An approach to personalized cell therapy in chronic complete paraplegia: The Puerta de Hierro phase I/II clinical trial.

BACKGROUND AIMS: Cell transplantation in patients suffering spinal cord injury (SCI) is in its initial stages, but currently there is confusion about the results because of the disparity in the techniques used, the route of administration, and the criteria for selecting patients. METHODS: We conducted a clinical trial involving 12 patients with complete and chronic paraplegia (average time of chronicity, 13.86 years; SD, 9.36). The characteristics of SCI in magnetic resonance imaging (MRI) were evaluated for a personalized local administration of expanded autologous bone marrow mesenchymal stromal cells (MSCs) supported in autologous plasma, with the number of MSCs ranging from 100 × 10(6) to 230 × 10(6). An additional 30 × 10(6) MSCs were administered 3 months later by lumbar puncture into the subarachnoid space. Outcomes were evaluated at 3, 6, 9 and 12 months after surgery through clinical, urodynamic, neurophysiological and neuroimaging studies. RESULTS: Cell transplantation is a safe procedure. All patients experienced improvement, primarily in sensitivity and sphincter control. Infralesional motor activity, according to clinical and neurophysiological studies, was obtained by more than 50% of the patients. Decreases in spasms and spasticity, and improved sexual function were also common findings. Clinical improvement seems to be dose-dependent but was not influenced by the chronicity of the SCI. CONCLUSION: Personalized cell therapy with MSCs is safe and leads to clear improvements in clinical aspects and quality of life for patients with complete and chronically established paraplegia.

Tumor neuroendocrino bien diferenciado intradural-extramedular primario del filum terminale. Presentación de un caso y revisión de la literatura / Primary well differentiated neuroendocrine tumor of the filum terminale. Case report and literature review

Objetivo: Presentar un caso de un tumor neuroendocrino primario bien diferenciado intradural-extramedular del filum terminale y revisar la literatura. Caso: Paciente de 68 años valorada tras presentar lumbociática de difícil control analgésico objetivándose una lesión intradural-extramedular lumbar. La lesión, en relación al filum terminal, fue resecada parcialmente siendo el diagnóstico anatomopatológico de tumor neuroendocrino bien diferenciado primario (carcinoide). Tras valoración multidisciplinaria, se decidió tratamiento radioterápico estereotáctico fraccionado. En los sucesivos controles no se evidenció progresión ni diseminación metastásica. Discusión: Los tumores neuroendocrinos son neoplasias heterogéneas derivadas predominantemente de células enterocromafines, en los cuales la quimioterapia tiene un rol muy limitado. Por otra parte, la radioterapia ha sido descrita en lesiones parcialmente resecadas. Conclusión: Los tumores neuroendocrinos primarios bien diferenciados con localización intradural-extramedular lumbosacra son una rareza excepcional. La resección quirúrgica aislada, o asociada a tratamiento adyuvante radioterápico en resecciones subtotales, podría ser considerada una estrategia terapéutica efectiva

Objective: To present a case of a well-differentiated primary intradural-extramedullary neuroendocrine tumor of the filum terminale and to conduct a literature review. Case: A 68-years old patient was assessed after presenting lower back pain and sciatica with ineffective pain relief. The patient presented an intradural-extramedullary lumbar lesion arising from the filum terminale, which was partially resected. The pathology diagnosis was a well-differentiated primary neuroendocrine tumor (carcinoid tumor). After a multidisciplinary evaluation, fractionated stereotactic radiotherapy was administered. No progression or metastatic spread was observed in successive assessments. Discussion: Neuroendocrine tumors are heterogeneous neoplasms derived predominantly from enterochromaffin cells, in which chemotherapy plays a very limited role. In contrast, radiotherapy has been described in partially resected lesions. Conclusion: Well-differentiated primary neuroendocrine tumors with intradural-extramedullary lumbosacral location are an exceptional rarity. Isolated surgical resection, or associated with an adjuvant radiotherapy treatment in subtotal resections, could be considered an effective therapeutic strategy

Lesiones cerebelosas en pompas de jabón y adenopatías mediastínicas / Cerebellar soap bubble lesions and mediastinal lymphnodes

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