Introducción: Los ACV son patologías mundialmente en ascenso, es por ello que, se han implementado nuevas estrategias biotecnológicas, terapéuticas e innovadoras como la VR. Objetivo: Analizar y ...describir la influencia de la VR en los pacientes adultos con ACV. Métodos: Se ejecutó una revisión sistemática, a través de diferentes bases de datos y motores de búsqueda, así mismo, se clasificó los artículos según su capacidad de responder a las interrogantes de investigación. Resultados: La realidad virtual en pacientes con ACV ha mostrado resultados beneficiosos, no obstante, es indispensable la terapia convencional para un pronóstico favorable. Conclusión: La efectividad de la VR en su totalidad es aún desconocida, sin embargo, los presentes estudios aluden a que esta terapia permite un mejoramiento en la capacidad motora y psicomotora.
Introduction: Donor lymphocyte infusion (DLI) is a useful therapy for mixed chimerism (MC) or measurable residual disease (MRD) after allogeneic hematopoietic cell transplantation (HSCT) in patients ...with malignancies, while it is less effective for overt relapse and is limited by graft-versus-host disease (GVHD). Multiple DLI products can be obtained from a single leukoapheresis without granulocyte-colony-stimulating factor (G-CSF) priming, while cryopreserving surplus is an alternative for peripheral blood grafts. The ideal DLI CD3+ cell dose remains undefined ranging from 1-500x106/kg. However, leukoapheresis and cryopreservation are not risk-free, they are expensive and their costs prohibitive for many patients in developing countries. Furthermore, T-cell doses present in standard whole blood units can reach ≥1x106/kg in healthy donors which can be further increased after G-CSF exposure. For these reasons we have used G-CSF-primed whole blood units (WB-DLI) in HLA-matched and haploidentical (Haplo) transplant recipients and report our single-center experience.
Methods: Patients ≥16 years of age who received WB-DLI at any time after HLA-matched related or Haplo peripheral blood HSCT due to relapse, MRD, MC or poor graft function were included from 2016-2018. Donors were stimulated with filgrastim 5 μg/kg every 24 hours for 3 days prior to donation. Standard pre-transfusion testing included major/minor crossmatch and flow cytometry analysis for lymphocyte subset quantification. The blood draw was performed on day 4 with the aim to collect 450 mL of whole blood in a standard collection bag. For patients with major and bidirectional ABO mismatch who had not undergone group switch or had a mixed population in solid-phase typing, a reactive major crossmatch was considered an absolute contraindication, while a reactive minor crossmatch was not. WB-DLI was infused fresh on the day of collection without manipulation in an outpatient basis. For relapsed patients, concurrent chemotherapy was administered on a case-by-case basis. Disease evaluation after relapse was performed on day +30 after treatment, while chimerism analysis was performed on day +60 through standard methods. GVHD prophylaxis was performed with oral cyclosporine A or tacrolimus and gradually tapered in a 60-day window.
Results: Fourteen patients received a single dose of WB-DLI, median age was 32 years (16-67), 50% were female. Most common diagnoses were acute lymphoblastic leukemia, (n=5) and acute myeloid leukemia (n=5), followed by myelodysplastic syndrome (n=2), non-Hodgkin lymphoma (n=1) and chronic myeloid leukemia (n=1). Nine patients received Haplo grafts, while 5 were HLA-matched. Three patients had previous GVHD inactive at the time of WB-DLI. Indication for WB-DLI was relapse for 6 patients, 3 had MRD while 5 remained in remission; one patient received WB-DLI due to poor graft function. Median chimerism at the time of WB-DLI was 72% (range 38-100%). A single infusion was administered in all cases. Median mononuclear cell count obtained was 32x10x6/kg (range, 9-74), while median CD3+ cell count was 6.7x106/Kg (range 5.2-19). No immediate, severe adverse effects were observed. Febrile non-hemolytic transfusion reaction was documented in 4 cases after completing the procedure. No complications were observed in n=4 ABO mismatch cases including (n=2) major and bidirectional patients. Overall 50% of patients responded. Chimerism was improved in 50%, with a median increase of 28% (range 9-53%). Median post-DLI chimerism was 92.5% (range 20-100). Regarding patients treated for relapse or MRD, 3/9 patients responded (33%). Overall 8/14 patients eventually relapsed (57%) with a 12-month progression free survival of 27.5%, lower in relapsed/MRD positive patients (Figure I) (log rank test p=0.02 and 0.04, respectively). Overall survival at 12 months was 61.2%. Three patients developed acute GVHD, two of them grade III/IV in a median of 13 days (range 7-38). Four patients died due to relapse. Median follow-up after WB-DLI was 5 months (range 0.6-20.1 months). The cost of obtaining and administering WB-DLI was $350 USD per dose.
Conclusions: DLI obtained from unmanipulated, GCSF-primed whole-blood is a safe and affordable adoptive cell therapy. It is effective and improves mixed chimerism after HSCT, while it was less effective for overt relapse.
Gomez-Almaguer:AbbVie: Consultancy; Novartis: Consultancy.
Introduction: Only a minority of patients can find a fully matched donor for hematopoietic stem cell transplantation (HSCT). HLA-haploidentical HSCT is an attractive option since the likelihood of ...identifying a donor is high. Stimulated by economic constraints in developing countries and the significant expenses related to HSCT, in an effort to lower costs and resources, our center has performed an outpatient-based haplo-HSCT program since 2012. In the present study, we describe the characteristics of those patients and analyze the factors relating to the performance of a successful ambulatory procedure.
Methods: Adult patients who underwent haplo-HSCT in an outpatient-intended basis were eligible. All were required to have a Karnofsky score ³70%, serum creatinine <2 mg/dL, residence near the hospital, an adequate caregiver, with appropriate educational level and treatment adherence. The conditioning regimen was delivered in all individuals as outpatients and consisted of fludarabine 25 mg/m2/day (day -5 to -3), cyclophosphamide (Cy) 350 mg/m2/day (day -5 to -3), and oral busulfan 4 mg/kg/day (day-2 to -1) or melphalan 50-100 mg/m2 (day -2 to -1). GVHD prophylaxis consisted of Cy (50 mg/kg/day, days 3 and 4), cyclosporine 6 mg/kg, and mycophenolate mofetil 1 g/day. After infusion, patients stayed at home and were seen in the outpatient clinic every day for the first 72 hours, every other day until hospitalization requirement or engraftment; afterwards weekly and bi-weekly through day +100, and thereafter according to physician criteria. Patients were instructed to report the presence of fever among other adverse effects at any hour of the day. Hospital beds were available for those needing admission.
Results: Thirty-six consecutive patients from February 2013 to May 2017 were eligible for analysis. Median follow-up was 12 months (4-40). Median age was 23 years (range, 15-63); 13 were female. Acute leukemia (13 lymphoblastic and 5 myeloblastic) was the most common indication for HSCT, followed by Hodgkin's lymphoma (5), non-Hodgkin's lymphoma (4), chronic myeloid leukemia (3), aplastic anemia (3), chronic lymphocytic leukemia (2), and chronic myelomonocytic leukemia (1). Median PBSC CD34+ cells/kg was 7x106 (range, 2-16). Neutrophil engraftment was achieved at a median of 16 days (range, 11-23), with platelet recovery at a median of 16 days (range, 13-100). Seven patients (19%) were followed in a fully outpatient basis while the other 29 (81%) required hospitalization. The median length of stay (LOS) was 10 days (0-35). Seven patients (19%) stayed ≤7 days in hospital, while 22 patients >7 days. Febrile neutropenia was the most common reason for hospitalization (65.5%). Other reasons included mucositis (27.5%) and hemorrhagic cystitis (6.9%). The median day of admission was day +3 (1-14). The development of febrile neutropenia (P=0.004) and a slower neutrophil engraftment (P=0.023) were significantly associated with the need for hospital admission. Eight of the 18 patients admitted for febrile neutropenia had a rapid response and no source of infection evidenced, thus LOS was ≤10 days in 9 patients. Age, gender, mucositis, and acute graft versus host disease were not associated with hospitalization need. The 2-year overall survival (OS) was 50% for patients with a completely ambulatory transplant vs. 28% for those requiring hospitalization (log rank P=0.08).
Conclusion: Currently conventional transplantation is unaffordable for the majority of patients living in the developing world. Almost 20% of our patients did not require hospital admission. Although 62% of the patients were admitted, most of them had a short LOS. Our outpatient haploidentical HSCT program is feasible, potentially resulting in cost savings and perhaps a higher quality of life.
Display omitted
Gomez-Almaguer:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
Introduction: Chronic Myeloid Leukemia (CML) represents 20% of adult leukemia. Tyrosine kinase inhibitors (TKI) of BCR-ABL, are the standard first-line therapy. Imatinib was the first TKI approved, ...however, a percentage of patients will present a suboptimal response or will develop resistance. Dasatinib has 325-fold increased potency over imatinib against BCR-ABL kinase in vitro and has activity against most of the mutated forms that have been associated with clinical resistance to imatinib. The approved dose in chronic phase is 100mg once a day and 140mg in accelerated phase. Lower doses of dasatinib have been successfully used and reported in intolerant patients so doubts arise if lower doses can reduce adverse effects and maintain anti-leukemic effect. In our country medical insurance cover is not universal, thus many patients cannot access to ITK treatment easily. We aim to demonstrate that 50mg of dasatinib is as effective as the full dose to induce molecular response as first line therapy in CML.
Methods : We performed a single-arm open label phase II study. All patients with newly diagnosed non-previously treated chronic-phase CML were included. They receive dasatinib 50mg once daily for 6 months. They were evaluated weekly the first two weeks and then monthly. Initial, 3 and 6 months BCR/ABL p210 polymerase chain reaction (PCR) were measured. We documented timing to obtain hematological response defined by a white blood cell count (WBC) <10,000/mL with no immature granulocytes and <5 percent basophils on differential; platelet count <450,000/microL; and spleen not palpable. Major molecular response (MMR) was defined as a ≥3-log reduction in BCR-ABL1/BCR ratio and was measured at 3 and 6 months. Adverse effects were documented.
Results: Seven patients have so far been included (5 males and 2 females). Mean age was 43 years (range, 16-73). The median WBC at diagnosis was 231,547 x 10^3/µL (range, 105,962-405,000). The hematological response was achieved in a median of 32 days (range, 14-56). Six patients (85%) had optimal response, including two with minor molecular response and one with mayor molecular response. Until now, only 3 patients have completed the 6th month evaluation, and two (66%) had achieved MMR. None presented any grade 3 or 4 adverse effects, and only one case of rash grade 1.
Conclusions: Until now the use of low-dose dasatinib had satisfactory results including two major molecular response and no major adverse effects. It is an interesting option for patients with low tolerance or in centers with limited resources.
Display omitted
Gomez-Almaguer:Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
Satisfaction with the inhaler is an important determinant of treatment adherence in patients with asthma and chronic obstructive pulmonary disease (COPD). However, few studies have compared these 2 ...groups to identify the factors associated with satisfaction with the inhaler.
To assess and compare satisfaction with the inhaler in patients with asthma or COPD and to determine the variables associated with high inhaler satisfaction.
A multicenter, cross-sectional study of 816 patients (406 with asthma and 410 with COPD) was conducted. Satisfaction was assessed with the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. All participants completed the Test of Adherence to Inhalers and either the Asthma Control Test (ACT) or the COPD Assessment Test (CAT).
Overall, the asthma group was significantly more satisfied with the inhaler (mean standard deviation FSI-10 scores: 44.1 6.5 vs 42.0 7.7; P < .001) and more satisfied on most (7 of 10; 70%) items. Patients with asthma were significantly more satisfied with the inhaler regardless of the adherence level or the type of nonadherence pattern. Younger age, good disease control (ACT ≥20 or CAT ≤10), previous inhaler training, and absence of unwitting nonadherence were all independently and significantly associated with high inhaler satisfaction.
Age, disease control, and training in inhalation technique all play a more significant role than the specific diagnosis in explaining satisfaction with the device in patients with asthma and COPD. These findings underscore the need to provide better training and more active monitoring of the inhalation technique to improve patient satisfaction, treatment adherence, and clinical outcomes.
Staghorn, struvite or coral calculus are the ones that completely or partially occupies the renal pelvis and branches to the renal calices. The presence of renal calculi of any kind in the urinary ...tracts is related to the appearing of malign tumor in the kidneys, especially in the absence or failed treatment. A male patient, 51 years old, native of Manaus, reports about dysuria and polyuria associated with constant fever episodes and urinary tract infections with improvement by using several antibiotics but returning the symptoms after suspending it. The patient return was in a month and no improvement of the pain in the patient's feeling, with the tomography image tests result showing atrophy in the right kidney, which presents dilatation of the collector system, that it's filled with material with density varying between thick liquid and soft parts (average of 45 UH), in addition to calculus in the pelvis and ureteropelvic junction, suggesting a pattern for xanthogranulomatous pyelonephritis and matching previous history of right staghorn calculus. The association between kidney cancer and staghorn calculus should be consider through the treatment. Patients with renal diseases of severe prognosis in both kidneys must be kept under constant surveillance by the urology and nephrology team, the association of both clinics is essential to a fortunate ending like the case reported.
En este artículo se presenta la experiencia pedagógica de aprendizaje basado en proyectos para el desarrollo comunitario, realizada durante el año 2018 en el marco de los cursos de Vivienda de ...interés social y Construcción de edificaciones del Programa de Ingeniería Civil de Uniminuto- Centro Regional Zipaquirá. El proyecto se basó en la metodología del diseño centrado en el humano, compuesta por tres etapas: la observación y escucha (inmersión e interacción con la comunidad en el contexto), ideación y diseño (alternativas de solución) y socialización y entrega (evaluación del producto y mejora), desarrolladas a través de un simulacro de licitación pública con sus correspondientes términos de referencia, realizados con el apoyo de la comunidad del Municipio de Pacho Cundinamarca y un equipo interdisciplinario de profesores. El objetivo del proyecto fue brindar herramientas a los estudiantes para que identifiquen las problemáticas y necesidades en torno a la vivienda y obras de cohesión social, y den soluciones que contribuyan al desarrollo comunitario; teniendo en cuenta que el modelo educativo de Uniminuto busca una formación integral mediante la fortaleza de las competencias profesionales, el desarrollo humano y la responsabilidad social a través de la praxis.
PDF
