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Maqbool S, Baloch MF, Khan MAK, Khalid A, Naimat K. Autologous hematopoietic stem cell transplantation conditioning regimens and chimeric antigen receptor T cell therapy in various diseases. World J Transplant 2024; 14:87532. [PMID: 38576761 PMCID: PMC10989471 DOI: 10.5500/wjt.v14.i1.87532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/21/2023] [Accepted: 01/08/2024] [Indexed: 03/15/2024] Open
Abstract
Conditioning regimens employed in autologous stem cell transplantation have been proven useful in various hematological disorders and underlying malig nancies; however, despite being efficacious in various instances, negative consequences have also been recorded. Multiple conditioning regimens were extracted from various literature searches from databases like PubMed, Google scholar, EMBASE, and Cochrane. Conditioning regimens for each disease were compared by using various end points such as overall survival (OS), progression free survival (PFS), and leukemia free survival (LFS). Variables were presented on graphs and analyzed to conclude a more efficacious conditioning regimen. In multiple myeloma, the most effective regimen was high dose melphalan (MEL) given at a dose of 200/mg/m2. The comparative results of acute myeloid leukemia were presented and the regimens that proved to be at an admirable position were busulfan (BU) + MEL regarding OS and BU + VP16 regarding LFS. In case of acute lymphoblastic leukemia (ALL), BU, fludarabine, and etoposide (BuFluVP) conferred good disease control not only with a paramount improvement in survival rate but also low risk of recurrence. However, for ALL, chimeric antigen receptor (CAR) T cell therapy was preferred in the context of better OS and LFS. With respect to Hodgkin's lymphoma, mitoxantrone (MITO)/MEL overtook carmustine, VP16, cytarabine, and MEL in view of PFS and vice versa regarding OS. Non-Hodgkin's lymphoma patients were administered MITO (60 mg/m2) and MEL (180 mg/m2) which showed promising results. Lastly, amyloidosis was considered, and the regimen that proved to be competent was MEL 200 (200 mg/m2). This review article demonstrates a comparison between various conditioning regimens employed in different diseases.
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Affiliation(s)
- Shahzaib Maqbool
- Department of Medicine, Holy Family Hospital, Rawalpindi 46000, Pakistan
| | - Maryam Farhan Baloch
- Department of Community Medicine, Allama Iqbal Medical College, Lahore 45000, Pakistan
| | | | - Azeem Khalid
- Department of Medicine, Allama lqbal Medical College, Lahore 45000, Pakistan
| | - Kiran Naimat
- Department of MedicineLiaquat University of Medical and Health Sciences, Karachi 43000, Pakistan
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Ruiz M, Rubens M, Ramamoorthy V, Chavez CB, Saxena A. Comparison of Inpatient Outcomes Between HIV Positive and Negative Hospitalizations for Autologous Stem Cell Transplant Treatment among Lymphoid Malignancies. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e307-e313. [PMID: 37244799 DOI: 10.1016/j.clml.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Comorbidity burden is higher among people living with HIV (PLWH). In addition, they experience adverse effects associated with antiretrovirals. In this study we looked for differences in adverse hospital outcomes between those with and without HIV among hospitalizations for autologous stem cell transplantations (ASCTs) for lymphoid malignancies. MATERIALS AND METHODS The current study was a retrospective analysis using the National Inpatient Sample (NIS) database, for the years 2005 to 2014. Adult hospitalizations ≥18 years of age, for ASCTs were included for the analysis, and were stratified into those with and without HIV. The primary outcome variables were in-hospital mortality, prolonged length of stay, and adverse dispositions. RESULTS We included a total of 117,686 ASCT hospitalizations, of which, 468 (0.4%) were HIV positive. Among HIV-positive hospitalizations, there were 251 (53.4%), non-Hodgkin lymphoma, 128 (27.4%), Hodgkin lymphoma, and 89 (19.2%) multiple myeloma cases. Only half of the PLWH among Black population received ASCT, compared to Whites (26.8% vs. 54.8%). Regression analyses showed that the odds of in-hospital mortality (OR, 0.77; 95% CI, 0.13-4.44), prolonged length of stay (OR, 1.18; 95% CI, 0.67-2.11), and dispositions other than home (OR, 1.26; 95% CI, 0.61-2.59) did not differ significantly between 2 groups. DISCUSSION We found that adverse hospital outcomes did not differ between those with and without HIV among hospitalized autologous stem cell transplant recipients. However, the rates of ASCT were substantially lower among Black PLWH. New interventions and approaches should be developed to improve ASCT rates among HIV positive racial minorities.
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Affiliation(s)
- Marco Ruiz
- Hematology Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
| | - Muni Rubens
- Hematology Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Health Science, Universidad Espíritu Santo, Samborondón, Guayas, Ecuador
| | | | | | - Anshul Saxena
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA
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Banday SZ, Guru F, Ayub M, Ahmed SN, Banday AZ, Mir MH, Nisar R, Hussain S, Bhat GM, Aziz SA. Long-Term Outcomes of Autologous Hematopoietic Stem Cell Transplant (HSCT) for Multiple Myeloma: While New Horizons Emerge, It Is Still Only a Silver Lining for Resource-Constrained Settings. Cureus 2023; 15:e36642. [PMID: 37155458 PMCID: PMC10122934 DOI: 10.7759/cureus.36642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/10/2023] Open
Abstract
Background Significant hurdles impede the optimal implementation of hematopoietic stem cell transplantation (HSCT) in low-middle income countries (LMICs). Herein, we highlight the challenges faced in LMICs while performing HSCT and report the long-term outcomes of patients with newly diagnosed multiple myeloma (MM) who underwent autologous HSCT (AHSCT) at our center. Besides, we provide a comprehensive review of studies reporting long-term outcomes of AHSCT in MM from the Indian subcontinent. Methodology This study was conducted at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Case records of all patients with MM who received AHSCT from December 2010 to July 2018 were reviewed retrospectively. A non-systematic literature search was performed using PubMed and Google Scholar databases. Data regarding clinicopathological parameters and long-term follow-up were extracted from relevant studies and for patients included in our study. Results At our center, 47 patients (median age 52.0 years) with MM underwent AHSCT. Majority of patients had stage III disease (ISS) and median time to transplant was 11.5 months. The five-year progression free survival (PFS) and overall survival (OS) were 59.1% and 81.2%, respectively. Studies from the Indian subcontinent have observed a five-year OS of ~50% to ~85%. However, a greater variability in the five-year PFS has been reported, ranging from ~20% to ~75%. The median time to transplant has ranged from seven to 17 months (indicating time delays) with median CD34 cell counts of 2.7-6.3×106 cells/kg (lower than developed countries). Conclusions Despite significant resource limitations in LMICs, AHSCT is increasingly been performed in MM with encouraging long-term outcomes.
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Affiliation(s)
- Saquib Z Banday
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Faisal Guru
- Department of Medical Oncology, Pediatrics Unit, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Maniza Ayub
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Syed N Ahmed
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aaqib Z Banday
- Department of Pediatrics, Government Medical College, Srinagar, IND
| | - Mohmad H Mir
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Rahila Nisar
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Saleem Hussain
- Department of Laboratory Hematology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Gull M Bhat
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sheikh A Aziz
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Rubens M, Cristian A, Ramamoorthy V, Ruiz M, Saxena A, McGranaghan P, Tonse R, Veledar E. Impact of Frailty on Hospital Outcomes Among Patients with Lymphoid Malignancies Receiving Autologous Hematopoietic Stem Cell Transplantation in the United States. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e427-e434. [PMID: 35027337 DOI: 10.1016/j.clml.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/21/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Frailty could affect outcomes of autologous hematopoietic stem cell transplantation (aHSCT). This study sought to examine the effects of frailty on hospital outcomes among patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM) who received aHSCT. MATERIALS AND METHODS This study was a retrospective analysis of Nationwide Inpatient Sample database, 2005 to 2014. Outcome variables were in-hospital mortality, prolonged length of stay and hospitalization cost. Frail patients were defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. RESULTS There were 20,573 NHL, 8,974 HL, and 40,750 MM patients. Among them, 5.5% NHL, 3.8% HL, and 4.8% MM patients were frail. Among patients with NHL, there were significant associations between frailty and in-hospital mortality (Odds Ratio [OR], 4.04, 95% CI: 2.11-7.76), and prolonged length of stay (OR, 2.32, 95% CI: 1.56-3.46). Similarly, among HL, there were significant associations between frailty and in-hospital mortality (OR, 1.82, 95% CI: 1.43-2.76), and prolonged length of stay (OR, 1.55, 95% CI: 1.34-2.84). Likewise, for MM, there were significant associations between frailty and in-hospital mortality (OR, 4.28, 95% CI: 2.16-8.48), and prolonged length of stay (OR, 3.00, 95% CI: 2.00-4.51). These associations remained significant after stratifying by age and comorbidities. Significant differences were observed in hospitalization cost between frail and non-frail patients. CONCLUSION Among patients with lymphoid malignancies undergoing HSCT, frailty was associated with greater in-hospital mortality, longer length of stay, and higher hospitalization costs. Comprehensive health status assessments for identifying and managing frail patients in this population could improve patient outcomes.
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Kumar S, Sharma A, Pramanik R, Pathak N, Gogia A, Kumar A, Kayal S, Sharma V, Sahoo RK, Thulkar S, Sharma MC, Gupta R, Mallick S, Thomas M, Raina V. Long-Term Outcomes and Safety Trends of Autologous Stem-Cell Transplantation in Non-Hodgkin Lymphoma: A Report From A Tertiary Care Center in India. JCO Glob Oncol 2022; 8:e2100383. [PMID: 35561291 PMCID: PMC9302266 DOI: 10.1200/go.21.00383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Published experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.
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Affiliation(s)
- Sudhir Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pathak
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Medical Oncology, Lab Oncology Unit, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mercy Thomas
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Fortis Memorial Research Institute, Gurgaon, India
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Janowiak-Majeranowska A, Lebiedziński F, Majeranowski A. Bone marrow donation in Poland: 2021 update, and the impact of the coronavirus disease 2019 pandemic on haematopoietic stem cell transplantation. CLINICAL ETHICS 2022; 17:22-31. [PMID: 35250386 PMCID: PMC8819559 DOI: 10.1177/14777509211036643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Haematopoietic stem cell transplantation is a treatment modality that saves the
health and lives of a growing number of patients around the world. In the
majority of cases, the procedure is conducted to treat haematologic neoplasms,
although it can also be used as a therapy for some non-haematooncological
diseases. The progress that has been taking place in the field of haematopoietic
stem cell transplantation involves the need for recruiting more and more
potential unrelated bone marrow donors for allotransplantation. In Poland, the
number of people registering as potential bone marrow donors has been
continuously growing and in order to maintain this trend, it is necessary, above
all, to consistently spread the noble idea of bone marrow donation and to raise
Poles’ awareness and knowledge about haematopoietic stem cell transplantation.
Unfortunately, the situation caused by the severe acute respiratory syndrome
coronavirus 2 pandemic limited the opportunities to act in public space and, as
a consequence, it has become more difficult to achieve the objectives associated
with recruiting new potential donors. The article provides a presentation of
ethical and practical aspects associated with bone marrow donations as well as
an overview of the legal situation concerning bone marrow donating and
transplantation in Poland. The purpose of the paper is to also present some of
the changes in transplantation procedures that have emerged as a consequence of
the current epidemiological situation. The authors would like to emphasize the
importance and the rightfulness of taking action that enables further
development of transplantology.
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Affiliation(s)
| | | | - Alan Majeranowski
- Department of Hematology and Transplantology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,Department of Cell Biology and Immunology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
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Dolai TK, De R, Sen A, Baul SN, Mitra S, Bhattacharya S, Mondal I, Mukhopadhyay K, Chattopadhyay A, Dutta S, Mandal PK. Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level. BLOOD CELL THERAPY 2022; 5:16-26. [PMID: 36714265 PMCID: PMC9847276 DOI: 10.31547/bct-2021-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 02/01/2023]
Abstract
Purpose Autologous stem cell transplantation (ASCT) is an established therapy for many hematological diseases. This study assessed the pattern of ASCTs at a tertiary care center and associated factors, including pre-harvest CD34+ stem cell levels, leading to improved engraftment outcomes. Methodology A retrospective study was conducted in India, between February 2009-August 2020. Patients who underwent ASCT for different hematological malignancies (n=65) were included, and the patients' age, sex, type and stage of disease, pre- and post-harvest CD34+ counts, and time to attain platelet/neutrophil engraftment or febrile neutropenia were analyzed. The post-harvest CD34+ dose was calculated. Pre-conditioning was performed using Granulocyte Colony Stimulating Factor (GCSF)±Plerixafor. Progression-free survival (PFS) was calculated using relapse/death as the endpoint. Results The median age of the cohort (n=65) was 49 years, with a male preponderance. Multiple myeloma was the most common malignancy (70.8% [46/65]), requiring ASCT. The median time to ASCT was 13 months. All patients had received GCSF, while Plerixafor was used in 17 patients with a pre-harvest CD34+ count of <10 cells/μL. The median pre-harvest CD34+ concentration and post-harvest CD34+ cell dose was 27.54 cells/μL (n=26) and 5.23×106 cells/kg body weight (n=65), respectively. The median time to engraftment was 11 and 12 days, for neutrophils and platelets, respectively. One patient did not engraft and was excluded from the analysis. The time required to attain neutrophil engraftment was significantly lower (p=0.02) among freshly harvested stem cells (n=48) than that of cryopreserved products (n=17). Platelet engraftment associated with CD34+ pre- and post-harvest levels was not significant (p=0.06). The time to attain neutropenia and subsequent febrile neutropenia was significantly lower with an adequate post-harvest CD34+ dose (p=0.009). Febrile neutropenia was seen in 83.1% (54/65) patients. The median time for febrile neutropenia was 4 days post-ASCT. Pre- and post-harvest CD34+ concentrations were directly proportional to each other (p<0.001). The median PFS was 112 months (n=65). Survival was better in males (median PFS: 112 months) vs. females (median PFS: 59 months) (p=0.27). Eight patients relapsed, and eight patients had died. Conclusion Although unrelated to age or sex, the post-harvest CD34+ dose was inversely related to febrile neutropenia. As pre- and post-harvest CD34+ levels were directly proportional, pre-harvest CD34+ concentrations may be reliably used to assess engraftment outcomes. Rapid neutrophil engraftment was noted in fresh stem cells with PFS of 112 months, and was better among males, the exact reason being unknown. Thus, a larger number of patients should be followed up to obtain an accurate picture.
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Affiliation(s)
- Tuphan Kanti Dolai
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Rajib De
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Ankita Sen
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Shuvra Neel Baul
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Sumit Mitra
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Subham Bhattacharya
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Indrani Mondal
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | | | - Arnab Chattopadhyay
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Shyamali Dutta
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Prakas Kumar Mandal
- Department of Haematology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
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Goel V, Arora P, Malhotra P, Gupta AK. Cost of HSCT in a Tertiary Care Public Sector Hospital in India. Indian J Hematol Blood Transfus 2022; 38:78-83. [PMID: 35125714 PMCID: PMC8804029 DOI: 10.1007/s12288-021-01421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
India harbours a significant burden of hematological diseases including cancers for which Hematopoietic Cell Transplant (HCT) is a definitive life-saving procedure. Very few studies in India have carried out the costing of the important procedure, hence we undertook a study to ascertain the cost of auto HCT in our tertiary care teaching hospital. We did a prospective study using Top-down and Bottom-up approach to arrive at the cost of autologous HCT which came out to be INR 699,200 ($10,282) out of which hospital bears 34% of the cost. The major share of the hospital cost is on account of expenditure on Human Resources. The rest 66% is Out of Pocket Expenditure (OOPE) for the patients. We also calculated the cost which is borne by patient attendants over & above the cost of procedure while caring for the patient, which on an average came to be INR 88,598. This is approximately 19% of the cost borne by the patient for the procedure itself. The cost is usually not factored in while contemplating the procedure and is not covered by any insurance scheme. The overall cost, OOPE & attendant cost can all lead to a substantial financial hardship. Hence, steps need to be taken to make HCT an affordable and accessible procedure.
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Affiliation(s)
- Vinay Goel
- grid.414546.60000 0004 1759 4765Deputy Medical Superintendent, Civil Hospital, Ambala (Cantt), Haryana India
| | - Pankaj Arora
- grid.415131.30000 0004 1767 2903Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar Gupta
- grid.415131.30000 0004 1767 2903Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Saeed N, Ahmad U, Moosajee M, Niazi ZAK, Siddiqui N, Aziz Z, Khan DH, Iftikhar F, Ahmad IN, Mir MA. A Multicenter Study of Clinical Presentations and Outcomes of Multiple Myeloma in Pakistan: The Real-World Analysis in a Resource-Constrained Country. Indian J Hematol Blood Transfus 2021; 38:309-318. [PMID: 35496958 PMCID: PMC9001789 DOI: 10.1007/s12288-021-01485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
This is the first multicenter study from Pakistan exploring the prevalence, clinical presentations and treatment outcomes of Multiple Myeloma patients. This retrospective study involved data collection from hospital record system of four tertiary care referral hospitals of Pakistan including all patients diagnosed as having Multiple Myeloma from January 2014 to December 2018. The demographic details, clinical presentations, laboratory findings, treatment responses, and mortalities were evaluated. The progression-free survival and overall survival were analyzed considering relapse and mortality as the end points, respectively. For the progression-free survival, the Kaplan-Meier survival analysis and the log rank test were used to compare the survival function for chemotherapy followed by autologous stem cell transplant (ASCT) as opposed to chemotherapy alone (non-ASCT). The overall survival analysis was assessed by Kaplan-Meier survival analysis. This study identified 403 Multiple Myeloma patients in five years. The median age at presentation was 55 years. Bortezomib based drug regimens were the most commonly used initial treatments (57.5%). Forty three patients received ASCT. The progression-free survival median for ASCT and non-ASCT patients were 50 months (95% CI, 42-57.9 months) and 26 months (95% CI, 21.5-30.5 months), respectively. The cumulative probability of survival rate at 60 months was 80%. This study identified 403 Multiple Myeloma patients over 5 years in four tertiary care hospitals of Pakistan. It underscores the importance of autologous stem cell transplant in Myeloma patients and advocates improving its facilities in Pakistan.
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Anuar NA, Tey KWF, Ng SC, Teh AKH, Abdul Rahman MHF, Chong BP, Gan GG. Outcomes of high dose therapy and autologous haematopoietic stem cell transplantation for non-hodgkin lymphoma: A retrospective analysis in a resource-limited country. Int J Clin Pract 2021; 75:e13823. [PMID: 33202073 DOI: 10.1111/ijcp.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
AIM To retrospectively report the clinical outcomes of non-Hodgkin's Lymphoma (NHL) patients post high dose therapy (HDT) with autologous haematopoietic stem cell transplant (AHSCT) and determine whether upfront transplant, which is a first-line consolidative treatment with induction chemotherapy, would be a feasible modality in a resource-limited country. METHODS The medical records for NHL patients who had undergone HDT followed by AHSCT from October 1997 to November 2016 from two hospitals in Klang Valley, Malaysia were obtained from the medical record database and analysed retrospectively through statistical analysis. RESULTS A total of 148 patients were retrospectively identified post-AHSCT, where the majority of whom had B cell lymphoma (53.4%). Majority of patients (88.5%) were in complete remission before AHSCT. The overall survival (OS) and event-free survival (EFS) at 3 years were 68.9% and 60.8%, respectively. The major cause of death was disease progression at 73.9%, while transplant-related mortality was 15.2%, with a median follow-up period of 179.5 weeks. CONCLUSION Our study illustrates the promising outcomes of HDT with AHSCT in NHL patients in a resource-limited country. We recommend larger studies to be conducted in the future with a longer duration of follow-up to validate our findings.
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Affiliation(s)
- Nur Adila Anuar
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kevin Wen Fei Tey
- Department of Pharmacology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Soo Chin Ng
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Alan Kee Hean Teh
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | | | - Bee Ping Chong
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gin Gin Gan
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Cruciani S, Santaniello S, Montella A, Ventura C, Maioli M. Orchestrating stem cell fate: Novel tools for regenerative medicine. World J Stem Cells 2019; 11:464-475. [PMID: 31523367 PMCID: PMC6716083 DOI: 10.4252/wjsc.v11.i8.464] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/28/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal stem cells are undifferentiated cells able to acquire different phenotypes under specific stimuli. In vitro manipulation of these cells is focused on understanding stem cell behavior, proliferation and pluripotency. Latest advances in the field of stem cells concern epigenetics and its role in maintaining self-renewal and differentiation capabilities. Chemical and physical stimuli can modulate cell commitment, acting on gene expression of Oct-4, Sox-2 and Nanog, the main stemness markers, and tissue-lineage specific genes. This activation or repression is related to the activity of chromatin-remodeling factors and epigenetic regulators, new targets of many cell therapies. The aim of this review is to afford a view of the current state of in vitro and in vivo stem cell applications, highlighting the strategies used to influence stem cell commitment for current and future cell therapies. Identifying the molecular mechanisms controlling stem cell fate could open up novel strategies for tissue repairing processes and other clinical applications.
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Affiliation(s)
- Sara Cruciani
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
- Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems – Eldor Lab, Innovation Accelerator, Consiglio Nazionale delle Ricerche, Bologna 40129, Italy
| | - Sara Santaniello
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
- Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems – Eldor Lab, Innovation Accelerator, Consiglio Nazionale delle Ricerche, Bologna 40129, Italy
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
- Operative Unit of Clinical Genetics and Developmental Biology, Sassari 07100, Italy
| | - Carlo Ventura
- Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems – Eldor Lab, Innovation Accelerator, Consiglio Nazionale delle Ricerche, Bologna 40129, Italy
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
- Laboratory of Molecular Biology and Stem Cell Engineering, National Institute of Biostructures and Biosystems – Eldor Lab, Innovation Accelerator, Consiglio Nazionale delle Ricerche, Bologna 40129, Italy
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Cagliari 09042, Italy
- Center for Developmental Biology and Reprogramming-CEDEBIOR, Department of Biomedical Sciences, University of Sassari, Sassari 07100, Italy
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12
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Abid MB, Mughal M, Babbra R, Abid MA, Blesing N, Anwer S. Small Centers with Big Ventures: Autologous Stem Cell
Transplantation Survival Data. Asian Pac J Cancer Prev 2019; 20:987-990. [PMID: 31030464 PMCID: PMC6948904 DOI: 10.31557/apjcp.2019.20.4.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present the first-ever autologous stem cell transplantation (ASCT) outcome data from a secondary-care healthcare facility. Albeit exact details of patient and disease characteristics and co-morbidity scores for all patients are not available, the engraftment and survival data is very similar to those published from large tertiary-care cancer centres, both regionally and internationally. Transplant Related Mortality (TRM) of 3.1% is within the expected range and includes a patient who died of acute drug reaction (ADR) during conditioning chemotherapy, prior to the ASCT. Furthermore, cyclophosphamide mobilization chemotherapy is given in the outpatient setting. This study is important in terms of healthcare resource optimization as well as patients’ convenience and highlights that ASCT can be performed in a safe and effective manner with comparable survival rates even at a DGH, provided the centre stays abreast with the recent developments and can offer its patients with standard of care treatment of the era.
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Affiliation(s)
- Muhammad Bilal Abid
- Department of Haematology, Great Western Hospitals NHS Trust, Swindon, UK. ,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Haematology, University Hospitals of Bristol NHS Trust, UK
| | - Mustafa Mughal
- Department of Internal Medicine, Liaquat College of Medicine & Dentistry, Karachi, Pakistan
| | - Ranjeet Babbra
- Department of Haematology, Great Western Hospitals NHS Trust, Swindon, UK.
| | - Muhammad Abbas Abid
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norbert Blesing
- Department of Haematology, Great Western Hospitals NHS Trust, Swindon, UK.
| | - Saiyed Anwer
- Department of Haematology, Great Western Hospitals NHS Trust, Swindon, UK.
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13
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Jaime-Pérez JC, Salazar-Cavazos L, Aguilar-Calderón P, Herrera-Garza JL, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Assessing the efficacy of an ambulatory peripheral blood hematopoietic stem cell transplant program using reduced intensity conditioning in a low-middle-income country. Bone Marrow Transplant 2018; 54:828-838. [DOI: 10.1038/s41409-018-0338-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/12/2018] [Accepted: 08/30/2018] [Indexed: 01/02/2023]
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14
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The Application of Human iPSCs in Neurological Diseases: From Bench to Bedside. Stem Cells Int 2016; 2016:6484713. [PMID: 26880979 PMCID: PMC4736583 DOI: 10.1155/2016/6484713] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 12/20/2022] Open
Abstract
In principle, induced pluripotent stem cells (iPSCs) are generated from somatic cells by reprogramming and gaining the capacity to self-renew indefinitely as well as the ability to differentiate into cells of different lineages. Human iPSCs have absolute advantages over human embryonic stem cells (ESCs) and animal models in disease modeling, drug screening, and cell replacement therapy. Since Takahashi and Yamanaka first described in 2007 that iPSCs can be generated from human adult somatic cells by retroviral transduction of the four transcription factors, Oct3/4, Sox2, Klf4, and c-Myc, disease specific iPSC lines have sprung up worldwide like bamboo shoots after a spring rain, making iPSC one of the hottest and fastest moving topics in modern science. The craze for iPSCs has spread throughout main branches of clinical medicine, covering neurology, hematology, cardiology, endocrinology, hepatology, ophthalmology, and so on. Here in this paper, we will focus on the clinical application of human iPSCs in disease modeling, drug screening, and cell replacement therapy for neurological diseases.
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