Znaczenie allogenicznego przeszczepienia krwiotwórczych komórek macierzystych w leczeniu chorych na chłoniaki

Lymphomas are a group of neoplasms with heterogenous biological characteristics, clinicalmanifestations and sensitivity to treatment. In significant proportion of cases the disease isrecurrent and/or resistant to applied therapy, including high-dose therapy supported by autologoushematopoietic stem cell transplantation. Allogeneic hematopoietic stem cell transplantation(allo-HSCT) can potentially provide cure, through the occurrence of graft versus lymphomaeffect. It may be possible even in patients where above mentioned therapeutic methodswere ineffective. However, high transplant-related mortality after allo-HSCT in these patients, reported historically, constituted so far a major obstacle in offering this method of treatment forpatients with lymphoma. A significant improvement in the outcome and increase in the numberof allo-HSCT procedures performed in patients with lymphoma was seen over the last decade.It was mainly due to the introduction of reduced intensity conditioning regimens into clinicalpractice. The purpose of this paper is to present, based on the current literature data, indicationsand results of allo-HSCT in patients with lymphoma.Chłoniaki stanowią grupę nowotworów zróżnicowanych pod względem cech biologicznych,objawów klinicznych oraz wrażliwości na leczenie. W części przypadków choroba ma charakternawrotowy i/lub oporny na stosowaną terapię, w tym wysokodawkowaną, wspomaganą autologicznymprzeszczepieniem krwiotwórczych komórek macierzystych. Zastosowanie allogenicznegoprzeszczepienia krwiotwórczych komórek macierzystych (allo-HSCT) potencjalnie, dziękiwystępowaniu reakcji przeszczep przeciw chłoniakowi, pozwala uzyskać wyleczenie nawetw grupie chorych, u których wcześniejsze strategie terapeutyczne okazały się nieskuteczne. Jednakwysoka śmiertelność związana z samą procedurą w tej grupie chorych, raportowana historycznie,stanowiła, jak dotąd, istotną przeszkodę w oferowaniu tej metody leczenia chorym nachłoniaki. W ostatniej dekadzie obserwuje się znaczącą poprawę wyników oraz wzrost liczbyprocedur allo-HSCT wykonywanych u chorych na chłoniaki, głównie za sprawą wprowadzeniado praktyki klinicznej przygotowania o zredukowanej intensywności. Celem niniejszegoopracowania jest przedstawienie, na podstawie aktualnych danych z piśmiennictwa, propozycjiwskazań i wyników terapii chorych na chłoniaki z użyciem allo-HSCT

Fotofereza pozaustrojowa w leczeniu chorych na twardzinę układową

Fotofereza pozaustrojowa (ECP) jest formą terapii komórkowej o działaniu immunomodulującym. Polega na separacji leukocytów z krwi obwodowej, ich aktywacja za pomocą metoksalenu, a następnie naświetleniu promieniowaniem UVA i reinfuzji do krwiobiegu. Fotofereza pozaustrojowa znajduje zastosowanie w leczeniu choroby przeszczep przeciw gospodarzowi po allogenicznej transplantacji komórek krwiotwórczych oraz w leczeniu chłoniaków skórnych. Jej skuteczność opisano też jednak w odniesieniu do wielu chorób autoimmunologicznych, w tym twardziny układowej (SSc). W niniejszej pracy przedstawiono metodologię ECP, mechanizmy działania, a także doświadczenia kliniczne u chorych na SSc, obejmującetrzy prospektywne badania randomizowane oraz siedem prospektywnych lub retrospektywnych analiz bez grupy porównawczej. Wskazują one, że poprawę w zakresie zmian skórnych można uzyskać u ponad połowy chorych. Metoda cechuje się dobrą tolerancją i może stanowić opcję, zwłaszcza dla chorych bez zajęcia narządów wewnętrznych. Forum Reumatol. 2019, tom 5, nr 1: 27–3

Incidence and mortality rates in breast, corpus uteri, and ovarian cancers in Poland (1980-2013) : an analysis of population-based data in relation to socioeconomic changes

OBJECTIVES: This study aimed to analyze incidence and mortality trends in breast cancer (BC), corpus uteri cancer (CUC), and ovarian cancer (OC) in Poland in the context of sociodemographic changes. MATERIALS AND METHODS: Incidence and mortality data (1980–2013) were retrieved from the Polish National Cancer Registry, while socioeconomic data (1960–2013) were obtained from the World Bank. Age-standardized incidence and mortality rates were calculated by direct standardization, and join-point regression was performed to describe trends using the average annual percentage change (AAPC). RESULTS: A significant decrease in birth and fertility rates and a large increase in gross domestic product were observed together with a decrease in the total mortality rate among women, as well as an increase in life expectancy for women. A large, significant increase in BC incidence was observed (AAPC(1980–1990) 2.14, AAPC(1990–1996) 4.71, AAPC(1996–2013) 2.21), with a small but significant decrease in mortality after a slight increase (AAPC(1980–1994) 0.52, AAPC(1994–2013) −0.66). During the period 1980–2013, a significant increase in CUC incidence (AAPC(1980–1994) 3.7, AAPC(1994–2013) 1.93) was observed, with an initial mortality-rate reduction followed by a significant increase (AAPC(1980–2006) −1.12, AAPC(2006–2013) 3.74). After the initial increase of both OC incidence and mortality from 1994, the incidence rate decreased significantly (AAPC(1980–1994) 2.98, AAPC(1994–2013) −0.49), as did the mortality rate (AAPC(1980–1994) 0.52, AAPC(1994–2013) −0.66). CONCLUSION: After 1994, a decrease in OC incidence was found, while the incidence of BC and CUC continued to increase. A reduction in mortality rate was observed for BC and OC predominantly at the end of the study period, while for CUC, after a long decreasing mortality trend, a significant increase was observed

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status

Introduction: DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium. Material and methods: DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle. Results: Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity. Conclusions: The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium

Immunity to hepatitis A virus among working professionals in Poland - Results of a 3-year serological survey 2013-2015

Introduction Hepatitis A (HA) is caused by infection with the hepatitis A virus (HAV). The differential etiological diagnosis of acute hepatitis is based on a positive result of the serological test detecting IgM class anti-HAV. For epidemiological studies on past infection and seroprevalence of HAV in populations, the tests measuring IgG class anti-HAV or total anti-HAV are used. Since the 1990s, specific prophylaxis is possible by vaccination against HA. In Poland, vaccination is recommended and in majority is performed at own cost. Material and methods Database was obtained from electronic medical records of the 2 major private health care providers networks (Luxmed and Medicover) operating in Poland. During a 3-year period (2013–2015), 1,124 persons with unknown status of anti-HA vaccination were tested for the presence of total anti-HAV. Objective. The aim of the study was to evaluate the seroprevalence of anti-HAV among working professionals in Poland. Results Anti-HAV were detected in 603 (53.6%) persons, while 521 (46.3%) tested negative. The study group was divided into 2 subgroups: 25–44 and 45–64-years-old. For detailed statistical analysis, the presence of anti-HAV was considered as a dependent variable, and its predictors were gender, age and the year of the test performance. The presence of anti-HAV was significantly more prevalent in older age group. The lack of specific antibodies was more prevalent in younger age group. Conclusions Results of the study show increasing susceptibility to HAV infection in the younger age group, compared with the older age group of corporate professional employees in large cities in Poland. Since the epidemiological situation of HA is currently changing with increasing number of symptomatic cases of HA, it is suggested that employers might consider including an additional procedure of vaccination against HA into their private health insurance portfolio

Work Ability Index (WAI) values in a sample of the working population in Poland

Introduction: Ability to work is most often defined as a relationship between a person’s resources and requirements specific to a particular type of work. It is the result of interaction between job requirements in terms of physical and mental strain, capabilities and skills of the employee, as well as his/her health condition and own evaluation of functioning in a given organizational and social situation. Objective: The primary objective of the study was to evaluate the current value of the Work Ability Index (WAI) in a sample of employees in Poland. Material and methods: The study sample was selected purposefully from 422,000 employees covered by the largest occupational health provider in Poland. The standard WAI questionnaire provided by CAWI (Computer-Assisted Web Interview) methodology was voluntary and completed anonymously by 688 employees within 12 months (0.16% response rate). The results were statistically analyzed using the Pearson’s chi-squared test and correlation coefficient, independent-sample T test and one-way analysis of variance (p<0.05). Results: It was found that the average value of WAI was 37.5 ± 7.7, and 37% of the participants represented low to moderate ability to work. The results showed no significant correlation between the WAI value and its 7 compounds and demographic variables. Nonetheless, a dependency between WAI level and industrial branch was observed. Conclusions: Subjects with moderate and low WAI (1/3 of the study population) had particular indications to implement prophylactic actions, especially for the health care employees and civil servants, whose ability to work may be subject to accelerated deterioration