3 research outputs found
Long-lasting responses with chemotherapy followed by T-cell therapy in recurrent or metastatic EBV-related nasopharyngeal carcinoma
BackgroundRefractory or metastatic nasopharyngeal carcinoma (NPC) patients have a poor prognosis due to the lack of effective salvage treatments and prolonged survival by means of combination chemotherapy being described only for a minority of younger patients with oligometastatic disease. Targeting the Epstein - Barr virus (EBV) proteins expressed in NPC cells has been shown to be a feasible strategy that could help control systemic disease.Patients and MethodsBetween 2011 and 2014, 16 patients with recurrent/metastatic EBV-NPC received first-line chemotherapy (CT) followed by 2 doses of autologous cytotoxic EBV specific T-lymphocytes (15-25 x 107 total cells/dose, 2 weeks apart), based on our previous studies showing the feasibility and efficacy of this infusion regimen. Cumulative overall survival (OS) and median OS were analysed in the whole population and according to specific clinical and biological parameters.ResultsAll patients received the planned T-cell therapy schedule, 9 after reaching partial (n=5) or complete (n=4) disease remission with CT, and 7 after failing to obtain benefit from chemotherapy. No severe adverse events were recorded. Patients who received cytotoxic T-lymphocytes (CTLs) had a cumulative 10-year OS of 44%, with a median OS of 60 months (95% CI 42-62). Patients responding to CT, with oligometastatic disease (<3 disease sites), and plasma EBV-DNA <1000 copies/mL had a better outcome.ConclusionsAutologous EBV-specific CTLs transplanted following conventional first-line CT demonstrated promising efficacy with several patients obtaining long-lasting disease control. The rationale provided by this study, with the crucial role likely played by the timing of CTL administration when trying to induce synergy with conventional treatment needs to be confirmed in a prospective controlled trial
VENTILATORY ASSOCIATED BAROTRAUMA IN COVID-19 PATIENTS: A MULTICENTER OBSERVATIONAL CASE CONTROL STUDY (COVI-MIX-STUDY)
Background
The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-
19 patients. The primary aim of this study was to evaluate the effect of the different respiratory
support strategies on barotrauma occurrence; we also sought to determine the frequency of
barotrauma and the clinical characteristics of the patients who experienced this complication.
Methods
This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included
COVID-19 patients who experienced barotrauma during hospital stay. They were matched with
controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and
multivariable logistic regression (OR) were performed to explore which factors were associated
with barotrauma and in-hospital death.
Results
We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of
patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive
ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of
barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation
(OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT,
did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00%
[95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed
(p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-
10.03, p<0.001).
ConclusionsC-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did
not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe
COVID-19 disease. Barotrauma was independently associated with mortality.
Trial registration: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
Keywords: COVID-19, acute respiratory failure, barotrauma, pneumothorax, High Flow Nasal
Cannula, Invasive Mechanical Ventilation