COVID-19 vaccine failure

COVID-19 affects the population unequally with a higher impact on aged and immunosuppressed people. Hence, we assessed the effect of SARS-CoV-2 vaccination in immune compromised patients (older adults and oncohematologic patients), compared with healthy counterparts. While the acquired humoral and cellular memory did not predict subsequent infection 18 months after full immunization, spectral and computational cytometry revealed several subsets within the CD8+ T-cells, B-cells, NK cells, monocytes and CD45RA+ CCR7- Tγδ cells differentially expressed in further infected and non-infected individuals not just following immunization, but also prior to that. Of note, up to 7 subsets were found within the CD45RA+ CCR7- Tγδ population with some of them being expanded and other decreased in subsequently infected individuals. Moreover, some of these subsets also predicted COVID-induced hospitalization in oncohematologic patients. Therefore, we hereby have identified several cellular subsets that, even before vaccination, strongly related to COVID-19 vulnerability as opposed to the acquisition of cellular and/or humoral memory following vaccination with SARS-CoV2 mRNA vaccines.This study has been funded through Programa Estratégico Instituto de Biología y Genética Molecular (IBGM Junta de Castilla y León. Ref. CCVC8485), Junta de Castilla y León (Proyectos COVID 07.04.467B04.74011.0) and the European Commission – NextGenerationEU (Regulation EU 2020/2094), through CSIC's Global Health Platform (PTI Salud Global; SGL21-03-026 and SGL2021-03-038)N

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature

Objectives: To evaluate the effectiveness of low doses of radiation therapy for symptomatic splenomegaly in malignant and benign diseases. Patients and methods: 5 patients with symptomatic splenomegaly were treated with low doses of radiation in our centre (January 2008–December 2016). 4/5 patients had malignant neoplasia (acute myeloid leukemia, non Hogdkin lymphoma and prolymphocytic B cell leukemia) and splenomegaly was caused by extramedullary hematopoiesis. 1/5 patient had benign disease (HBV liver cirrhosis) and splenomegaly was caused by vascular ectasia. Median age was 73 years (range 61–86 years). There were 4 females and 1 male. These patients had exclusively splenic pain or abdominal discomfort in 20%, exclusively cytopenias 40% and both 40%. Patients needed radiation therapy for symptomatic control. Dose per fraction was 0.5 Gy every two days; total dose initially prescribed 10 Gy. IGRT were performed in all patients to ensure an appropriate position and to adapt the treatment volume to the changes in the spleen volume along the treatment. Median craneocaudal length size of the spleen was more than 26 cm (range 15.2–34.9 cm). Results: Median radiation doses were 4.85 Gy (range 2.5–10). Median craneocaudal spleen size reduction was 4.6 cm (0–8 cm). Splenic pain and abdominal disturbances improved in all patients. Median increase of haemoglobin and platelets levels was 1.6 mg/dl and 27.950 cells respectively in the first week after the end of radiotherapy. One patient had to interrupt her treatment due to grade II neutropenia. No other toxicities were described. With a median follow-up of 39 months (16–89 months), only one recurrence was described at 24 months and consisted of thrombocytopenia. The patient received a second course of radiotherapy with excellent response. Conclusion: Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels

Influencia de la desnutrición en la calidad de vida del paciente oncológico antes del inicio del tratamiento quimio/radioterápico

Introduction: The measurement of the quality of life (QL) in the oncological patient makes it possible to establish an individual’s perception of his state of health-illness and the treatment instituted. The aim of this study is to analyze the influence of nutritional status on the QL of patients. Material and Methods: A transversal study was carried out at the Ramón y Cajal Hospital in 53 oncological patients over a period of 6 months. These patients were given the global subjective assessment (VGS), a 24-hour memory of the previous day’s intake, and were given the European Organisation for Research and Treatment of Cancer quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Of these 53 patients, 9 were excluded due to incomplete completion of the EORTC QLQ C-30 questionnaire. Of the remaining 44 patients, 52.3% belonged to the group of safe normonutrids (SGA A); 27.3% to the group of patients at risk of malnutrition (SGA B) and the remaining 20,5% to the group of patients with severe malnutrition (SGA C). Results: The functional scales (physical, social, emotional and cognitive functioning) were least affected by the nutritional status of the patients, with a value of p>0.05, while the functional or role scale (p=0.002), together with the overall health scale (p=0.049), as well as the symptoms of fatigue (p=0.011), nausea and vomiting (p=0.004) and the simple item of loss of appetite (p=0.001) are those that showed a statistically significant association with nutritional status. Conclusions: Malnutrition negatively affects the QL of oncology patients especially on the functional, overall health and symptom scales. More studies are needed to assess whether early nutritional intervention can reverse this negative influence of malnutrition.Introducción: La medición de la calidad de vida (CV) en el paciente oncológico permite establecer una percepción del individuo sobre su estado de salud-enfermedad y el tratamiento instaurado. El objetivo del presente estudio es analizar la influencia de la situación nutricional en la CV de los pacientes. Material y Métodos: Se llevó a cabo un estudio transversal en el Hospital Ramón y Cajal en 53 pa-cientes oncológicos durante un periodo de 6 meses. A estos pacientes se les realizó la valoración glo-bal subjetiva (VGS), un recuerdo 24h de la ingesta del día anterior y se les administró el cuestionario European Organisation for Research and Treatment of Cancer quality of Life Questionnaire Core 30 (EORTC QLQ-C30). De estos 53 pacientes, 9 fueron excluidos debido a una incompleta cumplimentación del cuestionario EORTC QLQ C-30. De los 44 pacientes restantes, el 52,3% pertenecía al grupo de normo-nutridos sin riesgo (VGS A); el 27,3 % al grupo de pacientes en riesgo de desnutrición o desnutrición moderada (VGS B) y el 20,5% restantes al grupo de pacientes con grave desnutrición (VGS C). Resultados: Las escalas funcionales (funcionamiento físico, social, emocional y cognitivo) fueron las menos afectadas por la situación nutricional de los pacientes, con valor de p>0,05, mientras que la escala funcional o de rol (p=0,002), junto con la escala global de salud (p=0,049), así como los síntomas de fatiga (p=0,011), náuseas y vómitos (p=0,004) y el ítem simple de pérdida de apetito (p=0,001) son las que mostraron una asociación estadísticamente significativa con la situación nu-tricional. Conclusiones: La desnutrición afecta negativamente a la CV de los pacientes oncológicos especial-mente en las escalas de funcional, escala global de salud y de síntomas. Son necesarios más estu-dios para evaluar si la intervención nutricional precoz puede revertir esta influencia negativa de la desnutrición

Metformin and statins: a possible role in high-risk prostate cancer

Aim and backgroundThere is increasing evidence that statins and oral anti-diabetic drugs, such as metformin, can have a favorable role in advanced prostate cancer treatment.Metformin has been shown to inhibit proliferation of tumor cells in vitro and statins inhibit carcinogenesis by suppressing angiogenesis/invasion mechanisms. However, clinical evidence on the protective effect of these drugs is still weak.The purpose of this study is to analyze if these drugs have an impact on Biochemical-Failure-Free-Survival (BFFS) and on Distant-Failure-Free-Survival (DFFS) in localized high-risk prostate cancer.Material and MethodsFrom 2002–2016, 447 patients with histologically confirmed high-risk prostate cancer were retrospectively evaluated. All patients received radiotherapy and androgen deprivation therapy. Biochemical recurrence was determined by the Phoenix criteria and metastatic patients were defined by the presence of radiological metastasis. Survival analysis was performed using the Kaplan-Meier method.Results175 patients were treated with statins (65.3 % with a dose ≤ 20 mg/day) and 70 with metformin (75.7 % with a dose ≤ 1700 mg/day). Median follow-up was 88 months (1–194) with no differences in BFFS and DFFS between metformin and non-metformin patients (77.4 % versus 80 %, p = 0.91 and 89.4 % versus 88.7 %, p = 0.56, respectively). We did not find a statistical difference in BFFS and DFFS in patients taking higher doses of those drugs.ConclusionMetformin and statins were not associated with BFFS or DFFS improvement in our analysis. However, the small number of patients treated with these drugs limits the reliability of the results and prospective studies are needed

Agreement in the assessment of metastatic spine disease using scoring systems

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