Graft-versus-host disease after an outpatient peripheral blood hematopoietic cell transplant using reduced-intensity conditioning: a single-center LATAM experience

BACKGROUND

HLA compatibility predicts allogeneic hematopoietic cell transplant (allo-HCT) and graft-versus-host disease (GvHD) outcomes. There is insufficient information regarding GvHD outcomes for outpatient HLA-identical and haploidentical-HCT employing reduced-intensity conditioning (RIC).

RESEARCH DESIGN AND METHODS

We compare GvHD outcomes between donor types and report risk factors associated with GvHD. Stem cell source was T-cell replete peripheral blood. GvHD prophylaxis was post-transplant cyclophosphamide (PT-CY), mycophenolic acid, and calcineurin inhibitors for haploidentical (n = 107) and oral cyclosporine (CsA) plus methotrexate i.v. for HLA-identical (n = 89) recipients.

RESULTS

One hundred and ninety-six HCT transplant patients were included. aGvHD and cGvHD frequency were similar between HCT types. aGvHD severity was comparable, but severe cGvHD was less frequent in the haploidentical group (p = .011). One-hundred-day cumulative incidence (CI) of aGvHD for haploidentical and HLA-identical was 31% and 33% (p = .84); 2-year CI of cGvHD was 32% and 38% (p = .6), respectively. Haploidentical recipients had less steroid-refractory cGvHD (p = .043). Patients with cGvHD had less 2-year relapse (p = .003); both aGvHD and cGvHD conferred higher OS (p = .010 and p = .001), respectively. Male sex was protective for steroid-refractory cGvHD (p = .028).

CONCLUSIONS

Acute and chronic GvHD rates were comparable between HLA-identical and haploidentical transplant groups. cGvHD severity was lower in the haploidentical group.

[Parkinson's disease phenotype based on age at onset in Latin American patients: a paired-based analysis]

INTRODUCTION

Studies have demonstrated a higher motor and non-motor burden in Parkinson's disease (PD) patients with old age at onset compared to those with middle age at onset. We decided to test these findings in a Latin American PD population.

PATIENTS AND METHODS

We recruited 24 PD patients with age at onset > 65 years, and each patient was matched to 1 control patient with disease onset at ages between 48 and 60 years, matched for gender and disease duration (±2 years). Clinical test batteries that assessed motor (MDS-UPDRS), non-motor (NMSS), cognitive (MoCA), and quality of life (PDQ-8) were recorded. Groups were compared with conditional logistic regression analysis. A comparative post-hoc analysis was also conducted, considering only patients with age at onset > 70 years (n = 11) and their matched controls.

RESULTS

Mean age at onset was 70.53 ± 3.28 and 53.79 ± 4.96 for the old-age and middle-age group, respectively. No significant differences were observed in most clinical batteries when comparing PD patients based on age at onset, with worse scores in MDS-UPDRS Part III and Tremor subscore in the middle-age onset group. The post-hoc analysis showed similar results, with non-significantly worse scores in the middle-age onset group.

CONCLUSION

This is the first study reporting a more benign motor phenotype in old-age onset PD patients. Despite the lower cut-off value used for old age onset PD, vascular, epidemiological, ethnic and treatment adherence features must be also considered as potential explicative factors, with further multicenter studies in larger populations needed.

Determinants of self-efficacy in patients with Parkinson's disease

BACKGROUND

Self-efficacy is the individual's assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases.

OBJECTIVE

To investigate self-efficacy in a population of Parkinson's disease (PD) patients in Mexico and study the factors that are associated with this measure.

METHODS

We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded.

RESULTS

We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (<7.75) had worse scores in MDS-UPDRS, NMSS, and PDQ-8 scales. CDSES scores were significantly correlated with MDS-UPDRS Part I (r=-0.497, p=<0.001), Part II (r= -0.271, p=0.020), Part III (r=-0.304, p=<0.001), PDQ-8 (r=-0.472, p=<0.001), and NMSS (r=-0.504, p=<0.001). Furthermore, when assessing the simultaneous effect of covariates associated with CDSES score, only Mood/Apathy domain of NMSS was significant (beta= -0.446, t= -3.807, p= 0.012).

CONCLUSIONS

PD patients with lower self-efficacy scores had worse motor and non-motor symptomatology and quality of life. Mood/Apathy disorders were negatively associated with self-efficacy and contributed significantly to this measure.

Clinical features of metabolic syndrome in patients with Parkinson's disease

INTRODUCTION

Focus on the metabolic causes underlying dopaminergic cell loss in Parkinson's disease (PD) has increased lately. Glucose imbalances have been shown to be present in patients with PD. A syndrome characterized principally by insulin resistance and glucose dysregulations is metabolic syndrome. Scarce literature has evaluated the relation between these two diseases.

AIM

To determine the prevalence and clinical features of metabolic syndrome and its components in patients with PD.

PATIENTS AND METHODS

We analyzed data from 99 patients with PD diagnosis. Scales that evaluate motor, non-motor, and cognitive function, as well as sleep disorders and quality of life were registered. Metabolic syndrome was diagnosed according to the World Health Organization criteria.

RESULTS

Metabolic syndrome was reported in 8% of the population. When subdividing patients based on positivity to metabolic syndrome criteria, no significant differences in motor and cognitive function, as well as quality of life and sleep disorders were observed between groups. However, patients with metabolic syndrome showed worse scores in Non-Motor Symptom Scale compared to patients without the syndrome, especially gastrointestinal, mood/apathy, sexual function, perceptual and miscellaneous symptoms. No significant differences in clinical correlates were observed when grouping patients based on which single metabolic syndrome component was present.

CONCLUSION

Metabolic syndrome might have an effect on non-motor symptomatology in PD, as patients with metabolic syndrome showed worse scores in Non-Motor Symptom Scale.