Rituximab therapy for chonic and refractory immune thrombocytopenic purpura: a long-term follow-up analysis

The aim of this study was to evaluate the long-term response to rituximab in patients with chronic and refractory immune thrombocytopenic purpura (ITP). Adults with ITP fail to respond to conventional therapies in almost 30% of cases, developing a refractory disease. Rituximab has been successfully used in these patients. We used rituximab at 375 mg/m2, IV, weekly for a total of four doses in 18 adult patients. Complete remission (CR) was considered if the platelet count was >100 × 109/l, partial remission (PR) if platelets were >50 × 109/l, minimal response (MR) if the platelet count was >30 × 109/l and <50 × 109/l, and no response if platelet count remained unchanged. Response was classified as sustained (SR) when it was stable for a minimum of 6 months. Median age was 43.5 years (range, 17 to 70). Median platelet count at baseline was 12.5 × 109/l (range, 3.0 to 26.3). CR was achieved in five patients (28%), PR in five (28%), MR in four (22%), and two patients were classified as therapeutic failures (11%). Two additional patients were lost to follow-up. The median time between rituximab therapy and response was 14 weeks (range, 4 to 32). SR was achieved in 12 patients (67%). There were no severe adverse events during rituximab therapy. During follow-up (median, 26 months; range, 12 to 59), no other immunosuppressive drugs were used. In conclusion, rituximab therapy is effective and safe in adult patients with chronic and refractory ITP. Overall response rate achieved is high, long term, and with no risk of adverse events

Edaphoclimatic descriptors of wild tomato species (Solanum Sect. Lycopersicon) and closely related species (Solanum Sect. Juglandifolia and Sect. Lycopersicoides) in South America

Wild species related to cultivated tomato are essential genetic resources in breeding programs focused on food security to face future challenges. The ecogeographic analysis allows identifying the species adaptive ranges and most relevant environmental variables explaining their patterns of actual distribution. The objective of this research was to identify the diversity, ecological descriptors, and statistical relationship of 35 edaphoclimatic variables (20 climatic, 1 geographic and 14 edaphic variables) from 4,649 accessions of 12 wild tomato species and 4 closely related species classified in Solanum sect. Lycopersicon and clustered into four phylogenetic groups, namely “Lycopersicon group” (S. pimpinellifolium, S. cheesmaniae, and S. galapagense), “Arcanum group” (S. arcanum, S. chmielewskii, and S. neorickii), “Eriopersicon group” (S. habrochaites, S. huaylasense, S. corneliomulleri, S. peruvianum, and S. chilense), “Neolycopersicon group” (S. pennellii); and two phylogenetically related groups in Solanum sect. Juglandifolia (S. juglandifolium and S. ochranthum), and section Lycopersicoides (S. lycopersicoides and S. sitiens). The relationship between the climate and edaphic variables were determined by the canonical correlation analysis, reaching 89.2% of variation with the first three canonical correlations. The most significant climatic variables were related to humidity (annual evapotranspiration, annual precipitation, and precipitation of driest month) and physicochemical soil characteristics (bulk density, pH, and base saturation percentage). In all groups, ecological descriptors and diversity patterns were consistent with previous reports. Regarding edaphoclimatic diversity, 12 climate types and 17 soil units were identified among all species. This approach has promissory applications for biodiversity conservation and uses valuable genetic resources related to a leading crop.Fil: Ramírez Ojeda, Gabriela. Universidad Autónoma Chapingo; MéxicoFil: Peralta, Iris Edith. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Provincia de Mendoza. Instituto Argentino de Investigaciones de las Zonas Áridas. Universidad Nacional de Cuyo. Instituto Argentino de Investigaciones de las Zonas Áridas; ArgentinaFil: Rodríguez Guzmán, Eduardo. Universidad de Guadalajara; MéxicoFil: Sahagún Castellanos, Jaime. Universidad Autónoma de Chapingo; MéxicoFil: Chávez Servia, José Luis. Instituto Nacional Politécnico; MéxicoFil: Medina Hinostroza, Tulio Cecilio. Gobierno del Perú. Ministerio del Ambiente; PerúFil: Rijalba Vela, Jorge Rodrigo. Universidad Pedro Ruiz Gallo; PerúFil: Vásquez Núñez, Leopoldo Pompeyo. Univeridad Pedro Ruiz Gallo; PerúFil: Rodríguez Pérez, Juan Enrique. Universidad Autónoma de Chapingo; Méxic

Debates Contemporáneos: Resistencia al Patriarca, Paz y Economías para la Vida

Este libro es producto de investigaciones realizadas desde diversos campos de conocimiento, emplazadas en lugares y tiempos distintos, teniendo como hilo conductor los debates contemporáneos acerca de los procesos de resistencia al patriarcado, la construcción de paz y de economías para la vida. En este orden de ideas, este documento reúne nueve (9) trabajos de investigación, análisis y reflexión que permiten adentrarnos en las voces de mujeres, hombres, campesinas/os, jóvenes e indígenas de diversos contextos socioculturales (Colombia y Chile). La lógica establecida para la presentación de los trabajos, derivó de las distintas escalas de análisis propuestas por las/os investigadoras/es, de tal manera que, los dos primeros capítulos dan cuenta de un análisis teórico amplio acerca del patriarcado y la naturaleza del Estado-nación, los tres capítulos siguientes incorporan el debate de la construcción de paz situada a partir de estudios de caso y los cuatro últimos escritos centran su atención en torno a las formas de despojo que agudizan los desequilibrios territoriales y amenazan entre otras cosas las economías locales para la vida.Introducción 9 Pensamiento Feminista: Pista para rastrear los caminos del patriarcado en la contemporaneidad 15 Colombia o Estado de naturaleza: 33 Estética y narrativas de guerra y paz, la comedia cinematográfica como un modo de relacionarse con la realidad 4

The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P = 0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P = 0.18), and for grades III–IV was 2.6% vs 11.6% (P = 0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P = 0.002) and extensive 5% vs 23.6% (P = 0.01). OS was 74% vs 76% for BM vs PBSCs (P = 0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P = 0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P = 0.005) respectively. In multivariate analysis, aGvHD II–IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1–5.6, P = 0.02) and aGvHD III–IV (HR 8.3 CI 3.4–20.2, Po0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patient

Ixazomib-lenalidomide-dexamethasone in routine clinical practice: Effectiveness in relapsed/refractory multiple myeloma

[Aim]: To evaluate the effectiveness and safety of ixazomib-lenalidomide-dexamethasone (IRd) in relapsed/refractory multiple myeloma in routine clinical practice. Patients & methods: Patient-level data from the global, observational INSIGHT MM and the Czech Registry of Monoclonal Gammopathies were integrated and analyzed.[Results]: At data cut-off, 263 patients from 13 countries were included. Median time from diagnosis to start of IRd was 35.8 months; median duration of follow-up was 14.8 months. Overall response rate was 73%, median progression-free survival, 21.2 months and time-to-next therapy, 33.0 months. Ixazomib/lenalidomide dose reductions were required in 17%/36% of patients; 32%/30% of patients discontinued ixazomib/lenalidomide due to adverse events.[Conclusion]: The effectiveness and safety of IRd in routine clinical practice are comparable to those reported in TOURMALINE-MM1.This work was supported by Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited

INSIGHT MM: a large, global, prospective, non-interventional, real-world study of patients with multiple myeloma

With the introduction of new drugs with different mechanisms of action, multiple myeloma (MM) patients’ outcomes have improved. However, the efficacy seen in clinical trials is often not seen in real-world settings and data on the effectiveness of MM therapies are needed. INSIGHT MM is a prospective, global, non-interventional, observational study that is enrolling approximately 4200 patients with newly diagnosed or relapsed/refractory MM, making it the largest study of its kind to date. The study aims to describe contemporary, real-world patterns of patient characteristics, clinical disease presentation, therapies chosen, clinical outcomes (response, treatment duration, time-to-next-therapy, progression-free and overall survival), safety, healthcare resource utilization and quality of life. One interim analysis has been conducted to date; current accrual is approximately 3094 patients

Rates of Influenza and Pneumococcal Vaccination and Correlation With Survival in Multiple Myeloma Patients

[Background]: Infections are a common reason for hospitalization and death in multiple myeloma (MM). Although pneumococcal vaccination (PV) and influenza vaccination (FV) are recommended for MM patients, data on vaccination status and outcomes are limited in MM.[Materials and Methods]: We utilized data from the global, prospective, observational INSIGHT MM study to analyze FV and PV rates and associated outcomes of patients with MM enrolled 2016-2019.[Results]: Of the 4307 patients enrolled, 2543 and 2500 had study-entry data on FV and PV status. Overall vaccination rates were low (FV 39.6%, PV 30.2%) and varied by region. On separate multivariable analyses of overall survival (OS) by Cox model, FV in the prior 2 years and PV in the prior 5 years impacted OS (vs. no vaccination; FV: HR, 0.73; 95% CI, 0.60-0.90; P = .003; PV: HR, 0.51; 95% CI, 0.42-0.63; P < .0001) when adjusted for age, region, performance status, disease stage, cytogenetics at diagnosis, MM symptoms, disease status, time since diagnosis, and prior transplant. Proportions of deaths due to infections were lower among vaccinated versus non-vaccinated patients (FV: 9.8% vs. 15.3%, P = .142; PV: 9.9% vs. 18.0%, P = .032). Patients with FV had generally lower health resource utilization (HRU) versus patients without FV; patients with PV had higher or similar HRU versus patients without PV.[Conclusion]: Vaccination is important in MM and should be encouraged. Vaccination status should be recorded in prospective clinical trials as it may affect survival. This trial was registered at www.clinicaltrials.gov as #NCT02761187.This study was sponsored by Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited.Peer reviewe

Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Impact of Exercise on Gut Microbiota in Obesity

Julio Plaza-Diaz is part of the “UGR Plan Propio de Investigación 2016” and the “Excellence actions: Unit of Excellence on Exercise and Health (UCEES), University of Granada”. Patricio Solis-Urra was supported by a fellowship from the National Agency for Research and Development (ANID) BECAS Chile/72180543. Julio Plaza-Diaz is supported by a fellowship awarded to postdoctoral researchers at foreign universities and research centers from the “Fundación Ramón Areces”, Madrid, Spain. Jerónimo Aragón-Vela was funded by a Postdoctoral fellowship from the ‘Fundación Alfonso Martín Escudero’ (Spain). Francisco Javier Ruiz-Ojeda is supported by a fellowship from Spanish Government “Agencia Estatal de Investigación-Juan de la Cierva-Incorporación” program (IJC2020-042739-I). We are grateful to Belén Vázquez-González for her assistance with the illustration service.Physical activity, exercise, or physical fitness are being studied as helpful nonpharmacological therapies to reduce signaling pathways related to inflammation. Studies describing changes in intestinal microbiota have stated that physical activity could increase the microbial variance and enhance the ratio of Firmicutes/Bacteroidetes, and both actions could neutralize the obesity progression and diminish body weight. The aim of this review is to provide an overview of the literature describing the relationship between physical activity profiles and gut microbiota and in obesity and some associated comorbidities. Promoting physical activity could support as a treatment to maintain the gut microbiota composition or to restore the balance toward an improvement of dysbiosis in obesity; however, these mechanisms need to be studied in more detail. The opportunity to control the microbiota by physical activity to improve health results and decrease obesity and related comorbidities is very attractive. Nevertheless, several incompletely answered questions need to be addressed before this strategy can be implemented.ANID BECAS Chile/72180543Agencia Estatal de Investigación-Juan de la Cierva-IncorporaciónNational Agency for Research and DevelopmentUniversity of GranadaFundación Alfonso Martín EscuderoFundación Ramón ArecesAgencia Estatal de Investigación IJC2020-042739-