Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 35
Filter
1.
Bone Marrow Transplant ; 59(6): 777-784, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38409332

ABSTRACT

Mesenchymal stromal cells (MSC) have immunomodulatory and tissue-regenerative properties and have shown promising results in acute respiratory distress syndrome (ARDS) of multiple causes, including COVID-19. We conducted a randomised (1:1), placebo-controlled, double-blind clinical trial to assess the efficacy and safety of one bone marrow-derived MSC infusion in twenty patients with moderate to severe ARDS caused by COVID-19. The primary endpoint (increase in PaO2/FiO2 ratio from baseline to day 7, MSC 83.3 versus placebo 57.6) was not statistically significant, although a clinical improvement at day 7 in the WHO scale was observed in MSC patients (5, 50% vs 0, 0%, p = 0.033). Median time to discontinuation of supplemental oxygen was also shorter in the experimental arm (14 versus 23 days, p = 0.007), resulting in a shorter hospital stay (17.5 versus 28 days, p = 0.042). No significant differences were observed for other efficacy or safety secondary endpoints. No infusion or treatment-related serious adverse events occurred during the one-year follow-up. This study did not meet the primary endpoint of PaO2/FiO2 increase by day 7, although it suggests that MSC are safe in COVID-19 ARDS and may accelerate patients' clinical recovery and hospital discharge. Larger studies are warranted to elucidate their role in ARDS and other inflammatory lung disorders.Trial Registration: EudraCT Number: 2020-002193-27, registered on July 14th, 2020, https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-002193-27/ES . NCT number: NCT04615429, registered on November 4th, 2020, https://clinicaltrials.gov/ct2/show/NCT04615429 .


Subject(s)
COVID-19 , Mesenchymal Stem Cell Transplantation , Respiratory Distress Syndrome , Humans , Double-Blind Method , COVID-19/therapy , COVID-19/complications , Mesenchymal Stem Cell Transplantation/methods , Male , Female , Middle Aged , Respiratory Distress Syndrome/therapy , Aged , Adult , SARS-CoV-2 , Treatment Outcome , Mesenchymal Stem Cells/cytology
2.
J Med Virol ; 95(3): e28679, 2023 03.
Article in English | MEDLINE | ID: mdl-36929737

ABSTRACT

The humoral immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern elicited by vaccination was evaluated in COVID-19 recovered individuals (Rec) separated 1-3 months (Rec2m) or 4-12 months (Rec9m) postinfection and compared to the response in naïve participants. Antibody-mediated immune responses were assessed in 66 participants by three commercial immunoassays and a SARS-CoV-2 lentiviral-based pseudovirus neutralization assay. Immunoglobulin (Ig) levels against SARS-CoV-2 spike were lower in naïve participants after two doses than in Rec after a single dose (p < 0.05). After two doses in Rec, levels of total Ig to receptor-binding domain were significantly increased in Rec9m compared to Rec2m (p < 0.001). The neutralizing potency observed in Rec9m was consistently higher than in Rec2m against variants of concern (VOCs) Alpha, Beta, Delta, and BA.1 sublineage of Omicron with 2.2-2.8-fold increases. Increasing the interval between SARS-CoV-2 infection and the vaccination with messenger RNA-based vaccines to more than 3 months generates a more efficient heterologous humoral immune response against VOCs by allowing enough time to mount a strong recall memory B cell response.


Subject(s)
COVID-19 , Humans , COVID-19/prevention & control , 2019-nCoV Vaccine mRNA-1273 , SARS-CoV-2/genetics , mRNA Vaccines , Biological Assay , Vaccination , Antibodies, Neutralizing , Antibodies, Viral , Spike Glycoprotein, Coronavirus/genetics
3.
Nurs Open ; 9(6): 2836-2846, 2022 11.
Article in English | MEDLINE | ID: mdl-34291607

ABSTRACT

OBJECTIVES: Less than 5% of all harmful medicine-related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs. DESIGN: One-group pre-test-posttest design. SETTING: Tertiary, public, teaching hospital in Spain. PARTICIPANTS: A total of 139 RNs responded to pre- and postintervention questionnaires constituting the paired sample subjected to analysis. INTERVENTION: A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes. MAIN OUTCOME MEASURES: Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34-170 points) by means of an electronic questionnaire. RESULTS: A statistically significant 7.96-point increase in OC from baseline to the final measurement was obtained (CI: 5.05-10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06-9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no-harm MI postintervention compared to 4.4% pre-intervention (p < .001). A one-point increase in OC improved the probability of becoming reporter by 2.9% and a one-point increase in skills by 6.4%. CONCLUSION: MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no-harm MIs reported.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Pharmacovigilance , Humans , Patient Safety , Surveys and Questionnaires , Spain
4.
J Clin Invest ; 131(20)2021 10 15.
Article in English | MEDLINE | ID: mdl-34473652

ABSTRACT

BACKGROUNDPassive immunotherapy with convalescent plasma (CP) is a potential treatment for COVID-19. Evidence from controlled clinical trials is inconclusive.METHODSWe conducted a randomized, open-label, controlled clinical trial at 27 hospitals in Spain. Patients had to be admitted for COVID-19 pneumonia within 7 days from symptom onset and not on mechanical ventilation or high-flow oxygen devices. Patients were randomized 1:1 to treatment with CP in addition to standard of care (SOC) or to the control arm receiving only SOC. The primary endpoint was the proportion of patients in categories 5 (noninvasive ventilation or high-flow oxygen), 6 (invasive mechanical ventilation or extracorporeal membrane oxygenation [ECMO]), or 7 (death) at 14 days. Primary analysis was performed in the intention-to-treat population.RESULTSBetween April 4, 2020, and February 5, 2021, 350 patients were randomly assigned to either CP (n = 179) or SOC (n = 171). At 14 days, proportion of patients in categories 5, 6, or 7 was 11.7% in the CP group versus 16.4% in the control group (P = 0.205). The difference was greater at 28 days, with 8.4% of patients in categories 5-7 in the CP group versus 17.0% in the control group (P = 0.021). The difference in overall survival did not reach statistical significance (HR 0.46, 95% CI 0.19-1.14, log-rank P = 0.087).CONCLUSIONCP showed a significant benefit in preventing progression to noninvasive ventilation or high-flow oxygen, invasive mechanical ventilation or ECMO, or death at 28 days. The effect on the predefined primary endpoint at 14 days and the effect on overall survival were not statistically significant.TRIAL REGISTRATIONClinicaltrials.gov, NCT04345523.FUNDINGGovernment of Spain, Instituto de Salud Carlos III.


Subject(s)
COVID-19/therapy , SARS-CoV-2 , Aged , COVID-19/mortality , COVID-19/physiopathology , Combined Modality Therapy , Disease Progression , Female , Hospitalization , Humans , Immunization, Passive/adverse effects , Kaplan-Meier Estimate , Male , Middle Aged , Odds Ratio , Pandemics , Spain/epidemiology , Treatment Outcome , COVID-19 Serotherapy
5.
Transplant Cell Ther ; 27(5): 424.e1-424.e9, 2021 05.
Article in English | MEDLINE | ID: mdl-33965182

ABSTRACT

HLA-haploidentical transplantation (haplo-HCT) using post-transplantation-cyclophosphamide (PT-Cy) is a feasible procedure in children with malignancies. However, large studies on Haplo-HCT with PT-Cy for childhood acute lymphoblastic leukemia (ALL) are lacking. We analyzed haplo-HCT outcomes in 180 children with ALL. Median age was 9 years, and median follow-up was 2.7 years. Disease status was CR1 for 24%, CR2 for 45%, CR+3 for 12%, and active disease for 19%. All patients received PT-Cy day +3 and +4. Bone marrow (BM) was the stem cell source in 115 patients (64%). Cumulative incidence of 42-day engraftment was 88.9%. Cumulative incidence of day-100 acute graft-versus-host disease (GVHD) grade II-IV was 28%, and 2-year chronic GVHD was 21.9%. At 2 years, cumulative incidence of nonrelapse mortality (NRM) was 19.6%. Cumulative incidence was 41.9% for relapse and 25% for patients in CR1. Estimated 2-year leukemia free survival was 65%, 44%, and 18.8% for patients transplanted in CR1, CR2, CR3+ and 3% at 1 year for active disease. In multivariable analysis for patients in CR1 and CR2, disease status (CR2 [hazard ratio {HR} = 2.19; P = .04]), age at HCT older than 13 (HR = 2.07; P = .03) and use of peripheral blood stem cell (PBSC) (HR = 1.98; P = .04) were independent factors associated with decreased overall survival. Use of PBSC was also associated with higher NRM (HR = 3.13; P = .04). Haplo-HCT with PT-Cy is an option for children with ALL, namely those transplanted in CR1 and CR2. Age and disease status remain the most important factors for outcomes. BM cells as a graft source is associated with improved survival.


Subject(s)
Precursor Cell Lymphoblastic Leukemia-Lymphoma , Transplantation, Haploidentical , Child , Cyclophosphamide/therapeutic use , Humans , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Retrospective Studies , Transplantation Conditioning
6.
Trials ; 22(1): 70, 2021 Jan 20.
Article in English | MEDLINE | ID: mdl-33472681

ABSTRACT

BACKGROUND: COVID-19 is a respiratory disease caused by a novel coronavirus (SARS-CoV-2) and causes substantial morbidity and mortality. At the time this clinical trial was planned, there were no available vaccine or therapeutic agents with proven efficacy, but the severity of the condition prompted the use of several pharmacological and non-pharmacological interventions. It has long been hypothesized that the use of convalescent plasma (CP) from infected patients who have developed an effective immune response is likely to be an option for the treatment of patients with a variety of severe acute respiratory infections (SARI) of viral etiology. The aim of this study is to assess the efficacy and safety of convalescent plasma in adult patients with severe COVID-19 pneumonia. METHODS/DESIGN: The ConPlas-19 study is a multicenter, randomized, open-label controlled trial. The study has been planned to include 278 adult patients hospitalized with severe COVID-19 infection not requiring mechanical ventilation (invasive or non-invasive). Subjects are randomly assigned in a 1:1 ratio (139 per treatment arm), stratified by center, to receive intravenously administered CP (single infusion) plus SOC or SOC alone, and are to be followed for 30 days. The primary endpoint of the study is the proportion of patients that progress to category 5, 6, or 7 (on the 7-point ordinal scale proposed by the WHO) at day 15. Interim analyses for efficacy and/or futility will be conducted once 20%, 40%, and 60% of the planned sample size are enrolled and complete D15 assessment. DISCUSSION: This clinical trial is designed to evaluate the efficacy and safety of passive immunotherapy with convalescent plasma for the treatment of adult patients hospitalized with COVID-19. The results of this study are expected to contribute to establishing the potential place of CP in the therapeutics for a new viral disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345523 . Registered on 30 March, 2020. First posted date: April 14, 2020.


Subject(s)
COVID-19/therapy , SARS-CoV-2/isolation & purification , Adult , COVID-19/diagnosis , Clinical Trials, Phase II as Topic , Female , Hospitalization , Humans , Immunization, Passive/adverse effects , Male , Middle Aged , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Severity of Illness Index , Standard of Care , Treatment Outcome , COVID-19 Serotherapy
7.
Trials ; 22(1): 9, 2021 Jan 06.
Article in English | MEDLINE | ID: mdl-33407777

ABSTRACT

OBJECTIVES: 1. To assess the efficacy of Mesenchymal Stromal Cells (MSC) versus a control arm as described in the primary endpoint. 2. To evaluate the effects of MSC on the secondary efficacy endpoints. 3. To evaluate the safety and tolerability profiles of MSC. 4. To study soluble and cellular biomarkers that might be involved in the course of the disease and the response to the investigational product. TRIAL DESIGN: A double-blind, randomized, controlled, trial to evaluate the efficacy and safety of MSC intravenous administration in patients with COVID-induced Acute Respiratory Distress Syndrome (ARDS) compared to a control arm. PARTICIPANTS: The trial is being conducted at a third level hospital, Hospital Universitario Puerta de Hierro, in Majadahonda, Madrid (Spain). Inclusion criteria 1. Informed consent prior to performing study procedures (witnessed oral consent with written consent by representatives will be accepted to avoid paper handling). Written consent by patient or representatives will be obtained whenever possible. 2. Adult patients ≥18 years of age at the time of enrolment. 3. Laboratory-confirmed SARS-CoV-2 infection as determined by Polymerase Chain Reaction (PCR), in oropharyngeal swabs or any other relevant specimen obtained during the course of the disease. Alternative tests (e.g., rapid antigen tests) are also acceptable as laboratory confirmation if their specificity has been accepted by the Sponsor. 4. Moderate to severe ARDS (PaO2/FiO2 ratio equal or less than 200 mmHg) for less than 96 hours at the time of randomization. 5. Patients requiring invasive ventilation are eligible within 72 hours from intubation. 6. Eligible for ICU admission, according to the clinical team. Exclusion criteria 1. Imminent and unavoidable progression to death within 24 hours, irrespective of the provision of treatments (in the opinion of the clinical team). 2. "Do Not Attempt Resuscitation" order in place. 3. Any end-stage organ disease or condition, which in the investigator's opinion, makes the patient an unsuitable candidate for treatment. 4. History of a moderate/severe lung disorder requiring home-based oxygen therapy. 5. Patient requiring Extracorporeal Membrane Oxygenation (ECMO), haemodialysis or hemofiltration at the time of treatment administration. 6. Current diagnosis of pulmonary embolism. 7. Active neoplasm, except carcinoma in situ or basalioma. 8. Known allergy to the products involved in the allogeneic MSC production process. 9. Current pregnancy or lactation (women with childbearing potential should have a negative pregnancy test result at the time of study enrolment). 10. Current participation in a clinical trial with an experimental treatment for COVID-19 (the use of any off-label medicine according to local treatment protocols is not an exclusion criteria). 11. Any circumstances that in the investigator's opinion compromises the patient's ability to participate in the clinical trial. INTERVENTION AND COMPARATOR: - Experimental treatment arm: Allogeneic MSC (approximately 1 x 106 cells/kg). - Control arm: placebo solution (same composition as the experimental treatment, without the MSC). One single intravenous dose of the assigned treatment will be administered on Day 0 of the study. All trial participants will receive standard of care (SOC). In the context of the current worldwide pandemic, SOC can include medicines that are being used in clinical practice (e.g. lopinavir/ritonavir; hydroxy/chloroquine, tocilizumab, etc.), as well as those authorised for COVID (e.g., remdesivir). MAIN OUTCOMES: Primary endpoint: Change in the PaO2/FiO2 ratio from baseline to day 7 of treatment administration, or to the last available PaO2/FiO2 ratio if death occurs before day 7. Secondary endpoints: - All-cause mortality on days 7, 14, and 28 after treatment. - PaO2/FiO2 ratio at baseline and days 2, 4, 7, 14 and 28 after treatment. - Oxygen saturation (by standardized measurement) at baseline, daily until day 14, and on day 28 after treatment. - Time to PaO2/FiO2 ratio greater than 200 mmHg. - Subjects' clinical status on the WHO 7-point ordinal scale at baseline, daily until day 14, and on day 28 after treatment. - Time to an improvement of one category from admission on the WHO 7-point ordinal scale. - Percentage of patients that worsen at least one category on the WHO 7-point ordinal scale. - Percentage of patients that improve at least one category (maintained 48h) on the WHO 7-point ordinal scale. - Sequential Organ Failure Assessment (SOFA) scale at baseline and days 2, 4, 7, 14 and 28 after treatment. - Duration of hospitalization (days). - Duration of ICU stay (days). - Oxygen therapy-free days in the first 28 days after treatment. - Duration of supplemental oxygen. - Incidence of and duration of non-invasive and invasive mechanical ventilation in the first 28 days after treatment. - Mechanical ventilation-free days in the first 28 days after treatment. - Ventilation parameters. - Incidence of new onset pulmonary fibrosis at 3 and 12 months after treatment, based on CT scan and pulmonary function tests. - Survival at 3 and 12 months. - Cumulative incidence of Serious Adverse events (SAEs) and Grade 3 and 4 Adverse Events (AEs). - Cumulative incidence of Adverse Drug Reactions (ADR) in the experimental treatment arm. - Cumulative incidence of AEs of special interest. - Levels of analytical markers (C-Reactive Protein, lymphocyte and neutrophil counts, lymphocyte subpopulations, LDH, ferritin, D-dimer, coagulation tests and cytokines...) at baseline and days 2, 4, 7, 14 and 28 after treatment. - Other soluble and cellular biomarkers that might be involved in the course of the disease and the response to MSC. RANDOMISATION: The assignment to treatment will be carried out randomly and blinded, with a 1:1 allocation. Randomization will be done through a centralized system embedded in the electronic Case Report Form (CRF). BLINDING (MASKING): To ensure blinding, treatments will be prepared for administration at the Cell Production Unit and the administration of the treatment will be masked, not allowing the identification of the Investigational Medicinal Product (IMP). NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 20 participants are planned to be randomized, 10 to each treatment group. TRIAL STATUS: Protocol version: 1.2, dated October 14th, 2020 Start of recruitment: 01/10/2020 End of recruitment (estimated): December 2020. TRIAL REGISTRATION: EudraCT Number: 2020-002193-27 , registered on July 14th, 2020. NCT number: NCT04615429 , registered on November 4th, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Subject(s)
Antiviral Agents/administration & dosage , COVID-19/therapy , Mesenchymal Stem Cell Transplantation/methods , Respiratory Distress Syndrome/therapy , Administration, Intravenous , Adult , Biomarkers/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Clinical Trials, Phase II as Topic , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Double-Blind Method , Female , Humans , Male , Mesenchymal Stem Cell Transplantation/adverse effects , Randomized Controlled Trials as Topic , Respiration, Artificial , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/virology , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Severity of Illness Index , Spain , Standard of Care , Transplantation, Homologous/adverse effects , Transplantation, Homologous/methods
8.
Oncologist ; 25(12): 1067-1074, 2020 12.
Article in English | MEDLINE | ID: mdl-33026700

ABSTRACT

The use of daratumumab in combination with established regimens for the treatment of newly diagnosed multiple myeloma has recently been authorized by the European Medicines Agency based on results from three separate phase III randomized, active controlled, open-label studies that have confirmed enhanced efficacy and tolerability in both transplant-ineligible (MMY3008 and MMY3007) and transplant-eligible (MMY3006) patients, without compromising transplant ability. Trial MMY3008 showed an improvement in progression-free survival (PFS) when daratumumab was added to lenalidomide and dexamethasone compared with lenalidomide and dexamethasone; the median PFS had not been reached in the daratumumab arm and was 31.9 months in the control arm (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.43-0.73; p < .0001). Trial MMY3007 showed an improvement in PFS when daratumumab was added to bortezomib, melphalan, and prednisone compared with bortezomib, melphalan, and prednisone; PFS had not been reached in the daratumumab arm and was 18.1 months in the control arm (HR, 0.5; 95% CI, 0.38-0.65; p < .0001). In trial MMY3006, daratumumab added to bortezomib, thalidomide, and dexamethasone was compared with bortezomib, thalidomide, and dexamethasone as induction and consolidation treatment prior to autologous stem cell transplant. The stringent complete response rate at day 100 after transplant in the daratumumab group was 29% compared with 20% in the control group (odds ratio, 1.60; 1.21-2.12 95% CI; p = .0010). Overall adverse events were manageable, with an increased rate of neutropenia and infections in the daratumumab arms. Regulatory assessment of efficacy and safety results from trials MMY3006, MMY3007, and MMY3008 confirmed a positive benefit-risk ratio leading to an approval of the extensions of indication. IMPLICATIONS FOR PRACTICE: A set of extensions of indication was recently approved for daratumumab (Darzalex) in the setting of newly diagnosed multiple myeloma in combination with established regimens. Results of the MMY3006, MMY3007, and MMY3008 trials have shown enhanced efficacy and a favorable side effect profile of several daratumumab-based combinations in patients both ineligible and eligible for transplant, without compromising transplant ability. The combinations of daratumumab with either lenalidomide and low-dose dexamethasone or bortezomib, melphalan, and prednisone were approved for transplant-ineligible patients. The combination of daratumumab with bortezomib, thalidomide, and dexamethasone was approved for transplant-eligible patients. These combinations are expected to improve the survival outlook for patients with multiple myeloma, without an unacceptable risk of increase in adverse events, and updated information on progression-free survival and overall survival is expected from the above trials.


Subject(s)
Multiple Myeloma , Adult , Antibodies, Monoclonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bortezomib/therapeutic use , Dexamethasone/therapeutic use , Humans , Multiple Myeloma/drug therapy , Treatment Outcome
9.
Article in English | MEDLINE | ID: mdl-32571831

ABSTRACT

Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.


Subject(s)
Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Interferons/therapeutic use , Lopinavir/therapeutic use , Methylprednisolone/therapeutic use , Pneumonia, Viral/drug therapy , Ritonavir/therapeutic use , Aged , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/immunology , Cardiovascular Diseases/mortality , Cardiovascular Diseases/virology , Comorbidity , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Coronavirus Infections/virology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/immunology , Diabetes Mellitus/mortality , Diabetes Mellitus/virology , Drug Administration Schedule , Drug Combinations , Drug Therapy, Combination , Dyslipidemias/drug therapy , Dyslipidemias/immunology , Dyslipidemias/mortality , Dyslipidemias/virology , Female , Hospitals, University , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Male , Middle Aged , Neoplasms/drug therapy , Neoplasms/immunology , Neoplasms/mortality , Neoplasms/virology , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Survival Analysis
10.
Biol Blood Marrow Transplant ; 26(5): 936-942, 2020 05.
Article in English | MEDLINE | ID: mdl-31926364

ABSTRACT

Allogeneic hematopoietic cell transplantation (HCT) is recommended in high-risk patients with T cell acute lymphoblastic leukemia (T-ALL). For patients without an HLA-identical donor, haploidentical (haplo-) HCT is becoming the leading source of stem cell donation. However, data are scarce on predictive factors for outcome in that setting. We identified 122 adults (20% female; median age, 31 years; range, 18 to 68 years) with T-ALL who underwent haplo-HCT with post-transplantation cyclophosphamide (ptCy) between 2010 and 2017. The median duration of follow-up of living patients was 23 months. The 2-year incidences of relapse and nonrelapse mortality were 45% and 21%, respectively. The 2-year leukemia-free survival (LFS), overall survival (OS), and graft-versus-host disease, relapse-free survival (GRFS) were 34%, 42%, and 27%, respectively. The 2-year LFS and OS were highly influenced by disease status at transplantation, being 49% and 55%, respectively, for patients in first complete remission (CR1); 34% and 50%, respectively, for those in second CR (CR2); and 8% and 12%, respectively, for patients with active disease. On multivariate analysis, only disease status was found to affect LFS and OS. Transplantation in CR2 negatively affected LFS, whereas active disease at the time of haplo-HCT negatively affected LFS and OS. In conclusion, haplo-HCT with ptCy produced encouraging results in this challenging disease, particularly when performed in patients in CR. Despite the limitation of the small sample size, our results were not affected by the type of conditioning, calling into question the need for total body irradiation-based myeloablative conditioning in that setting.


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma , Adolescent , Adult , Aged , Bone Marrow , Cyclophosphamide/therapeutic use , Disease-Free Survival , Female , Graft vs Host Disease/prevention & control , Humans , Male , Middle Aged , Retrospective Studies , T-Lymphocytes , Transplantation Conditioning , Transplantation, Haploidentical , Young Adult
11.
Biol Blood Marrow Transplant ; 25(9): 1825-1831, 2019 09.
Article in English | MEDLINE | ID: mdl-31152794

ABSTRACT

Persistent thrombocytopenia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Romiplostim and eltrombopag are the currently available thrombopoietin receptor agonists (TPO-RAs), and some studies with very small numbers of cases have reported their potential efficacy in the allo-SCT setting. The present retrospective study evaluated the safety and efficacy of TPO-RAs in 86 patients with persistent thrombocytopenia after allo-HSCT. Sixteen patients (19%) had isolated thrombocytopenia (PT), and 71 (82%) had secondary failure of platelet recovery (SFPR). TPO-RA therapy was started at a median of 127 days (range, 27 to 1177 days) after allo-SCT. The median initial and maximum administered doses were 50 mg/day (range, 25 to 150 mg/day) and 75 mg/day (range, 25 to 150 mg/day), respectively, for eltrombopag and 1 µg/kg (range, 1 to 7 µg/kg) and 5 µg/kg (range, 1 to 10 µg/kg), respectively, for romiplostin. The median platelet count before initiation of TPO-RA therapy was 14,000/µL (range, 1000 to 57,000/µL). Platelet recovery to ≥50,000/µL without transfusion support was achieved in 72% of patients at a median time of 66 days (range, 2 to 247 days). Eighty-one percent of the patients had a decreased number of megakaryocytes before treatment, showing a slower response to therapy (P = .011). The median duration of treatment was 62 days (range, 7 to 700 days). Grade 3-4 adverse events (hepatic and asthenia) were observed in only 2% of the patients. At last follow-up, 81% of patients had discontinued TPO-RAs and maintained response, and 71% were alive. To our knowledge, this is the largest series analyzing the use of TPO-RAs after allo-SCT reported to date. Our results support the efficacy and safety in this new setting. Further prospective trials are needed to increase the level of evidence and to identify predictors of response.


Subject(s)
Benzoates/administration & dosage , Hematopoietic Stem Cell Transplantation , Hydrazines/administration & dosage , Pyrazoles/administration & dosage , Receptors, Fc/administration & dosage , Receptors, Thrombopoietin/agonists , Recombinant Fusion Proteins/administration & dosage , Thrombocytopenia , Thrombopoietin/administration & dosage , Adolescent , Adult , Allografts , Benzoates/adverse effects , Child , Child, Preschool , Female , Humans , Hydrazines/adverse effects , Infant , Male , Platelet Count , Pyrazoles/adverse effects , Recombinant Fusion Proteins/adverse effects , Retrospective Studies , Severity of Illness Index , Spain , Thrombocytopenia/blood , Thrombocytopenia/drug therapy , Thrombocytopenia/etiology , Thrombopoietin/adverse effects
12.
Stem Cells Int ; 2018: 6025918, 2018.
Article in English | MEDLINE | ID: mdl-29535772

ABSTRACT

ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n = 108) will be randomly assigned to either the experimental low dose (n = 36), the experimental high dose (n = 36), or the comparator arm (n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

14.
Future Cardiol ; 11(5): 525-9, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26090568

ABSTRACT

Rivaroxaban is a once-daily oral anticoagulant currently indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also indicated for the prevention and treatment of venous or pulmonary thromboembolism. Despite the known advantages of rivaroxaban over standard therapy, this treatment is not exempt from bleeding. We present the case of a 51-year-old woman with arterial hypertension and paroxysmal atrial fibrillation anticoagulated with rivaroxaban 20 mg o.d. Patient was admitted to the emergency department because of intense abdominal pain, high temperature, hypotension, tachycardia and a big tumor in the right abdominal area. The ultrasonic exam showed a big collection in the thoracic and abdominal area, compatible with hematoma. Due to clinical instability, urgent surgery was required. Based on the results of coagulation parameters (PT: 17.5 s), the time from the last rivaroxaban dose was taken, and the patient weight, nonactivated prothrombin complex concentrate at a single dose of 1000 IU was administrated intravenously 1 h before the surgery. PT value decreased to normal value (13.5 s), and surgery was performed without any bleeding complication. The management of patients treated with rivaroxaban who require urgent surgery is discussed in this report.


Subject(s)
Abdomen/blood supply , Atrial Fibrillation/complications , Blood Coagulation Factors/administration & dosage , Emergencies , Hematoma/chemically induced , Rivaroxaban/adverse effects , Abdomen/diagnostic imaging , Abdomen/surgery , Administration, Oral , Blood Coagulation/drug effects , Drug Administration Schedule , Embolism/etiology , Embolism/prevention & control , Factor Xa Inhibitors/administration & dosage , Factor Xa Inhibitors/adverse effects , Female , Hematoma/diagnosis , Hematoma/therapy , Humans , Injections, Intravenous , Middle Aged , Rivaroxaban/administration & dosage , Tachycardia, Paroxysmal/complications , Tomography, X-Ray Computed , Ultrasonography
16.
Eur J Clin Pharmacol ; 71(6): 715-722, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25953736

ABSTRACT

AIM: The aim of this pharmacokinetic (PK) study was to evaluate tacrolimus (TAC) exposure in stable cystic fibrosis (CF) lung transplant (LT) recipients, converted from TAC twice daily to TAC once daily in an open-label, prospective, single-centre study. METHODS: Eligible patients were post-transplant CF patients (18-65 years) with stable lung function, on stable doses of TAC twice daily and who were candidates to switch to TAC once daily. Twelve consecutive patients were included in the study. Patients had their first PK analysis on day 1, still under the stable TAC twice-daily regimen, and were converted to TAC once daily from day 2 onwards. The doses were adjusted according to clinical judgement to achieve target levels, and a second 24-h PK period profile was obtained once the patient was on a stable dosage on the therapeutic range. RESULTS: The mean total (SD) daily dose of TAC twice daily at baseline upon enrolment was 0.17 (0.10) mg/kg/day. The mean (SD) daily dose of TAC once daily after adjustments was 0.22 (0.12) mg/kg/day. In order to achieve target C min levels with a similar AUC0-24, 82% of subjects who were converted to TAC once daily required an increase of dose, in a range of 0-66.7%, with a mean dose increase of 28%. CONCLUSIONS: Our study results indicate that the switch for conversion from TAC twice daily to TAC once daily in patients with CF may need dose adjustment in order to reach levels within the therapeutic target.


Subject(s)
Cystic Fibrosis/metabolism , Cystic Fibrosis/physiopathology , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/pharmacokinetics , Tacrolimus/administration & dosage , Tacrolimus/pharmacokinetics , Administration, Oral , Adult , Area Under Curve , Drug Administration Schedule , Female , Humans , Lung Transplantation/methods , Male , Young Adult
17.
Alzheimer (Barc., Internet) ; (55): 21-28, sept.-dic. 2013. tab
Article in Spanish | IBECS | ID: ibc-118537

ABSTRACT

Los genéricos son a veces objeto de dudas y malentendidos por parte del médico o del paciente. En el caso del paciente con enfermedad de Alzheimer, el «baile» de genéricos puede ser un motivo de preocupación y causar problemas en la identificación del tratamiento habitual. Sin embargo, la eficacia y la seguridad del medicamento genérico están perfectamente avaladas al haberse demostrado su bioequivalencia con el medicamento innovador o de referencia. La bioequivalencia tiene como base una metodología cuyo fundamento es garantizar no solo que el medicamento genérico tiene la misma cantidad de principio activo que el medicamento de referencia, sino también que se absorbe exactamente del mismo modo, lo que permite asumir que producirá los mismos efectos sistémicos. El menor precio del genérico está sujeto a diversos factores, pero no se debe a diferencias en calidad, ya que su fabricación cumple con idénticos estándares a los del medicamento de referencia. Algunos conceptos relevantes en este campo son los de «prescribilidad », intercambiabilidad y políticas de sustitución. Así, un medicamento genérico autorizado puede ser prescrito con las mismas garantías de calidad, eficacia y seguridad que el medicamento de referencia y se debe considerar intercambiable, si bien es preferible evitar sustituciones innecesarias en los pacientes (AU)


The use of generic drugs is often surrounded by misunderstandings and questions, from patients and physicians. The switch between generic drugs is frequently a concern because it can difficult the ability of Alzheimer’s patients to recognize their daily medication. The efficacy and safety of a generic drug is fully endorsed by demonstrating its bioequivalence with the reference drug. The demonstration of bioequivalence guarantees not only that the generic drug contains the same active substance quantity, but it is also absorbed in the same manner than the reference drug. This methodology allows us to conclude that both drugs produce the same systemic effects. The lower price of a generic drug is due to several different factors, but none of them incur in differences in quality, since the manufacture of a generic drug follows identical requirements to those followed by the reference drug. "Prescribility", "interchangeability" and "drug substitution" policies are relevant concepts to discuss in the context of generic drugs use. In that sense, an approved generic drug can be prescribed with the same quality, efficacy and safety guaranties that those of the reference drug and both of them can be considered exchangeable. However, it is preferred to avoid any unnecessary drug substitutions in a patient chronic treatment (AU)


Subject(s)
Humans , Male , Female , Alzheimer Disease/drug therapy , Alzheimer Disease/epidemiology , Drugs, Generic/therapeutic use , Generic Drug Policy , Drugs, Generic/administration & dosage , Drugs, Generic/metabolism , Drugs, Generic/pharmacokinetics , Therapeutic Equivalency
18.
Rev. esp. cardiol. (Ed. impr.) ; 66(6): 450-457, jun. 2013. tab, ilus
Article in Spanish | IBECS | ID: ibc-112900

ABSTRACT

Introducción y objetivos. Diferentes estudios han mostrado mejoría funcional en pacientes con miocardiopatía dilatada no isquémica tratada con terapia celular. Sin embargo, los factores que influyen en la respuesta no son bien conocidos. El presente estudio investiga los cambios funcionales y los factores que influyen en la mejora de la fracción de eyección a los 6 meses en 27 pacientes con miocardiopatía dilatada tratados con terapia celular intracoronaria. Métodos. Los pacientes recibieron una infusión intracoronaria de células mononucleares autólogas de la médula ósea (media de células infundidas, 10,2±2,9 × 108). En todos se efectuó análisis funcional y citometría de flujo de las células infundidas. Resultados. La ganancia en fracción de eyección observada a los 6 meses osciló entre el ¿9 y el 34% (media, 9%). Estos cambios formaron dos grupos de pacientes: 21 (78%) que mostraron una mejora significativa (ganancia media, 14±7%), frente a 6 (22%) que no mostraron respuesta (ganancia media, ¿5±3%). Los respondedores eran más jóvenes (50±12 frente a 62±9 años; p<0,04). Se encontró una correlación inversa (r=¿0,41; p<0,003) entre la ganancia en la fracción de eyección y los valores basales de lipoproteínas de alta densidad. La capacidad migratoria de las células infundidas a las 24h estaba significativamente reducida en el grupo de respondedores (factor de crecimiento del endotelio vascular, 5,4±1,7 × 108 frente a 8,1±2,3 × 108; p<0,009; factor 1 derivado de células estromales, 5,8±1,7 × 108 frente a 8,4±2,9 × 108; p<0,002). Conclusiones. Los pacientes más jóvenes con miocardiopatía dilatada y concentración plasmática de lipoproteínas de alta densidad más baja parecen tener mayor beneficio funcional tras la terapia celular. La mejoría funcional también parece aumentada en los pacientes con menor capacidad migratoria de las células infundidas (AU)


Introduction and objectives. Different studies have shown improvement in patients with idiopathic nonischemic dilated cardiomyopathy treated with cell-therapy. However, factors influencing responsiveness are not well known. This trial investigates functional changes and factors influencing the 6-month gain in ejection fraction in 27 patients with dilated cardiomiopathy treated with intracoronary cell-therapy. Methods. Patients received intracoronary infusion of autologous bone-marrow mononuclear cells (mean infused, 10.2 [2.9]×108). Flow cytometry and functional analyses of the cells were also performed. Results. The 6-month angiographic gain in ejection fraction ranged from −9% to 34% (mean, 9%). These changes were distinguished into 2 groups: 21 patients (78%) with a significant improvement at the 6-month evaluation (mean gain, 14 [7]%), and 6 patients who had no response (mean gain, −5 [3]%). The responders were younger as compared to the nonresponders (50 [12] years vs 62 [9] years; P<.04). There was an inverse correlation (r=−0.41; P<.003) between the gain in ejection fraction and the high density lipoprotein level, suggesting higher functional gain with low high density lipoprotein levels. The 24h migratory capability of the infused cells was significantly reduced in the responders’ group (5.4 [1.7]×108 vs 8.1 [2.3]×108; P<.009 for vascular endothelial growth factor and 5.8 [1.7]×108 vs 8.4 [2.9]×108; P<.002 for stromal cell-derived factor-1). Conclusions. Younger patients with dilated cardiomiopathy and lower plasma high density lipoprotein levels gain greater benefit from intracoronary cell-therapy. Functional improvement also seems to be enhanced by a lower migratory capacity of the infused cells (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Cardiomyopathy, Dilated/therapy , Cardiomyopathy, Dilated/diagnosis , Cell- and Tissue-Based Therapy/instrumentation , Cell- and Tissue-Based Therapy/methods , Cardiac Catheterization/standards , Cardiac Catheterization , Ventricular Remodeling/physiology , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated , Cell- and Tissue-Based Therapy/trends , Cell- and Tissue-Based Therapy , Cardiac Catheterization/methods , Cardiac Catheterization/trends , Angiography/instrumentation , Angiography/methods , Hemodynamics/physiology
19.
Rev Esp Cardiol (Engl Ed) ; 66(6): 450-7, 2013 Jun.
Article in English | MEDLINE | ID: mdl-24776047

ABSTRACT

INTRODUCTION AND OBJECTIVES: Different studies have shown improvement in patients with idiopathic nonischemic dilated cardiomyopathy treated with cell-therapy. However, factors influencing responsiveness are not well known. This trial investigates functional changes and factors influencing the 6-month gain in ejection fraction in 27 patients with dilated cardiomiopathy treated with intracoronary cell-therapy. METHODS: Patients received intracoronary infusion of autologous bone-marrow mononuclear cells (mean infused, 10.2 [2.9]×10(8)). Flow cytometry and functional analyses of the cells were also performed. RESULTS: The 6-month angiographic gain in ejection fraction ranged from -9% to 34% (mean, 9%). These changes were distinguished into 2 groups: 21 patients (78%) with a significant improvement at the 6-month evaluation (mean gain, 14 [7]%), and 6 patients who had no response (mean gain, -5 [3]%). The responders were younger as compared to the nonresponders (50 [12] years vs 62 [9] years; P<.04). There was an inverse correlation (r=-0.41; P<.003) between the gain in ejection fraction and the high density lipoprotein level, suggesting higher functional gain with low high density lipoprotein levels. The 24 h migratory capability of the infused cells was significantly reduced in the responders' group (5.4 [1.7]×10(8) vs 8.1 [2.3]×10(8); P<.009 for vascular endothelial growth factor and 5.8 [1.7]×10(8) vs 8.4 [2.9]×10(8); P<.002 for stromal cell-derived factor-1). CONCLUSIONS: Younger patients with dilated cardiomiopathy and lower plasma high density lipoprotein levels gain greater benefit from intracoronary cell-therapy. Functional improvement also seems to be enhanced by a lower migratory capacity of the infused cells.


Subject(s)
Bone Marrow Transplantation/methods , Cardiomyopathy, Dilated/therapy , Adult , Aged , Cardiomyopathy, Dilated/diagnostic imaging , Coronary Vessels , Female , Humans , Infusions, Intra-Arterial , Male , Middle Aged , Stroke Volume , Treatment Outcome , Ultrasonography
20.
PLoS One ; 7(4): e34656, 2012.
Article in English | MEDLINE | ID: mdl-22506042

ABSTRACT

Wnt/ß-catenin pathway controls biochemical processes related to cell differentiation. In committed cells the alteration of this pathway has been associated with tumors as hepatocellular carcinoma or hepatoblastoma. The present study evaluated the role of Wnt/ß-catenin activation during human mesenchymal stem cells differentiation into hepatocytes. The differentiation to hepatocytes was achieved by the addition of two different conditioned media. In one of them, ß-catenin nuclear translocation, up-regulation of genes related to the Wnt/ß-catenin pathway, such as Lrp5 and Fzd3, as well as the oncogenes c-myc and p53 were observed. While in the other protocol there was a Wnt/ß-catenin inactivation. Hepatocytes with nuclear translocation of ß-catenin also had abnormal cellular proliferation, and expressed membrane proteins involved in hepatocellular carcinoma, metastatic behavior and cancer stem cells. Further, these cells had also increased auto-renewal capability as shown in spheroids formation assay. Comparison of both differentiation protocols by 2D-DIGE proteomic analysis revealed differential expression of 11 proteins with altered expression in hepatocellular carcinoma. Cathepsin B and D, adenine phosphoribosyltransferase, triosephosphate isomerase, inorganic pyrophosphatase, peptidyl-prolyl cis-trans isomerase A or lactate dehydrogenase ß-chain were up-regulated only with the protocol associated with Wnt signaling activation while other proteins involved in tumor suppression, such as transgelin or tropomyosin ß-chain were down-regulated in this protocol. In conclusion, our results suggest that activation of the Wnt/ß-catenin pathway during human mesenchymal stem cells differentiation into hepatocytes is associated with a tumoral phenotype.


Subject(s)
Cell Nucleus/metabolism , Hepatocytes/metabolism , Mesenchymal Stem Cells/cytology , Mesenchymal Stem Cells/metabolism , beta Catenin/metabolism , Biomarkers/metabolism , Carcinoma, Hepatocellular/metabolism , Cell Differentiation/physiology , Cell Proliferation , Down-Regulation/physiology , Gene Expression Profiling/methods , Humans , Immunophenotyping/methods , Liver Neoplasms/metabolism , Membrane Proteins/metabolism , Neoplastic Stem Cells/metabolism , Protein Transport , Spheroids, Cellular/metabolism , Tumor Suppressor Protein p53/metabolism , Up-Regulation/physiology , Wnt Proteins/metabolism , Wnt Signaling Pathway/physiology
SELECTION OF CITATIONS
SEARCH DETAIL
...