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.

Patients' quality of life: Validation of the functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) instrument for the Mexican population.

OBJECTIVE: The functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) is a widely used instrument to assess quality of life (QOL) in hematopoietic stem cell transplant (HSCT) patients, but there is little evidence of its validity in Latin American populations. This study evaluated the psychometric properties of the Spanish language version of the FACT-BMT in Mexican patients. METHOD: First, the original version was piloted with 15 HSCT patients to obtain an adequate cultural version, resulting in the adaptation of one item. After that, the new version was completed by 139 HSCT patients. RESULTS: The results showed a FACT factor structure that explains 70.84% of the total variance, a factor structure similar to the original FACT structure, and with a high internal consistency (Cronbach's alpha = 0.867). For the BMT subscale, the best factor structure included 17 items which explain 61.65% of the total variance with an adequate internal consistency (Cronbach's alpha = 0.696). SIGNIFICANCE OF THE RESULTS: The FACT-BMT was found to be a valid and reliable instrument to evaluate QOL in Mexican patients. Our results constitute new FACT-BMT empirical evidence that supports its clinical and research uses.

IFNG +874 A/T is associated with acute lymphoblastic leukemia in Mexican Mestizos.

Acute lymphoblastic leukemia (ALL), the most common type of cancer in children worldwide, has one of the highest incidence rates in Mexico. It is a multifactorial disease and different cytokine single nucleotide polymorphisms (SNP), have been associated with ALL expression. Few studies have been published analyzing IFNG +874 T/A and IL2 -330 G/T in this type of leukemia. These SNPs are involved in high or low expression, and are central to cellular immunity, influencing greatly tumor growth. The purpose of this work was to explore the association of IFNG +874 A/T (rs2430561) and IL2 -330 G/T (rs2069762) SNPs with ALL susceptibility and/or protection in 488 Mexican Mestizos patients, as compared to 950 Mexican Mestizo healthy controls. The results demonstrated that IFNG +874 T allele (pc = 0.00004, OR = 0.673) and the TT genotype (pc = 0.00015, OR = 0.349), protect against ALL expression with no specific gender association; however, the TT homozygote genotype (vs. TA+AA) seems more protective in males (pc = 0.00683). IL2 -330 G/T does not contribute to the development of ALL. In healthy Mexicans, the most common genotypes for IL2 and IFNG, are the low cytokine producers, suggesting that the genetic background in this ethnic group, may be partly responsible for the high incidence of ALL. These results show for the first time in Mexicans, the relevant role that IFNG SNP has in the genetic etiology of ALL. Thus, a large group of patients belonging to different ethnicities will be very helpful to study in order to demonstrate if these SNPs contribute to the genetic etiology of ALL, as shown here in Mexican Mestizos.

Efectos de una intervención cognitivo conductual y actividad física sobre variables médicas y psicológicas en pacientes sometidos a trasplante hematopoyético de células madre / Effects of a cognitive-behavioral intervention and physical activity on medical and psychological variables in patients treated with hematopoietic stem cell transplantation

Objetivo:Evaluar el efecto de una intervención cognitivo conductual y un programa de actividad física sobre variables psicológicas y médicas en pacientes sometidos a trasplante de células progenitoras hematopoyéticas (TCPH). Método: Diseño N=1 con grupo control histórico, participaron 14 adultos con quienes se implementó psicoeduación y relajación progresiva muscular pasiva previo a la hospitalización y se realizó un programa de actividad física durante la estancia hospitalaria. Se midieron variables psicológicas mediante la Escala Hospitalaria de Ansiedad y Depresión (HADS) al momento de la evaluación, día de hospitalización, día de alta y primer consulta de seguimiento y con el Termómetro de Estrés (DT) en la evaluación y todos los días durante la hospitalización. Por otro lado se creó un grupo control histórico con 21 pacientes tratados en la misma unidad, con quienes se compararon el número de interconsultas a psiquiatría, el requerimiento farmacológico y los días de estancia hospitalaria. Resultados: En los sujetos que se beneficiaron de la intervención, se observó que ansiedad, depresión y estrés, tuvieron variaciones que se mantuvieron en rangos normales. Al comparar entre grupos se observó que en el grupo de intervención fue menor el número de pacientes que requirieron interconsultas a psiquiatría, menor número de interconsultas y una estancia hospitalaria más corta en comparación con grupo control. Conclusiones: La intervención permitió mantener la estabilidad psicológica de los pacientes, así como menor comorbilidad psiquiátrica y farmacológica que facilita el seguimiento y al reducir la estancia hospitalaria se reducen costos y alteraciones psicosociales en el paciente

Purpose: The purpose of the study was to evaluate the effect of a cognitive behavioral intervention and a physical activity program on psychological and medical variables in patients undergoing hematopoietic stem cell transplantation (HSCT). Method: The design used was N = 1 with historical control group, participants were 14 adults. The intervention consisted in psicoeducation and passive progressive muscle relaxation training prior to hospitalization, and a program of physical activity during the hospital stay. Psychological variables were measured trough the Hospital Anxiety and Depression Scale (HADS) in four different moments: baseline assessment, hospital admission, hospital discharge, and first follow-up consultation. The Distress Thermometer (DT) was also used in the baseline assessment and every day during hospitalization. On the other hand, the historical control group consisted of 21 patients treated in the same unit. We compared: number of interconsultations to psychiatry, drug requirement and number of days in hospitalization. Results: The differences observed were: in the intervention group, the number of patients requiring a psychiatric consultation was lower, the patients who were referred to psychiatry required less interconsultations, and hospital stay was shorter compared with control group. Conclusions: It was concluded that the intervention allowed maintain psychological stability of patients and minor psychiatric and pharmacological comorbidity facilitates monitoring and reduce hospitalization costs and reduced psychosocial distress in the patient

[National guidelines of diagnosis and treatment of the non-Hodgkin lymphoma]. / Guías nacionales de diagnóstico y tratamiento de linfoma no Hodgkin.

Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources.