (p = 0,030), cloro (p = 0,043), fósforo (p = 0,001), potasio (p = 0,006) y proteínas totales (< 0,0001). Conclusión: destacamos la mejoría en el control de la mayoría de los síntomas y algunos parámetros bioquímicos en el grupo de intervención que recibió vitaminas y oligoelementos junto con hidratación endovenosa. Se necesitan más estudios.

A modified CALGB 10403 in adolescents and young adults with acute lymphoblastic leukemia in Central America.

Mexico and Central America have a high incidence of acute lymphoblastic leukemia (ALL) in adolescents and young adults. Historically, this patient group has been treated using adult-based regimens, which entails a high rate of treatment-related mortality and a poor overall survival (OS). The use of the CALGB 10403, a pediatric-inspired regimen, has been proven effective in this patient subgroup. Nonetheless, low- and middle-income countries (LMICs) may present limited access to standard care treatments implemented elsewhere, warranting the need for further research to improve outcomes among vulnerable populations. In this study, we present the outcomes in terms of safety and effectiveness of using a modified CALGB 10403 regimen to reflect drug and resource availability in LMICs. Modifications included the use of Escherichia coli asparaginase,6-mercaptopurine instead of thioguanine and the use of rituximab among patients with CD20+. A total of 95 patients with a median age of 23 (range, 14-49) years treated with this modified scheme were prospectively assessed at 5 centers in Mexico and 1 in Guatemala. Among these, 87.8% achieved a complete response after induction. During follow-up, 28.3% of patients relapsed. Two-year OS rate was 72.1%. Factors associated with worse OS included hyperleukocytosis (hazard ratio [HR], 4.28; 95% confidence interval [CI], 1.81-10.10) and postinduction minimal residual disease (HR, 4.67; 95% CI, 1.75-12.44). Most patients presented hepatotoxicity (51.6% and 53.7% during induction and consolidation, respectively), and the treatment-related mortality was 9.5%. Overall, results highlight that implementing a modified CALGB 10403 regimen in Central America is feasible, and it is associated with improvements in clinical outcomes and a manageable safety profile.

Ruxolitinib as a treatment strategy for SARS-CoV-2 pneumonia: clinical experience in a real-world setting.

INTRODUCTION: Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) infection is characterised by a viral phase and a severe pro-inflammatory phase. The inhibition of the JAK/STAT pathway limits the pro-inflammatory state in moderate to severe COVID-19. METHODOLOGY: We analysed the data obtained by an observational cohort of patients with SARS-CoV-2 pneumonia treated with ruxolitinib in 22 hospitals of Mexico. The applied dose was determined based on physician's criteria. The benefit of ruxolitinib was evaluated using the 8-points ordinal scale developed by the NIH in the ACTT1 trial. Duration of hospital stay, changes in pro-inflammatory laboratory values, mortality, and toxicity were also measured. RESULTS: A total of 287 patients were reported at 22 sites in Mexico from March to June 2020; 80.8% received ruxolitinib 5 mg BID and 19.16% received ruxolitinib 10 mg BID plus standard of care. At beginning of treatment, 223 patients were on oxygen support and 59 on invasive ventilation. The percentage of patients on invasive ventilation was 53% in the 10 mg and 13% in the 5 mg cohort. A statistically significant improvement measured as a reduction by 2 points on the 8-point ordinal scale was described (baseline 5.39 ± 0.93, final 3.67± 2.98, p = 0.0001). There were 74 deaths. Serious adverse events were presented in 6.9% of the patients. CONCLUSIONS: Ruxolitinib appears to be safe in COVID-19 patients, with clinical benefits observed in terms of decrease in the 8-point ordinal scale and pro-inflammatory state. Further studies must be done to ensure efficacy against mortality.

Nutritional status in patients with COVID-19 and cancer: the experience of the National Cancer Institute in Mexico.

INTRODUCTION: Background: nutritional status might vary according to different underlying illnesses such as cancer or infectious diseases, including COVID-19. In this context, data from developing countries remain scarce. Objectives: the objective of this study was to assess the nutritional status and outcomes of Mexican cancer patients diagnosed with COVID-19 at a tertiary care center. Methods: this was a retrospective study including 121 consecutive cancer patients diagnosed with COVID-19 at the National Cancer Institute, Mexico City, during four months. Results: the most frequent oncological diagnoses were gynecological (19 %) and hematological (17 %). Most patients were overweight (35 %). In the univariate analysis, ≥ 65 years, intubation, hypoalbuminemia, high creatinine, lymphopenia, nutrition-impact symptoms, and ECOG 2-4 were statistically associated with lower survival. The median survival of the cohort was 41 days. Conclusions: to our best knowledge, this is the first study of its kind performed in Mexico, and as other studies from other regions, our results might aid in identifying cancer patients most at risk for severe COVID-19, and could be potentially useful to enhance public health messaging on self-isolation and social distancing among Mexican cancer patients.

INTRODUCCIÓN: Antecedentes: el estado nutricional puede variar según las diferentes enfermedades subyacentes, como el cáncer o las enfermedades infecciosas, por ejemplo, la COVID-19. En este contexto, los datos de los países en desarrollo siguen siendo escasos. Objetivos: el objetivo de este estudio fue evaluar el estado nutricional y los resultados de pacientes mexicanos con cáncer diagnosticados de COVID-19 en un centro de atención terciaria. Métodos: se trata de un estudio retrospectivo que incluyó a 121 pacientes consecutivos con cáncer diagnosticados de COVID-19 en el Instituto Nacional del Cáncer de la Ciudad de México durante cuatro meses. Resultados: los diagnósticos oncológicos más frecuentes fueron los ginecológicos (19 %) y hematológicos (17 %). La mayoría de los pacientes tenían sobrepeso (35 %) y obesidad (31 %). En el análisis univariado, ≥ 65 años, intubación, hipoalbuminemia, creatinina alta, linfopenia, síntomas de impacto nutricional y ECOG 2-4 se asociaron estadísticamente con una menor supervivencia. La mediana de supervivencia de la cohorte fue de 41 días. Conclusiones: hasta donde sabemos, este es el primer estudio de este tipo realizado en México y, al igual que otros estudios de otras regiones, nuestros resultados podrían ayudar a identificar a los pacientes con cáncer y mayor riesgo de COVID-19 grave; también podrían ser potencialmente útiles para mejorar los mensajes de salud sobre el autoaislamiento y el distanciamiento social entre los pacientes mexicanos con cáncer.

Incidence and characteristics of metabolic syndrome in patients of the National Cancer Institute of Mexico.

INTRODUCTION: Objective: the exact prevalence of obesity in Mexico is not well known and varies between sources, but more than 30% of Mexico's population are obese. Obesity is associated with several diseases such as metabolic syndrome; the latter, along with cancer, have become public health concerns worldwide, and their association has been widely studied in developed countries. The aim of this study was to identify the overall prevalence of metabolic syndrome and to describe its characteristics among first-time cancer patients at a referral center in Mexico. Methods: a prospective, observational, cohort study of first-time patients of the National Cancer Institute of Mexico in the period of September 2016-2017. We identified 1,165 first-time patients, and 316 patients with known or recently diagnosed metabolic syndrome were included. Results: median age was 55 years old and most were female (81%). The most frequent tumors were breast, gynecological, and hematological. Obesity (class 1-3) and abnormal glucose and/or previous diabetes mellitus diagnosis were mostly observed in patients with skin and soft tissue tumors; dyslipidemia, high triglycerides, and/or low HDL-cholesterol were mostly observed in patients with gastrointestinal tumors. Conclusion: the prevalence of metabolic syndrome among first-time cancer patients was 27%. As obesity and cancer are of public concern in Mexico, the implementation of preventive strategies for metabolic syndrome patients, focusing on the first level of care during early stages in order to reduce the risk of cancer, is needed.

INTRODUCCIÓN: Objetivo: la prevalencia de la obesidad en México es mayor del 30% de la población total. La obesidad se asocia con diversas enfermedades, entre ellas el síndrome metabólico; este y el cáncer se han convertido en problemas de salud pública a nivel mundial, y su asociación ha sido ampliamente estudiada en países desarrollados. El objetivo de este estudio fue identificar la prevalencia del síndrome metabólico y describir las características entre pacientes oncológicos de primera vez en un hospital de tercer nivel en México. Métodos: estudio prospectivo, observacional y de cohortes que incluye a pacientes oncológicos atendidos por primera vez en el Instituto Nacional de Cancerología durante el periodo de septiembre 2016 a 2017. Identificamos 1165 pacientes; 316 tenían el diagnóstico de síndrome metabólico y fueron incluidos en el presente estudio. Resultados: la mediana de edad fue de 55 años y la mayoría de los pacientes eran del sexo femenino (81%). Las neoplasias más frecuentes fueron las de mama, ginecológicas y hematológicas. La obesidad (clase 1-3) y la glucosa anormal y/o un diagnóstico previo de diabetes mellitus se observaron mayormente en pacientes con neoplasias de piel y tejidos blandos; los pacientes con neoplasias gastrointestinales presentaron mayormente dislipidemia, triglicéridos elevados y/o HDL bajo. Conclusiones: la prevalencia del síndrome metabólico en nuestros pacientes oncológicos fue de 27%. Al ser la obesidad y el cáncer problemas de salud pública en México, la implementación de medidas preventivas para pacientes con síndrome metabólico debe enfocarse en el primer nivel de atención, durante etapas tempranas, para poder reducir el riesgo de cáncer.

Nutritional status in patients with COVID-19 and cancer: the experience of the National Cancer Institute in Mexico / Estado nutricional en pacientes con COVID-19 y cáncer: la experiencia del Instituto Nacional de Cancerología de México

Background: nutritional status might vary according to different underlying illnesses such as cancer or infectious diseases, including COVID-19. In this context, data from developing countries remain scarce. Objectives: the objective of this study was to assess the nutritional status and outcomes of Mexican cancer patients diagnosed with COVID-19 at a tertiary care center. Methods: this was a retrospective study including 121 consecutive cancer patients diagnosed with COVID-19 at the National Cancer Institute, Mexico City, during four months. Results: the most frequent oncological diagnoses were gynecological (19 %) and hematological (17 %). Most patients were overweight (35 %). In the univariate analysis, ≥ 65 years, intubation, hypoalbuminemia, high creatinine, lymphopenia, nutrition-impact symptoms, and ECOG 2-4 were statistically associated with lower survival. The median survival of the cohort was 41 days. Conclusions: to our best knowledge, this is the first study of its kind performed in Mexico, and as other studies from other regions, our results might aid in identifying cancer patients most at risk for severe COVID-19, and could be potentially useful to enhance public health messaging on self-isolation and social distancing among Mexican cancer patients. (AU)

Antecedentes: el estado nutricional puede variar según las diferentes enfermedades subyacentes, como el cáncer o las enfermedades infecciosas, por ejemplo, la COVID-19. En este contexto, los datos de los países en desarrollo siguen siendo escasos. Objetivos: el objetivo de este estudio fue evaluar el estado nutricional y los resultados de pacientes mexicanos con cáncer diagnosticados de COVID-19 en un centro de atención terciaria. Métodos: se trata de un estudio retrospectivo que incluyó a 121 pacientes consecutivos con cáncer diagnosticados de COVID-19 en el Instituto Nacional del Cáncer de la Ciudad de México durante cuatro meses. Resultados: los diagnósticos oncológicos más frecuentes fueron los ginecológicos (19 %) y hematológicos (17 %). La mayoría de los pacientes tenían sobrepeso (35 %) y obesidad (31 %). En el análisis univariado, ≥ 65 años, intubación, hipoalbuminemia, creatinina alta, linfopenia, síntomas de impacto nutricional y ECOG 2-4 se asociaron estadísticamente con una menor supervivencia. La mediana de supervivencia de la cohorte fue de 41 días. Conclusiones: hasta donde sabemos, este es el primer estudio de este tipo realizado en México y, al igual que otros estudios de otras regiones, nuestros resultados podrían ayudar a identificar a los pacientes con cáncer y mayor riesgo de COVID-19 grave; también podrían ser potencialmente útiles para mejorar los mensajes de salud sobre el autoaislamiento y el distanciamiento social entre los pacientes mexicanos con cáncer. (AU)

Incidence and characteristics of metabolic syndrome in patients of the National Cancer Institute of Mexico / Incidencia y características del síndrome metabólico en pacientes del Instituto Nacional de Cancerología de México

Objective: the exact prevalence of obesity in Mexico is not well known and varies between sources, but more than 30% of Mexico's population are obese. Obesity is associated with several diseases such as metabolic syndrome; the latter, along with cancer, have become public health concerns worldwide, and their association has been widely studied in developed countries. The aim of this study was to identify the overall prevalence of metabolic syndrome and to describe its characteristics among first-time cancer patients at a referral center in Mexico. Methods: a prospective, observational, cohort study of first-time patients of the National Cancer Institute of Mexico in the period of September 2016-2017. We identified 1,165 first-time patients, and 316 patients with known or recently diagnosed metabolic syndrome were included. Results: median age was 55 years old and most were female (81%). The most frequent tumors were breast, gynecological, and hematological growths. Obesity (class 1-3) and abnormal glucose and/or previous diabetes mellitus diagnosis were mostly observed in patients with skin and soft tissue tumors; dyslipidemia, high triglycerides, and/or low HDL-cholesterol were mostly observed in patients with gastrointestinal tumors. Conclusion: the prevalence of metabolic syndrome among first-time cancer patients was 27%. As obesity and cancer are of public concern in Mexico, the implementation of preventive strategies for metabolic syndrome patients, focusing on the first level of care during early stages in order to reduce the risk of cancer, is needed

Objetivo: la prevalencia de la obesidad en México es mayor del 30% de la población total. La obesidad se asocia con diversas enfermedades, entre ellas el síndrome metabólico; este y el cáncer se han convertido en problemas de salud pública a nivel mundial, y su asociación ha sido ampliamente estudiada en países desarrollados. El objetivo de este estudio fue identificar la prevalencia del síndrome metabólico y describir las características entre pacientes oncológicos de primera vez en un hospital de tercer nivel en México. Métodos: estudio prospectivo, observacional y de cohortes que incluye a pacientes oncológicos atendidos por primera vez en el Instituto Nacional de Cancerología durante el periodo de septiembre 2016 a 2017. Identificamos 1165 pacientes; 316 tenían el diagnóstico de síndrome metabólico y fueron incluidos en el presente estudio. Resultados: la mediana de edad fue de 55 años y la mayoría de los pacientes eran del sexo femenino (81%). Las neoplasias más frecuentes fueron las de mama, ginecológicas y hematológicas. La obesidad (clase 1-3) y la glucosa anormal y/o un diagnóstico previo de diabetes mellitus se observaron mayormente en pacientes con neoplasias de piel y tejidos blandos; los pacientes con neoplasias gastrointestinales presentaron mayormente dislipidemia, triglicéridos elevados y/o HDL bajo. Conclusiones: la prevalencia del síndrome metabólico en nuestros pacientes oncológicos fue de 27%. Al ser la obesidad y el cáncer problemas de salud pública en México, la implementación de medidas preventivas para pacientes con síndrome metabólico debe enfocarse en el primer nivel de atención, durante etapas tempranas, para poder reducir el riesgo de cáncer