ABSTRACT
Introduction: Many noninfectious pulmonary complications occur immediately within the first few weeks after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to evaluate the efficacy of chest physical therapy (CPT) performed during the pre-transplant period in terms of spirometric values and respiratory muscle strength (RMS) in patients waiting for allo-HSCT. Material and methods: Fifty patients aged 40 to 55 years who were scheduled for allo-HSCT were randomly allocated into two equal-sized groups, a CPT group and a control group. The CPT group (n = 25) received CPT in addition to routine medical treatment, while the control group (n = 25) received routine medical treatment only. Patients in both groups received standard physical therapy during the inpatient waiting period. Interventions were conducted daily for 3 weeks before allo-HSCT. Pulmonary function (FEV1, FVC, and FEV1/FVC) was measured by spirometry, and RMS was measured by a respiratory pressure meter. A baseline assessment was done 3 weeks before allo-HSCT (T0), then at the end of treatment immediately before allo-HSCT (T1) and the last assessment at 3 weeks after allo-HSCT (T2) for all measured variables. Results: In comparing the two groups at T1 and T2, the mean spirometric values and RMS, maximal inspiratory pressure, and maximal expiratory pressure were all improved significantly in the CPT group in comparison with the control group (p < 0.05). Conclusions: Adding a 3-week CPT intervention to the pre-transplant rehabilitation program seems to be effective and safe for allo-HSCT recipients, as it improves pre-transplant pulmonary function and respiratory muscle strength and prevents their post-transplant decrease.
ABSTRACT
BACKGROUND: Advanced urothelial carcinoma (UC) is an aggressive disease whose mutagenic processes are yet to be elucidated. Targeted therapies are urgently needed, but the road from bench to bedside is slowly progressing. In this review, we discuss urothelial carcinoma etiology, along with the most recent advances in UC candidate targeted therapies. METHODOLOGY: A comprehensive database search was performed. We aimed to review the most recent updates on UC genomics and targeted therapies. Pre-clinical as well as clinical studies were included. RESULTS: Our review highlights the advances in understanding the molecular basis of urothelial tumorigenesis, including smoking, chemical parasitic carcinogens, inheritance, and APOBEC3 editing enzymes. We discussed how these factors contributed to the current mutational landscape of UC. Therapeutic options for UC are still very limited. However, several promising therapeutic approaches are in development to leverage our knowledge of molecular targets, such as targeting fibroblast growth factor receptors (FGFR), DNA damage repair pathways, and HER2. CONCLUSIONS: Blindly testing targeted therapies based on other cancer data is not sufficient. UC-specific biomarkers are needed to precisely use the appropriate drug for the appropriate population. More efforts to understand UC biology and evolution are urgently needed.
ABSTRACT
The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) was developed and validated to weigh the burden of pretransplantation comorbidities and estimate their impact on post-transplantation risks of nonrelapse mortality (NRM). Recently, the HCT-CI was augmented by the addition of both age and the values of 3 markers: ferritin, albumin, and platelet count. So far, research involving The HCT-CI has been limited almost exclusively to recipients of allogeneic hematopoietic cell transplantation (HCT) from HLA-matched grafts. To this end, we sought to investigate the discriminative capacity of an augmented comorbidity/age index among 724 recipients of allogeneic HCT from HLA-mismatched (nâ¯=â¯345), haploidentical (n = 117), and umbilical cord blood (UCB; nâ¯=â¯262) grafts between 2000 and 2013. In the overall cohort, the augmented comorbidity/age index had a higher c-statistic estimate for prediction of NRM compared with the original HCT-CI (.63 versus .59). Findings were similar for recipients of HLA-mismatched (.62 versus .59), haploidentical (.60 versus .54), or UCB grafts (.65 versus .61). Compared with patients with an HCT-CI score ≥4, those with a score <4 had a higher survival rate among recipients of HLA-mismatched (55% versus 39%; P < .0008), HLA-haploidentical (58% versus 38%; P = .01), or UCB (67% versus 48%; P = .004) grafts. Our results demonstrate the utility of the augmented comorbidity/age index as a valid prognostic tool among recipients of allogeneic HCT from alternative graft sources.
