Feasibility of allogeneic hematopoietic stem cell transplantation in advanced age

Although it is known that increasing age is associated with increased morbidity and mortality in allogeneic transplantation (allo-HSCT), individualization of the process may allow to perform it in progressively older patients.This study analyzed the outcome of 97 patients older than 60 years with a first allo-HSCT performed at our institution between 2011 and 2019.Median age was 66 years (range 60-79) and 15.4% were older than 70 years. The most frequent diagnosis was acute leukemia (50.5%), and 58.8% received a myeloablative conditioning. With a median follow-up of 33.9 months (range 7.9-111.5), at 3-years overall survival (OS) was 50%; progression-free survival (PFS), 46%; cumulative incidence of relapse, 22%; and non-relapse mortality (NRM), 32%. There were no significant differences in OS (p = 0.415), PFS (p = 0.691), cumulative incidence of relapse (p = 0.357) or NRM (p = 0.658) between patients of 60-64 years (n = 37), 65-69 (n = 45) and ≥ 70 years (n = 15). No differences were observed either depending on the intensity of the conditioning regimen in terms of OS (p = 0.858), PFS (p = 0.729), cumulative incidence of relapse (p = 0.416) or NRM (p = 0.270).In conclusion, older adults can safely and effectively undergo allo-HSCT with proper patient selection and individualized transplantation procedures.

Oxygen consumption (V̇O2) during trotting on a 10% decline

REASONS FOR PERFORMING STUDY

Although there have been reports of oxygen consumption measurements of horses running on the level and incline, there are no measurements during decline locomotion. This may be due, in part, to the potential for muscle damage produced by eccentric contractions. In man, running on a 10% decline, VO2 decreased by 35% and stride frequency (SF) decreased by 3% when compared to level locomotion.

HYPOTHESIS

The rate of O2 consumption and SF would be decreased in horses on a 10% decline when compared to the level.

METHODS

Six horses (average 467 +/- 68 kg) were acclimated to trotting on the level and decline prior to data collection. VO2 under moderate conditions was measured (using open flow respirometry) during trotting between 2.25 and 4.0 m/sec (at 0.25 m/sec increments) on a treadmill on the level and declined 10%. Stride frequencies were counted manually.

RESULTS

VO2 decreased (P<0.009) on the decline by an average of 45% (range 42-47%), and SF was 2.7% slower. The speed at which the minimum Cost of Transport occurs on the decline was faster than on the level. SF was reduced on the decline. No evidence of muscle soreness was noted in response to the downhill running.

CONCLUSIONS AND POTENTIAL RELEVANCE

Downhill trotting, eccentric exercise, can be done safely in the horse and requires almost half the energetic costs as trotting on the level. It is not known whether this is the optimum downhill gradient or if the horse adjusts its preferred speed to accommodate downhill trotting.

Hereditary ochronosis: hyperpigmented skin overlying cartilaginous structures

Hereditary ochronosis, or alkaptonuria, results from deficiency of homogentisic acid oxidase. It is an autosomal recessive condition found in geographically isolated populations. The excess homogentisic acid deposits in collagenous structures, leading to unusual pigmentation of the skin overlying cartilaginous structures, but on occasion pigment is also seen in the sclera, in sweat after oxidation, and classically, in urine when left standing at room temperature. This case report highlights the pathogenesis and expression of this rare disorder.