354 results on '"Ruiz-Argüelles GJ"'
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2. Protein C resistance and antiphospholipid antibodies
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Ruiz-Argüelles, GJ, primary
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- 1996
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3. Significance of one human leukocyte antigen mismatch on outcome of nonmyeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule.
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Ruiz-Argüelles, GJ, López-Martínez, B, Manzano, C, Gómez-Rangel, JD, and Lobato-Mendizábal, E
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HLA histocompatibility antigens , *STEM cell transplantation , *BONE marrow , *HOMOGRAFTS , *BLOOD diseases , *GRAFT versus host disease - Abstract
Summary:Using the Mexican approach to conduct nonablative stem cell transplantation (NST), we have prospectively performed 58 allografts in individuals with various malignant and nonmalignant hematological diseases using sibling donors, either HLA identical (6/6) or compatible, with one mismatch (5/6). When comparing allografts obtained from HLA identical (n=40) or compatible (n=18) siblings, respectively, the overall median survival was found to be 33 vs 8 months (P<0.01), the 52-month survival was 47 vs 38%(P>0.2), the prevalence of acute graft-versus-host disease (GVHD) 57 vs 38%, that of chronic GVHD 25 vs 11%and the relapse rate 45 vs 55%. The two patients who failed to engraft were both 5/6 matches. Probably stemming from the low number of patients, and despite a trend toward worse results in patients allografted from HLA compatible (5/6) siblings, most differences in outcome were not significant. It seems that NST can be offered to individuals with either an HLA identical or a compatible sibling donor.Bone Marrow Transplantation (2005) 35, 335-339. doi:10.1038/sj.bmt.1704780 Published online 10 January 2005 [ABSTRACT FROM AUTHOR]
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- 2005
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4. Acute promyelocytic leukemia can be fully treated on an outpatient basis: a single institution experience.
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García-Vélez D, Gallardo-Pérez MM, Cruz-Pérez GE, Melgar-de-la-Paz M, Hamilton-Avilés LE, Negrete-Rodríguez P, Lira-Lara O, Robles-Nasta M, Olivares-Gazca JC, Garcés-Eisele SJ, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Adult, Male, Female, Middle Aged, Young Adult, Adolescent, Ambulatory Care, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Treatment Outcome, Doxorubicin therapeutic use, Child, Tretinoin therapeutic use, Tretinoin administration & dosage, Leukemia, Promyelocytic, Acute drug therapy, Outpatients
- Abstract
The objective of this study is to explore the possibility of treating APL patients fully as outpatients. A total of 21 consecutive APL patients were identified over 30 years in the Centro de Hematología y Medicina Interna de Puebla, at Clínica Ruiz, but only 17 were studied, treated as outpatients, and followed for at least 1 month; they were observed for median of 95 months, their median age was 27 years and all were treated with ATRA, prednisone, and adriamycin as outpatients. Treatment was completed on an outpatient basis in 15/17 cases. Molecular remission was achieved in 16/17 patients. The median follow-up was 95 months (IQR 19 - 360). The median OS and LFS were not reached, and the 12-month LFS was 94%. We have confirmed that APL can be treated entirely on an outpatient basis: this observation is of utmost relevance in a resource-limited setting, such as those prevailing in low- and middle-income countries.
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- 2024
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5. More about post-transplant cyclophosphamide in haploidentical grafts: full or reduced doses?
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Gallardo-Pérez MM, Gutiérrez-Aguirre CH, Olivares-Gazca JC, and Ruiz-Argüelles GJ
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- Humans, Cyclophosphamide adverse effects, Recurrence, Transplantation Conditioning adverse effects, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Graft vs Host Disease etiology
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Haploidentical hematopoietic can be conducted on an outpatient basis but the two main reasons to accept into the hospital a patient in this setting are complications of the hematological toxicity and/or the cytokine-release syndrome. With the aim of reducing the post-transplant cyclophosphamide-dependent toxicity without compromising its effectivity, attempts to reduce the dose of post-transplant cyclophosphamide have been made: Decreases from the conventional total dose of post-transplant cyclophosphamide (100 mg/Kg) have been explored worldwide, showing that decreasing the total dose to even 50 mg/Kg significantly decreases the toxicity of the procedure without compromising its efficacy, safety and results. We present here the salient data of the attempts to diminish the doses of post-transplant cyclophosphamide which have been done and published worldwide, information that suggests that the conventional doses of post-transplant cyclophosphamide can be significantly reduced thus decreasing the toxicity, without compromising the effectiveness of the procedure, mainly the development of graft versus host disease.
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- 2024
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6. The Latin-American Experience in POEMS Syndrome: A Study of the GELAMM (Grupo de Estudio Latinoamericano de Mieloma Múltiple).
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Gallardo-Pérez MM, Negrete-Rodríguez P, Gertz MA, Peña C, Riva E, Gilli V, Rodríguez G, Samánez C, Ferreira J, Portiño S, Montaña J, León P, Gutiérrez Y, Del-Castanhel C, Seehaus C, Funes ME, Meneces-Bustillo R, Duarte P, Shanley C, Elvira G, Ochoa P, López-Vidal H, Martinez-Cordero H, Vasquez J, von-Glasenapp A, Donoso J, Viñuela JL, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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Introduction: POEMS syndrome is a rare paraneoplastic syndrome caused by an underlying plasma cell disorder. The acronym refers to the following features: polyradiculoneuropathy, organomegaly, endocrinopathy, monoclonal paraproteinemia, and skin changes., Methods: The study was conducted at 24 hematological centers across 8 Latin-American countries. The study included a total of 46 patients {median age was 52 years (interquartile range [IQR]: 42-61.5), 30 males and 16 females} fulfilling the POEMS syndrome criteria diagnosed over a period of 12 years (January 1, 2011, through July 31, 2023). Epidemiological and clinical data were collected in an ad hoc database sent to the members of GELAMM, as well as the Kolmogorov-Smirnov test and Kaplan-Meier estimates., Results: All patients had polyneuropathy and monoclonal gammopathy; 89% had bone marrow plasma cell infiltration, 33% had sclerotic bone lesions. Only 10 patients underwent vascular endothelial growth factor (VEGF) testing in plasma samples. The paraproteinemia was IgG λ in 32% and IgA λ in 30%. 59% patients presented with cutaneous changes, mainly hyperpigmentation, 54% had organomegaly, and 74% endocrinopathy. The median interval from symptom onset to diagnosis was 7.7 months (IQR: 4.0-12.6). 69% of patients received a single line of treatment. The median follow-up period was 25 months (IQR: 9.37-52.0) and the 2-year overall survival rate was 100%. All patients who underwent transplantation (43%) are alive, with a median follow-up of 45.62 months (IQR: 15.46-70)., Conclusion: This study investigates POEMS syndrome in Latin America and presents an initial overview of the disease in the region. VEGF usage is recommended for accurate diagnosis, but only 7 hematology centers in the region used it. Survival rate in Latin America is comparable with those observed internationally., (© 2024 S. Karger AG, Basel.)
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- 2024
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7. Neutrophil to lymphocyte ratio and systemic immune-inflammatory index as markers of response to autologous hematopoietic stem cell transplantation in persons with multiple sclerosis.
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Ocaña-Ramm G, Gallardo-Pérez MM, Garcés-Eisele SJ, Sánchez-Bonilla D, Robles-Nasta M, Hernández-Flores EJ, Hamilton-Avilés LE, Negrete-Rodríguez P, Melgar-de-la-Paz M, Lira-Lara O, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Female, Male, Adult, Middle Aged, Inflammation blood, Lymphocyte Count, Hematopoietic Stem Cell Transplantation, Neutrophils, Multiple Sclerosis therapy, Multiple Sclerosis blood, Transplantation, Autologous, Lymphocytes, Biomarkers blood
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Introduction: Biomarkers that help to evaluate the immune system and could be useful in multiple sclerosis (MS) are the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII). The objective of this work is to evaluate the significance of the SII index, PLR, and NLR before and after transplantation in individuals with MS who underwent autologous hematopoietic stem cell transplant (aHSCT) at a single institution., Methods: Patients with MS who received an aHSCT between 2017 and 2022 were included in the study. NLR, PLR, and SII index were calculated prior to the transplant and 100 days after, and evaluation of the expanded disability status scale (EDSS) was done before the transplant and 12 months after. The cohort was divided into two groups: aHSCT responders (R) and nonresponders (NR)., Results: Fifty-eight individuals were examined: 37 patients in the responders group R group and 21 in NR group. There was no statistically significant difference in the SII, NLR, and PLR prior to the transplant, however at 100 days post-HSCT, NLR in the R group was 1.8 versus 3.1 in the NR group (p = 0.003), PLR was 194 versus 295, respectively (p = 0.024), meanwhile SII index was 489.5 versus 729.3 (p < 0.001)., Conclusion: High NLR and SII index values after the aHSCT were associated with a worsening in the EDSS score. However, since this is the first ever study that compared NLR and SII index with the aHSCT response in persons with MS, further studies must be performed to corroborate this information., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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8. Prevalence and Consequences of a Delayed Diagnosis in Multiple Myeloma: A Single Institution Experience.
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Negrete-Rodríguez P, Gallardo-Pérez MM, Lira-Lara O, Melgar-de-la-Paz M, Hamilton-Avilés LE, Ocaña-Ramm G, Robles-Nasta M, Sánchez-Bonilla D, Olivares-Gazca JC, Mateos MV, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Male, Female, Middle Aged, Aged, Prevalence, Adult, Aged, 80 and over, Mexico epidemiology, Multiple Myeloma diagnosis, Multiple Myeloma epidemiology, Multiple Myeloma mortality, Delayed Diagnosis
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Background: Multiple myeloma (MM) is a disease with unspecific initial symptoms which may lead into a delay in the diagnosis, seemingly increasing the risk of complications and in turn reducing the overall survival (OS)., Objective: To analyze the consequences of a delayed diagnosis of MM in both the OS and the progression-free survival (PFS) of the patients in a single center in México., Methods: The study included patients with MM who were diagnosed at Clínica Ruiz, Puebla, México, between 1983 and 2022. According to the time elapsed between the onset of symptoms to the establishment of the definite diagnosis of MM, 4 groups were constructed: 1) Less than 3 months, 2) 3-6 months, 3) 6-12 months, and 4) More than 12 months., Results: About 136 patients had a complete clinical record and at least a 3-month follow up period. A delay in the diagnosis of MM (more than 3 months from the onset of symptoms) was recorded in 92/136 persons (68%). The median follow-up for the whole group was 24.7 months, median OS was 131.4 months, whereas median PFS was 85.4 months. There was a significant trend for being in earlier stages of the disease and being diagnosed within 3 months from the onset of symptoms (P = .049). Both OS and PFS were similar in the patients diagnosed before or after 3 months from the symptoms onset (P = .772). The 6-12 months group was the group with the better median both OS (197.4 months) and DFS (197.4) from the diagnosis. The median OS for the other groups were similar among them., Conclusion: A delay in the diagnosis of MM is very frequent in México (68% of cases); despite the fact that there was a significant trend for being in earlier stages of the disease and being diagnosed within 3 months from the onset of symptoms, we did not find a relationship between a delay on the diagnosis of the disease and a higher risk of complications and/or poor prognosis. Possible explanations to these findings are discussed., Competing Interests: Disclosure The authors declare that there is no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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9. D-dimer in Coronavirus 2019: An Acute Phase Reactant?
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Minutti-Zanella C, Gallardo-Pérez MM, and Ruiz-Argüelles GJ
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- Humans, Fibrin Fibrinogen Degradation Products, Biomarkers, Acute-Phase Proteins, COVID-19
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Competing Interests: None declared.
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- 2024
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10. Primary thrombophilia in Mexico XVIII: Increased rate of thrombosis in persons with the sticky platelet syndrome in the COVID-19 era.
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Melgar-de-la-Paz M, Gallardo-Pérez MM, Olivares-Gazca JC, and Ruiz-Argüelles GJ
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- 2024
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11. The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation.
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Pastelín-Martínez ML, Gallardo-Pérez MM, Gómez-de-León A, Olivares-Gazca JC, Hernández-Flores EJ, Sánchez-Bonilla D, Montes-Robles M, Robles-Nasta M, Ocaña-Ramm G, Soto-Olvera S, Gómez-Almaguer D, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Female, Male, Adult, Middle Aged, Time Factors, Mexico, Young Adult, Disability Evaluation, Treatment Outcome, Hematopoietic Stem Cell Transplantation adverse effects, Transplantation, Autologous, Delayed Diagnosis, Multiple Sclerosis therapy, Multiple Sclerosis diagnosis, Disease Progression
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Objectives: We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given autologous hematopoietic stem cell transplantation (aHSCT)., Methods: Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS)., Results: The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group., Conclusions: These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)
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- 2024
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12. Therapeutic Choices in Patients with Ph-Positive Chronic Myelogenous Leukemia In Mexico in the Era of Tyrosine Kinase Inhibitors: Stem Cell Transplantation or Tyrosine Kinase Inhibitors? Fifteen Years Later.
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Robles-Nasta M, Sánchez-Bonilla D, Gallardo-Pérez MM, Hernández-Flores EJ, Montes-Robles MA, Pastelín-Martínez ML, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Mexico, Retrospective Studies, Male, Female, Middle Aged, Adult, Young Adult, Aged, Adolescent, Survival Rate, Transplantation, Homologous, Tyrosine Kinase Inhibitors, Leukemia, Myelogenous, Chronic, BCR-ABL Positive drug therapy, Protein Kinase Inhibitors therapeutic use, Hematopoietic Stem Cell Transplantation methods
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Background: Chronic myelogenous leukemia is a neoplastic proliferation of the granulocytic series. In Mexico, chronic myelogenous leukemia accounts for approximately 10% of all leukemias. Tyrosine-kinase inhibitors are considered front-line therapy in high-income countries, whereas allogeneic hematopoietic stem cell transplantation is a recognized therapeutic approach, mainly in low- and middle-income countries., Objective: To analyze the overall survival of persons with chronic myelogenous leukemia who have received tyrosine-kinase inhibitors or allogeneic hematopoietic stem cell transplantation in a medical center, since 1994, and briefly discuss the current indications of these treatments in the tyrosine-kinase inhibitors era., Methods: We retrospectively analyzed all patients with a diagnosis of chronic myelogenous leukemia treated in a medical center between 1994 and 2023; subsets of individuals who received an allogeneic hematopoietic stem cell transplantation or tyrosine-kinase inhibitors therapy as first-line treatment were analyzed., Results: 60 persons with chronic myelogenous leukemia were treated with allogeneic hematopoietic stem cell transplantation or tyrosine-kinase inhibitors: 35 received an allogeneic hematopoietic stem cell transplantation, whereas 25 were given tyrosine-kinase inhibitors. All patients who underwent an allogeneic hematopoietic stem cell transplantation engrafted successfully, and the procedure was completed on an outpatient basis in most cases (29/35). The median survival in allogeneic hematopoietic stem cell transplantation was 78.3 months (CI 95%: 0-205.6) and in persons given tyrosine-kinase inhibitors the median was not reached., Conclusion: Tyrosine-kinase inhibitors were significantly superior to allogeneic hematopoietic stem cell transplantation in prolonging the overall survival of persons with chronic myelogenous leukemia in our single institution experience., (Copyright: © 2023 Permanyer.)
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- 2024
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13. Second Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis: A Single-Center Prospective Experience.
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Hernández-Flores EJ, Gallardo-Pérez MM, Robles-Nasta M, Montes-Robles MA, Sánchez-Bonilla D, Pastelín-Martínez ML, Ocaña-Ramm G, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Prospective Studies, Immunosuppressive Agents adverse effects, Treatment Outcome, Transplantation, Autologous methods, Multiple Sclerosis surgery, Multiple Sclerosis drug therapy, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods
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Immunosuppressive therapy is useful in persons with multiple sclerosis (MS), and autologous hematopoietic stem cell transplantation (aHSCT) is the most effective immunosuppressive treatment in this setting. Information on the usefulness of a second aHSCT in patients with MS is scarce. In a group of 1225 individuals with MS prospectively managed with aHSCT, we analyzed the salient features of 4 patients who received 2 consecutive transplants. After a moderate initial response to the first aHSCT, the patients were transplanted again after deterioration of their neurologic status; the second transplant was well tolerated and, in all instances, was completed on an outpatient basis and with no associated undesired toxicity. The autograft protocol is registered in ClinicalTrials.gov, identifier NCT02674217. After the second graft, the expanded disability status scale score stabilized in 2 patients; in 1, the post-transplant period was too short to assess the response, and in another, the development of associated Parkinson's disease precluded the assessment of the outcome. In conclusion, a second aHSCT in persons with MS is feasible, safe, and may lead to a positive response in some cases., Competing Interests: Declaration of Competing Interest All the authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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14. Impaired lung function in multiple sclerosis: a single-center observational study in 371 persons.
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Murrieta-Álvarez I, A Fernández-Gutiérrez J, A Pérez C, León-Peña AA, Reyes-Cisneros ÓA, Benítez-Salazar JM, Sánchez-Bonilla D, Olivares-Gazca JC, Fernández-Lara D, Pérez-Padilla R, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Cross-Sectional Studies, Magnetic Resonance Imaging, Vital Capacity, Lung diagnostic imaging, Multiple Sclerosis complications, Multiple Sclerosis diagnostic imaging, Multiple Sclerosis pathology, Multiple Sclerosis, Chronic Progressive
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Introduction: Abnormal lung function in people with multiple sclerosis (PwMS) could be considered as the result of muscle weakness or MS-specific structural central nervous system (CNS) abnormalities as a precipitant factor for the worsening of motor impairment or cognitive symptoms., Methods: This is a cross-sectional observational study in PwMS. Forced spirometry was conducted, and normative metrics of forced vital capacity (FVC), forced expiratory volume in the first second (FEV
1 ), and the relation FEV1/FVC were calculated. Qualitative and quantitative brain magnetic resonance imaging (MRI) examinations were carried out., Results: A total of 371 PwMS were included in the study. Of those, 196 (53%) had RRMS, 92 (25%) SPMS, and 83 (22%) PPMS. Low FVC and FEV1 was present in 16 (8%), 16 (19%), and 23 (25%) of the patients in the RRMS, PPMS, and SPMS, respectively. PwMS with T2-FLAIR lesions involving the corpus callosum (CC) had a significantly higher frequency of abnormally low FVC and FEV1 (OR 3.62; 95% CI 1.33-9.83; p = 0.012) than patients without lesions in that region. This association remained significant in the RRMS group (OR 10.1; 95% CI 1.3-67.8; p 0.031) when the model excluded PPMS and SPMS. According to our study, for every increase of 1 z score of FVC, we observed an increase of 0.25 cm3 of hippocampal volume (β 0.25; 95% CI 0.03-0.47; p 0.023) and 0.43 cm3 of left hippocampus volume (β 0.43; 95% CI 0.16-0.71; p 0.002)., Conclusions: We observed an incremental prevalence of abnormally low pulmonary function tests that parallels a sequence from more early relapsing courses to long-standing progressive courses (RRMS to PPMS or SPMS)., (© 2023. Fondazione Società Italiana di Neurologia.)- Published
- 2023
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15. SARS-CoV-2-infection in the setting of autotransplants for multiple sclerosis.
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Olivares-Gazca JC, Gale RP, Sánchez-Bonilla D, Gallardo-Pérez MM, Soto-Olvera S, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Adult, Humans, SARS-CoV-2, Autografts, Cyclophosphamide, COVID-19, Multiple Sclerosis therapy
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The severe adult respiratory syndrome virus type 2 (SARS-CoV-2) related acute respiratory distress syndrome (ARDS) has a strong immunological and inflammatory component; accordingly investigators are employing monoclonal antibodies to ameliorate the virus-induced cytokine storm such as antibodies against interleukin 6 (IL-6), tumor necrosis factors alpha (TNF-alpha) and CC chemokine receptor 5 (CCR5) (1). Cyclophosphamide (Cy) has proven its role in various settings including autoimmune diseases, and in the post-haploidentical stem cell transplant setting; Cy depletes cytotoxic and effector T cell populations while relatively sparing the regulatory T cells (Tregs) and could tip the balance away from the overtly pro-inflammatory setting (1). We present here the cases of three persons who were infected by the SARS-CoV-2 virus during the Cy-induced pancytopenia of an autologous hematopoietic stem cell transplantation (HSCT), aimed to down-regulate the immune response in multiple sclerosis (MS) (2). The surprisingly benign course of the COVID-19 in the three cases suggest that the Cy could have had a role in abrogating the inflammatory response in these persons.
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- 2023
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16. In persons with CIDP, auto-HSCT can be conducted fully on an outpatient basis and induces significant clinical responses: A prospective study in a single center.
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Montes-Robles MA, Gallardo-Pérez MM, Hernández-Flores EJ, Pastelín-Martínez ML, Sánchez-Bonilla D, Robles-Nasta M, Ocaña-Ramm G, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Prospective Studies, Outpatients, Immunosuppressive Agents therapeutic use, Polyradiculoneuropathy, Chronic Inflammatory Demyelinating drug therapy, Hematopoietic Stem Cell Transplantation methods
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Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is one of the world's most common treatable neuropathy which usually responds to immunosuppressive treatment. Autologous hematopoietic stem cell transplantation (aHSCT) is an intense way of inducing immunosuppression., Objective: We analyze the evolution of CIDP patients treated with aHSCT in our center., Methods: Between 2018 and 2023, persons with CIDP were prospectively autografted employing the "Mexican method" to conduct grafts on an outpatient basis, employing cyclophosphamide 200 mg/Kg and rituximab 1000 mg. The protocol is registered in ClinicalTrials.gov identifier NCT02674217., Results: In our center 21 autologous transplant cases were completed in 2018-2023. Seven patients provided data to assess the efficacy of the procedure. Positive responses (stabilization and/or improvement) were observed in all seven patients: Five reported improvements in the Inflammatory Neuropathy Cause and Treatment (INCAT) score and one reported stabilization. In the Inflammatory Rasch-Built Overall Disability Scale (I-RODS) score. Median INCAT score was 5 (range 1-9), whereas median I-RODS score was 24 (range 11-29). Five patients (71%) reported improvement in the INCAT score, one reported stabilization and one informed worsening; concerning the I-RODS score 5 (71%) informed improvement, whereas two reported stabilization., Conclusion: aHSCT conducted fully in an outpatient basis, employing the conditioning regimen of the "Mexican method" appears to be a feasible therapeutic option for persons with CIDP. Additional studies are needed to confirm these observations., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest. The authors declare that no patient data appear in this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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17. Can doses of post-transplantation cyclophosphamide in haploidentical stem cell allografts be reduced?
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Olivares-Gazca JC, Pastelín-Martínez ML, Montes-Robles MA, Gallardo-Pérez MM, Hernández-Flores EJ, Robles-Nasta M, Sánchez-Bonilla D, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Prospective Studies, Cyclophosphamide, Transplantation Conditioning methods, Allografts, Stem Cells, Retrospective Studies, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation
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Objectives: Allogeneic hematopoietic stem cell transplantation (HSCT) remains the most important curative modality for several hematologic malignancies, but an HLA-matched sibling or unrelated donor is not always available, particularly for ethnic minorities and multiethnic families. We have shown that Haplo-HSCT can be conducted safely on an outpatient basis, using peripheral blood stem cells; this leading into substantial decreases in the costs. Methods: In this study twenty-one patients prospectively received the conventional dose of post-transplantation cyclophosphamide (PTCy): (50 mg/Kg on days 3 and 4), whereas 10 were given reduced doses of the drug (25 mg/Kg on days 3 and 4). Results: According to the statistical analysis, the two comparative groups (PTCy 50 mg/kg vs PTCy 25 mg/kg) had no significant difference in terms of age, sex, hematological recovery, and type of conditioning regimen. The median OS for the group PTCy 50 mg/kg is 5.7 months meanwhile for the group PTCy 25 mg/kg the median is 6.4 months. The median follow up for entire group is 4.5 months (IQR: 1.1-18.9 mo). Conclusion: These results could indicate that the Cy-dependent hematological toxicity can be reduced without compromising its effectivity. This preliminary observation may be considered as an idea to conduct prospective randomized studies to explore the possibility of significantly reducing the doses of PT-Cy in the setting of Haplo-HSCT. Trial registration: ClinicalTrials.gov identifier: NCT05780554.
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- 2023
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18. Serum Electrolyte and Metabolic Changes During Conditioning of Autologous Hematopoietic Stem Cell Transplantation in Patients with Autoimmune Diseases: A Prospective Study in a Single Institution.
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Méndez-Laureano BJ, Gallardo-Pérez MM, Minutti-Zanella C, and Ruiz-Argüelles GJ
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- Adult, Aged, Humans, Middle Aged, Young Adult, Blood Glucose, Creatinine, Cyclophosphamide therapeutic use, Prospective Studies, Transplantation Conditioning methods, Transplantation, Autologous, Uric Acid, Autoimmune Diseases etiology, Hematopoietic Stem Cell Transplantation methods, Hyponatremia chemically induced
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Background and Objectives: A hematopoietic stem cell transplant (HSCT) includes a conditioning regimen which may cause unwanted metabolic changes. We analyzed the changes in electrolytes, glucose, urea, and glomerular filtration rate in patients with multiple sclerosis (MS) who underwent an autologous HSCT employing the "Mexican method.", Patients and Methods: Serum and urinary electrolytes, blood glucose, creatinine, uric acid, and estimated glomerular filtration rate (eGFR) were prospectively assessed on days -11, -9, and 0 in a group of 75 patients with MS receiving an autologous HSCT employing the "Mexican method," which includes high doses of both cyclophosphamide (Cy, 200 mg/kg) and rituximab (1000 mg)., Results: The median age of the patients was 46 years, with a range of 20-65. Baseline data were defined at day -11 of the HSCT. There were significant changes in serum and urinary electrolytes, which diminished substantially after the delivery of high-dose Cy; 12 patients (16%) developed hyponatremia and 2 had hyponatremia-induced seizures, which resulted in hospital admissions. A comparison of baseline blood metabolites with those obtained after the full Cy dosage (day 0) revealed a significant increase in blood glucose and uric acid levels with an associated decrease in serum calcium, sodium, and potassium levels. The salient findings were drug-induced hyponatremia and hyperglycemia., Conclusion: Significant changes in serum electrolytes, blood glucose, creatinine, uric acid, and estimated glomerular filtration rate (eGFR) were observed in patients given autologous HSCT for MS employing high-dose Cy. Some of these changes may have clinical consequences, mainly those derived from iatrogenic hyponatremia. No evidence of damage to renal function was observed at day 0.
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- 2023
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19. Long-term results of autografting persons with multiple sclerosis are better in those not exposed to prior disease-modifying therapies.
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Sánchez-Bonilla D, Robles-Nasta M, Gallardo-Pérez MM, Hernández-Flores EJ, Montes-Robles M, Pastelín-Martínez ML, Garcés-Eisele SJ, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
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- Humans, Transplantation, Autologous methods, Treatment Outcome, Immunosuppressive Agents therapeutic use, Multiple Sclerosis drug therapy, Hematopoietic Stem Cell Transplantation methods, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Introduction: Multiple sclerosis (MS) is a disabling disease that affects young adults. Treatments for MS have increased exponentially in number, efficacy and risk. Autologous hematopoietic stem cell transplantation (aHSCT) can change the natural history of the disease. To analyze if aHSCT should be done early in the course of the disease or after failing of other therapies, we have studied the long-term results of aHSCT in a cohort of persons with MS who were given, or not, immunosuppressive drugs before the transplant., Materials and Methods: Patients with MS referred to our center for aHSCT between June 2015 and January 2023 were prospectively entered in the study. All phenotypes of MS were included (relapsing remitting, primary progressive and secondary progressive). The follow up was assessed with the patient reported EDSS score in an online form; only patients followed by three or more years were included in the analysis. Patients were divided into two groups: Given or not disease modifying treatments (DMT) before the aHSCT., Results: 1132 subjects were prospectively enrolled. 74 patients were followed for more than 36 months, and the subsequent analysis was done in this cohort. The response rate (RR = improvement + stabilization) at 12, 24 and 36 mo was 84%, 84% and 58% respectively for patients not receiving prior DMT and 72%, 90% and 67% for patients receiving DMT. In the whole group, the EDSS score dropped from a mean of 5.5 to 4.5 at 12 mo, to 5.0 at 24 mo and to 5.5 at 36 mo, after the aHSCT. The EDSS score was on average worsening in patients before the aHSCT, but the transplant stabilized the EDSS score at 3 years in patients with prior exposure to DMT, whereas in persons not given DMT, the transplant resulted in a significant decrease (p = .01) of the EDSS score. This indicates a positive response in all patients given aHSCT, but significantly better in those not exposed to DMT before the graft., Conclusion: The response to aHSCT was better for persons not exposed to immunosuppressive DMT before the transplant, thus suggesting that aHSCT should be done early in the course of the disease and probably before the treatment with DMT. Additional studies are needed to further analyze the impact of the use of DMT therapies before the aHSCT in MS, as well as the timing of the procedure., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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20. Therapy of childhood acute lymphoblastic leukemia in resource-poor geospaces.
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Gallardo-Pérez MM, Gale RP, Reyes-Cisneros OA, Sánchez-Bonilla D, Fernández-Gutiérrez JA, Stock W, Murrieta-Álvarez I, Olivares-Gazca JC, Ruiz-Delgado GJ, Fonseca R, and Ruiz-Argüelles GJ
- Abstract
The therapy of children with acute lymphoblastic leukemia (ALL) in limited resource geospaces is challenging and must balance safety, efficacy, availability, and affordability. We modified the control arm of the St. Jude Total XI protocol for outpatient delivery including once-weekly daunorubicin and vincristine in initial therapy, postponing intrathecal chemotherapy until day 22, prophylactic oral antibiotics/antimycotics, use of generic drugs, and no central nervous system (CNS) radiation. Data were interrogated from 104 consecutive children ≤12 years (median, 6 years [interquartile range (IQR), 3, 9 years]. All therapies were given in an outpatient setting in 72 children. Median follow-up is 56 months (IQR 20, 126 months). A total of 88 children achieved a hematological complete remission. Median event-free survival (EFS) is 87 months [95% confidence interval (CI), 39, 60], 7.6 years in low-risk children (3.4, 8 years) whereas 2.5 years (1, 10 years) in high-risk children. The 5-year cumulative incidence of relapse (CIR) is 28% (18, 35%), 26% (14, 37%) in low-risk children and 35% (14, 52%) in high-risk children. Median survival for all subjects is not reached but must exceed 5 years. A total of 36 children relapsed at a median of 12 months (5, 23 months). Outcomes were comparable to those reported in the control arm of the Total Therapy XI study, but inferior to current treatment protocols in high-income countries. The average cost of the first 2 years of therapy was $28,500 USD compared with an average cost of approximately $150,000 USD in the US, an 80% saving. In conclusion, using an outpatient-based modification of the St. Jude Total XI protocol, we obtained good results with relatively few hospitalizations or adverse events and at a substantial saving. This model can be applied in other resource-poor geospaces., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gallardo-Pérez, Gale, Reyes-Cisneros, Sánchez-Bonilla, Fernández-Gutiérrez, Stock, Murrieta-Álvarez, Olivares-Gazca, Ruiz-Delgado, Fonseca and Ruiz-Argüelles.)
- Published
- 2023
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21. Letter to the Editor on "Hematopoietic cell transplants in resource-poor countries: challenges and opportunities".
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Ruiz-Argüelles GJ
- Subjects
- Humans, Health Resources, Hematopoietic Stem Cell Transplantation
- Published
- 2023
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22. Professor Peter Kubisz (1942-2022)-Un hommage à trois étincelles.
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Ruiz-Argüelles GJ
- Abstract
Competing Interests: None declared.
- Published
- 2023
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23. [Clinical research and the pharmaceutical industry].
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Mimenza-Alvarado AJ, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla A, Martínez I, Moreno M, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Sotelo J, Verástegui E, Vilar-Compte D, and Toussaint S
- Published
- 2023
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24. Cannabinoids and their therapeutic use.
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Islas-Andrade S, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza AJ, Moreno M, Reyes-Sánchez AA, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, and Verástegui E
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- Humans, Cannabinoids therapeutic use
- Published
- 2023
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25. Some reflections about physicians' updating.
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Ruiz-Argüelles GJ, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza AJ, Moreno M, Reyes-Sánchez AA, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, and Verástegui E
- Published
- 2023
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26. Conducting hematopoietic stem cell transplantation in low and middle income countries.
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Ruiz-Argüelles GJ, Seber A, and Ruiz-Delgado GJ
- Subjects
- Developing Countries, Humans, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Homologous, Biosimilar Pharmaceuticals, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation methods
- Abstract
Background: Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic procedure; costs limit its widespread use in low and middle income countries (LMIC)., Methods: Over a 30-year period, we have conducted HSCT in LMIC, making adaptations to the conventional procedures conducted in high-income countries (HIC)., Results: These salient observations stem from our practice: (1) Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma; cell freezing devices are not necessary. (2) Next, consider auto-HSCT in patients with autoimmune diseases. (3) Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conducting the HSCT on an outpatient basis is cheaper and safer. (4) Do not build HEPA-filtered rooms nor laminar flow cabins. (5) Do not graft cord blood cells nor start a cord blood blank. (6) Engage in haploidentical transplantations which are more feasible and cost-effective. (7) Matched unrelated donors are extremely expensive. (8) Use generic drugs and biosimilars. (9) Blood product irradiation devices are not necessary. (10) Do not try to reproduce other HSCT programs from HIC; develop your own methods., Conclusions: HSCT can be conducted in LMIC with reduced costs and similar efficacy, thus making this therapeutic option affordable for more persons.
- Published
- 2022
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27. Hematopoietic stem cell transplantation activity in Mexico during the COVID19 pandemic: on the way to recovery.
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León AG, Gil-Flores L, Colunga-Pedraza P, Bourlon C, Vargas-Serafín C, Del Campo-Martínez MLÁ, Olaya-Vargas A, Pérez-García M, González-Leal XJ, Herrera Rojas MA, Lozano-Rodríguez S, Solano-Genesta M, Rodríguez-Zúñiga AC, Sánchez-Arteaga A, Ruiz-Argüelles GJ, and Gómez-Almaguer D
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- Humans, Pandemics, Cross-Sectional Studies, Mexico epidemiology, COVID-19 epidemiology, Hematopoietic Stem Cell Transplantation methods
- Abstract
Objective: To analyze the number of HSCTs performed in 2019 vs. 2020 and report the status of transplant centers (TCs) during and a year after the COVID-19 pandemic., Methods: We performed a comprehensive cross-sectional nationwide study including active TCs interrogating HSCT activity from 2019 through September 2021. An electronic survey was sent to TCs and consisted of items regarding the number and characteristics of procedures performed and were compared yearly. Changes to their institutions' transplant policies and practices during the COVID19 pandemic were also documented. Fifty centers were invited to participate, 33 responded., Results: Most TCs were part of the public health system (63.7%). Almost half are in the country's capital, Mexico City (45.5%). Most centers performed <10 procedures per year. The number of HSCTs decreased from 835 in 2019-505 in 2020 ( p < .001), representing a 40% reduction in transplant activity. The monthly transplant rate in 2021 increased to 58.3, compared to 42 in 2020 and close to 69.5 in 2019 ( p < .001). All types of HSCTs decreased excluding haploidentical transplants. All institutions treated patients with COVID19, and over two-thirds experienced some form of hospital reconversion. Transplant activity stopped completely in 23 TCs (70%) during the pandemic with a median closure duration of 9.9 months (range, 1-21). In 2021, 9.1% of TCs remained closed, all of them in the public setting., Conclusion(s): The limited transplant activity in Mexico decreased significantly during the pandemic but is recovering and nearly in pre-pandemic levels.
- Published
- 2022
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28. Long-term results of the treatment of adolescents and adults with acute lymphoblastic leukemia with a pediatric-inspired regimen delivered on an outpatient basis: A single institution experience.
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García-Villaseñor E, Cortés JE, Reyes-Cisneros OA, Fernández-Gutiérrez JA, Sánchez-Bonilla D, Bojalil-Álvarez L, Murrieta-Álvarez I, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Antineoplastic Combined Chemotherapy Protocols adverse effects, Cyclophosphamide, Cytarabine, Daunorubicin, Doxorubicin therapeutic use, Etoposide therapeutic use, Humans, Mercaptopurine, Methotrexate therapeutic use, Outpatients, Prednisone, Vincristine therapeutic use, Asparaginase, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy
- Abstract
The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem to be related with better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude´s TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80 % of patients were able to receive the initial seven-week period of induction / consolidation fully as outpatients and 77 % achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48 %. In adults, the median probability of OS was 24 months, and the 5-year OS was 32 %. Patients with T-cell ALL did significantly worse than those with a B cell phenotype (OS at 5 years 17 versus 40 %, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD. We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
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29. Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia.
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Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Abstract
Introduction: We have previously shown that some patients present thrombocytopenia (less than 100 × 10
9 /L platelets) in non-alcoholic fatty liver disease (NAFLD). To further explore the nature of this association, we have now analyzed the association of thrombocytopenia with neutropenia (less than 0.5 × 109 /L granulocytes) in NAFLD., Material and Methods: Persons with NAFLD were prospectively accrued in the study after February 2018. The presence of NAFLD was defined by both serologic determinations (Fibromax ®) and liver transient elastography (TE/Fibroscan ®)., Results: In 123 consecutive patients with NAFLD without cirrhosis, thrombocytopenia was identified in 20 (16%), whereas neutropenia was identified in 9 (7%). In the subset of 20 patients with NAFLD and thrombocytopenia, granulocytopenia was identified in 5 (25%), whereas in the subset of 9 patients with granulocytopenia, thrombocytopenia was identified in 5 (55%). We found a significant association between thrombocytopenia and both leukopenia and granulocytopenia (OR 8.25, 95% CI 1.9-34.2, p = 0.004)., Conclusions: Both thrombocytopenia and neutropenia were identified in persons with NAFLD and, as there is a significant relationship between these two variables, we speculate that this finding may support the possibility of hypersplenism being involved in the cytopenias found in NAFLD without cirrhosis., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest., (Copyright © 2021 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2022
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30. SARS-CoV-2 vaccination patterns in a private hematology and internal medicine outpatient clinic.
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García-Villaseñor E, Bojalil-Álvarez L, Reyes-Cisneros OA, Fernández-Gutiérrez JA, Sánchez-Bonilla D, Robles-Nasta M, Gallardo-Pérez MM, Murrieta-Álvarez I, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Ambulatory Care Facilities, COVID-19 Vaccines, Cross-Sectional Studies, Humans, SARS-CoV-2, Vaccination, COVID-19, Hematology
- Abstract
Objective: Determine the proportion of vaccinated patients in a private hematology and internal medicine outpatient clinic and potential factors in adherence in at-risk patients (due to onco-hematological diseases)., Materials and Methods: This is a cross-sectional study of outpatients from a private clinic. We applied a non-validated instrument to all patients attending the outpatient clinic from May to October 2021. According to the primary diagnosis, we classified patients into onco-hematological and non-onco-hematological patients. Since national authorities exclusively executed and planned the rollout of vaccines, the order and eligibility defined by authorities of vaccination was considered when conducting the analysis and patients were classified according to the their corresponding group., Results: 397 participants were accrued, 269 (68%) had an onco-hematological condition. In the whole group, 73 (18.3%) had a history of infection. Vaccination history was present in 286 persons (72%); 82% had two doses. In the subset of 269 persons with an onco-hematological condition, 191 (71%) were vaccinated, whereas 95 participants with non-hematological conditions (73%) had received the vaccine. Vaccination status was associated with age (OR 1.07, 95%CI: 1.03,1.10, p<0.0001) and body mass index (OR 1.11, 95%CI: 1.04,1.17, p<0.0001)., Conclusions: According to our study, vaccination adherence at our center is significantly different from the nationwide proportion of vaccines.
- Published
- 2022
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31. Primary Thrombophilia XVII: A Narrative Review of Sticky Platelet Syndrome in México.
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Minutti-Zanella C, Villarreal-Martínez L, and Ruiz-Argüelles GJ
- Abstract
Sticky Platelet Syndrome (SPS) is a disorder characterized by platelet hyperaggregability, diagnosed by studying in vitro platelet aggregation with ADP and epinephrine. It is the second most common cause of thrombophilia in Mexican Mestizos and manifests as an autosomal dominant trait which, combined with other coagulopathies, contributes significantly to the morbidity and mortality of patients with primary thrombophilia. It is easily treatable with antiplatelet drugs; however, the methods for diagnosis are not readily available in all clinical laboratories and the disorder is often overlooked by most clinicians. Herein, we present the results of more than 20 years of Mexican experience with the study of SPS in a Mestizo population.
- Published
- 2022
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32. Long term survival in multiple myeloma: a single institution experience in underprivileged circumstances.
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Bojalil-Alvarez L, Gertz MA, Garcia-Villaseñor E, Fernández-Gutiérrez JA, Reyes-Cisneros OA, Murrieta-Alvarez I, Cantero-Fortiz Y, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Cohort Studies, Disease-Free Survival, Humans, Prognosis, Retrospective Studies, Transplantation, Autologous, Treatment Outcome, Hematopoietic Stem Cell Transplantation, Multiple Myeloma drug therapy, Multiple Myeloma therapy
- Abstract
There is data suggesting that the clinical behavior of multiple myeloma (MM) may be different in Latin Americans than in Caucasian or African-Americans, consistent with a less aggressive course of MM in Latinos. We analyzed the overall survival (OS) of 139 persons with MM in a single institution in México, as well the variables which were associated with long-term OS. Of all patients, the median OS was 11 years whereas the 5-year and 10-year OS were 75% and 55% respectively. The analysis of variables showed that the variable related with five-year survival was having hematopoietic stem cell transplantation (HSCT), whereas the variables related with 10-year survival were HSCT, age at diagnosis (patients younger than 50 survived longer), light chain type (kappa survived longer) and ISS stage (stage I patients survived longer). The only variable associated with both 5 and 10-year survival was HSCT. A plateau in the OS was reached after 10 years, both in grafted and non-grafted patients. We have confirmed the critical role of HSCT in the prognosis of persons with MM, independent of the induction treatment or the maintenance post-transplant, and we have identified a better prognosis in this cohort, as compared with African-Americans or Caucasians, since the proportion of long-term survivors in our group is seemingly better than those in other populations.
- Published
- 2022
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33. Démonstration de Faisabilité: Nonalcoholic Fatty Liver Disease May Cause Thrombocytopenia.
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Ruiz-Argüelles GJ
- Subjects
- Humans, Liver, Non-alcoholic Fatty Liver Disease complications, Thrombocytopenia diagnosis, Thrombocytopenia etiology
- Abstract
Competing Interests: None declared.
- Published
- 2022
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34. Splitting the Total Dose of Cyclophosphamide in Two Blocks Apart during the Conditioning of Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Results in Diminished Cardiotoxicity: Experience in 1,000 Patients.
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Olivares-Gazca JC, Guerrero-Pesqueira F, Murrieta-Alvarez I, Cantero-Fortiz Y, León-Peña AA, Priesca-Marín JM, Gomez-Almaguer D, Gomez-De-Leon A, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Cyclophosphamide adverse effects, Humans, Transplantation, Autologous, Hematopoietic Stem Cell Transplantation methods, Multiple Sclerosis drug therapy
- Published
- 2022
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35. Who judges medical practice?
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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, and Sotelo J
- Subjects
- Humans, Physician-Patient Relations, Malpractice
- Abstract
Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship., (Copyright: © 2022 Permanyer.)
- Published
- 2022
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36. Families of doctors at Academia Nacional de Medicina de México.
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Marín-López A, García-Villaseñor E, Bojalil-Álvarez L, Murrieta-Álvarez I, Cantero-Fortiz Y, Viesca-Treviño CA, Sánchez-Anzaldo FJ, and Ruiz-Argüelles GJ
- Subjects
- Cross-Sectional Studies, Humans, Mexico, Academies and Institutes, Physicians
- Abstract
Introduction: The decision to get involved in the study and practice of medicine is not easy. Within the scientific environment, achieving both professional and personal success requires a strict discipline, where effort becomes an essential part of daily life; in addition, having family support becomes crucial in order for not to lose hope when confronting the different adversities that arise during medical training., Objective: To identify families where at least two members belong to the Academia Nacional de Medicina de México (ANMM)., Methods: A cross-sectional study was carried out to identify families of Mexican doctors where at least two members, consanguineous or in-laws, have been or are ANMM members through a review of 2017 ANMM Directory and personal contact with the different academics., Results: Information on 45 families belonging to the ANMM was collected., Conclusions: From this study, it is possible to show the great influence that some doctors have in their family environment, which makes the study of medicine attractive as a life project., (Copyright: © 2022 Permanyer.)
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- 2022
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37. Role of individual physicians in pharmacovigilance.
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Lifshitz A, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo-Morales J, Toussaint S, Vilar-Compte D, and Verástegui E
- Subjects
- Humans, Pharmacovigilance, Health Knowledge, Attitudes, Practice, Physicians, Drug-Related Side Effects and Adverse Reactions
- Published
- 2022
- Full Text
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38. Moral Distress: Its Manifestations in Healthy Donors during Peripheral Blood Hematopoietic Stem Cell Harvesting.
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Gutiérrez-Aguirre CH, Jaime-Pérez JC, de la Garza-Salazar F, Guerrero-González G, Guzmán-López A, Ruiz-Argüelles GJ, Gómez-Almaguer D, and Cantú-Rodríguez OG
- Subjects
- Adult, Hematopoietic Stem Cells, Humans, Male, Morals, Transplantation, Homologous, Hematopoietic Stem Cell Mobilization, Tissue Donors
- Abstract
Hematopoietic stem cell donors (HSCDs) may have ambivalent feelings about donation. These feelings are related to moral obligation to help a sick relative and/or fear about the donation procedure. This ambivalence can produce moral distress (MD) and anxiety, which are usually unnoticed by the treating physician. The aim of this study was to evaluate the incidence of MD and anxiety in a group of related HSCDs for allogeneic transplantation. In this prospective observational study, to assess MD and anxiety, we applied 3 self-answered questionnaires-a questionnaire developed to assess MD (MDQ), State Trait Anxiety Index (STAI), and Edmonton Symptom Assessment System (ESAS)-before, during, and after hematopoietic stem cell donation. A total of 60 consecutive related HSCDs with a mean age of 38.2 years were included. Thirty-six were male. Hematopoietic stem cell collections were done by apheresis, performed as an outpatient process in all cases. The incidence of MD during the donation process was 56%. The proportion of HSCDs with moderate to high state anxiety decreased significantly from before donation (63%) to after donation (30%). Higher scores for MD correlated with higher scores on the STAI questionnaire (r = 0.448; P < .005). Thirty-seven donors (62%) had at least 1 physical symptom even before the stem cell mobilization process started, mainly anxiety (33%), difficulty sleeping (33%), and fatigue (30%). The number of symptomatic donors increased during donation (100%) and decreased after the procedure (80%). We conclude that MD and anxiety symptoms experienced by HSCDs are very common and can be explained by mixed feelings about the donation process. Providing comprehensive psychological support before starting the donation process and guaranteeing respect for the donor's autonomy are needed to decrease the negative impact of the donation experience., (Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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39. Long-term results of the treatment of Hodgkin's lymphoma in a resource-constrained setting: Real-world data from a single center.
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Sánchez-Valledor LF, Habermann TM, Murrieta-Alvarez I, Córdova-Ramírez AC, Rivera-Álvarez M, León-Peña A, Cantero-Fortiz Y, Olivares-Gazca JC, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Abstract
Background: The outcomes of Hodgkin´s lymphoma (HL) in México have not been widely reported. Simplified and affordable treatments have been adopted in middle-income countries., Aim: The aim was to evaluate long-used therapies for HL in México in a long-term basis., Methods: In a 34-year time period, 88 patients with HL were treated at a single institution in México. Patients were treated with adriamycin bleomycin vinblastine and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone (MOPP). Relapsed or refractory patients were given ifosfamide, carboplatin, and etoposide (ICE) followed by autologous or allogeneic stem cell transplants., Results: Thirty-seven women and 51 men were included; the median age was 29 years. Patients were followed for a mean of 128 mo. The 310-mo overall survival (OS) was 83% for patients treated with MOPP and 88% for those treated with ABVD. The OS of patients who received autologous stem cell transplantation was 76% (330 mo) vs 93% (402 mo) in those who did not., Conclusion: HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, regardless of clinical stage., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflicting interests., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2021
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40. Prescription Patterns of Daratumumab in Patients with Multiple Myeloma in Underprivileged Circumstances: A Multicenter Experience in Mexico.
- Author
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Vela-Ojeda J, Gómez-Almaguer D, Espinoza-Zamora R, Ramírez-Alvarado AG, Villalobos A, Herrera-Rojas MA, Alvarado-Ibarra M, Pérez-Ramírez OJ, Sandoval-Villa CC, Loarca-Piña LM, Ceballos-López AA, Rivas-Lamas JR, García-Castillo C, and Ruiz-Argüelles GJ
- Subjects
- Antibodies, Monoclonal, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Humans, Mexico, Prescriptions, Multiple Myeloma drug therapy
- Abstract
Background: Despite novel therapies, multiple myeloma (MM) remains an incurable malignancy, daratumumab (DARA) being a major game changer, may be a good option for treatment., Aimed of the Study: To assess the prescription patterns of DARA in patients with MM in Mexico., Methods: 47 patients with MM were analyzed in 13 different hospitals in Mexico., Results: Five (10.5%) of patients received DARA as first line therapy, 13 (27.5%) as second line, whereas 29 (62%) received its in ≥3
rd line. In 32% DARA was used in combination with dexamethasone, 64% received DARA on a triple combination, and 4% as a 4 drug combination. Eighty three percent of patients had a response, including 32% in complete remission. Progression free survival (PFS) was higher in patients in ISS stage 1, and in patients achieving ≥PR. Overall survival (OS) was lower in patients not achieving ≥PR, in patients having increased LDH, and extramedullary disease. Grade 1-2 infusion related reactions were present in 34%, and grade 3-4 neutropenia and lymphopenia in 25 and 17% of the patients., Conclusions: In Mexico, 62% of patients with MM received DARA as a third or further line of treatment. DARA employed as a doublet or triplet combination is useful in relapsed/refractory patients with tolerable adverse events., (Copyright © 2021. Published by Elsevier Inc.)- Published
- 2021
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41. Bien plus Encore: Haplos Indeed Can be Completed on an Outpatient Basis.
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Murrieta-Álvarez I and Ruiz-Argüelles GJ
- Subjects
- Humans, Outpatients
- Published
- 2021
- Full Text
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42. Genetic variants associated with methotrexate-induced mucositis in cancer treatment: A systematic review and meta-analysis.
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Maagdenberg H, Oosterom N, Zanen J, Gemmati D, Windsor RE, Heil SG, Esperón P, Jabeen S, Ruiz-Argüelles GJ, Zolk O, Hoerning S, Sleurs C, Lopéz-Lopéz E, Moreno-Galván M, van den Heuvel-Eibrink MM, Maitland-van der Zee AH, and Carleton BC
- Subjects
- Antimetabolites, Antineoplastic adverse effects, Humans, Methotrexate adverse effects, Methylenetetrahydrofolate Reductase (NADPH2) genetics, Polymorphism, Single Nucleotide, Mucositis chemically induced, Mucositis genetics, Neoplasms drug therapy, Neoplasms genetics
- Abstract
Methotrexate (MTX), an important chemotherapeutic agent, is often accompanied with mucositis. The occurrence and severity are unpredictable and show large interindividual variability. In this study, we review and meta-analyze previously studied genetic variants in relation to MTX-induced mucositis. We conducted a systematic search in Medline and Embase. We included genetic association studies of MTX-induced mucositis in cancer patients. A meta-analysis was conducted for single nucleotide polymorphisms (SNPs) for which at least two studies found a statistically significant association. A total of 34 SNPs were associated with mucositis in at least one study of the 57 included studies. Two of the seven SNPs included in our meta-analysis were statistically significantly associated with mucositis: MTHFR c.677C > T (recessive, grade ≥3 vs grade 0-2, OR 2.53, 95 %CI [1.48-4.32], False Discovery Rate[FDR]-corrected p-value 0.011) and MTRR c.66A > G (overdominant, grade ≥1 vs grade 0, OR 2.08, 95 %CI [1.16-3.73], FDR-corrected p-value 0.042)., (Copyright © 2021 Elsevier B.V. All rights reserved.)
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- 2021
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43. The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge.
- Author
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Murrieta-Álvarez I, Cantero-Fortiz Y, León-Peña AA, Olivares-Gazca JC, Priesca-Marín JM, Ruiz-Delgado GJ, Gómez-De-León A, Gonzalez-Lopez EE, Jaime-Pérez JC, Gómez-Almaguer D, and Ruiz-Argüelles GJ
- Abstract
After gaining experience conducting both auto and allografts in persons with hematological diseases in the HSCT programs in Puebla and Monterrey, México, this study outlines subsequent program autografting patients with autoimmune conditions. The first transplant in multiple sclerosis was conducted in Puebla on July 5, 2006. From 2015 we increased activity autografting persons with autoimmune conditions in the two campuses of the HSCT-México program: Puebla and Monterrey. By December 6, 2020, patient number 1,000 in the program was autografted. In our experience, a significant reduction in the expanded disability status scale score was achieved in all of the three phenotypes of the disease (from a median of 5.1 to 4.5 points), whereas the response rate (defined as a decrease of at least 0.5 of EDSS score regardless of baseline EDSS, or unchanged EDSS) was 83, 78, and 73% after 12 months in the relapsing-remitting, primary-progressive and secondary-progressive forms of multiple sclerosis, respectively. In addition to analyzing the viability, safety, and efficacy of our method, this study contributes new knowledge to the field of both stem cell transplantation and multiple sclerosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Murrieta-Álvarez, Cantero-Fortiz, León-Peña, Olivares-Gazca, Priesca-Marín, Ruiz-Delgado, Gómez-De-León, Gonzalez-Lopez, Jaime-Pérez, Gómez-Almaguer and Ruiz-Argüelles.)
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- 2021
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44. Lessons Learned Treating Patients with Multiple Myeloma in Resource-Constrained Settings.
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Ruiz-Argüelles GJ and Gómez-Almaguer D
- Subjects
- Antineoplastic Agents economics, Antineoplastic Agents therapeutic use, Bortezomib economics, Bortezomib therapeutic use, Developing Countries, Dexamethasone economics, Dexamethasone therapeutic use, Humans, Immunosuppressive Agents economics, Immunosuppressive Agents therapeutic use, Multiple Myeloma diagnosis, Multiple Myeloma economics, Poverty, Stem Cell Transplantation economics, Thalidomide economics, Thalidomide therapeutic use, Multiple Myeloma therapy
- Abstract
Purpose of Review: Based on personal experiences, recommendations for physicians treating patients with multiple myeloma (MM) in low- and middle-income countries (LMICs) are proposed., Recommendations: (1) Implement strategies to keep the patient in the best possible condition for the longest time, in addition to focusing on ways to avoid financial toxicity; (2) if lenalidomide is unavailable, start treatment with thalidomide and dexamethasone, include, if possible, bortezomib; (3) conduct an outpatient-based autologous stem cell transplantation (ASCT) in all eligible patients; (4) use thalidomide as post-ASCT maintenance treatment if lenalidomide is unavailable for the standard risk patients; (5) monitor monoclonal proteins with serum protein electrophoresis and free light chain measurements; (6) employ novel drugs in cases of relapsed or refractory disease; and (7) do not forget supportive therapy. The therapeutic recommendations to treat patients with MM are somewhat different for physicians working in LMICs, compared with those treating patients in high-income countries. These are relevant since more than 50% of the inhabitants of the world live in LMICs, thus indicating that the vast majority of patients with MM are being treated in resource-constrained settings. As time goes by, physicians may acquire the ability to analyze and express their feelings and experiences about topics in the practice of medicine in which they could have learned lessons (1). Since 1980, we have been treating patients with multiple myeloma (MM); to date, we have been personally involved in the study and treatment of more than 300 patients with this disease (2). Having gained experience dealing with MM patients in underprivileged circumstances, such as those prevailing in our country: México, having explored different ideas, treatments, and methods, and being aware of the financial implications which may impact our selection of therapeutic strategies and recommendations, we felt that it was appropriate to share in this article some of these ideas with practitioners around the world who are involved in the treatment of patients with MM in low- and middle-income countries (LMICs).
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- 2021
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45. PERSPECTIVES IN DIAGNOSIS AND THERAPEUTICS IN HEMATOLOGY.
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Ruiz-Argüelles GJ and Gómez-Almaguer D
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- Humans, Anemia diagnosis, Anemia therapy, Blood Coagulation Disorders diagnosis, Blood Coagulation Disorders therapy, Hematology, Leukemia diagnosis, Leukemia therapy, Multiple Myeloma diagnosis, Multiple Myeloma therapy
- Abstract
In this article, the perspectives on both the diagnosis and treatment of acute leukemias, chronic leukemias, multiple myeloma, anemia, platelet, and coagulation disorders are briefly discussed. We emphasize the limitations facing the practice of hematology in low- and middle-income countries., (Copyright: © 2021 Permanyer.)
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- 2021
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46. Primary Thrombophilia XVI: A Look at the Genotype of the Sticky Platelet Syndrome Phenotype.
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García-Villaseñor E, Bojalil-Álvarez L, Murrieta-Álvarez I, Cantero-Fortiz Y, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Animals, Genotype, Humans, Mice, Phenotype, Syndrome, Thrombophilia pathology, Blood Platelet Disorders genetics, Platelet Aggregation genetics, Thrombophilia etiology
- Abstract
The sticky platelet syndrome (SPS) was described by Mammen in 1983. Since then, scientists in several countries have identified the condition and published cases or series of patients, thus enabling the description of the prevalence of the inherited condition, its salient clinical features, and the treatment of the disease. The diagnosis of the SPS phenotype requires fresh blood samples and special equipment which is not available in all coagulation laboratories. In the era of molecular biology, up to now it has not been possible to define a clear association of the SPS phenotype with a specific molecular marker. Some molecular changes which have been described in platelet proteins in some persons with the phenotype of the SPS are here discussed. Nowadays, the SPS phenotype may be considered as a risk factor for thrombosis and most cases of the SPS developing vaso-occlussive episodes are the result of its coexistence with other thrombosis-prone conditions, some of the inherited and some of them acquired, thus leading to the concept of multifactorial thrombophilia. Ignoring all these evidence-based concepts is inappropriate, same as stating that the SPS is a nonentity simply because not all laboratories are endowed with adequate equipment to support the diagnosis.
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- 2021
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47. IF WE HAVE SEEN FURTHER, IT IS BY STANDING ON THE SHOULDERS OF GIANTS.
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Ruiz-Argüelles GJ, Gómez-Almaguer D, Ruiz-Delgado GJ, Gómez-De-León A, and Murrieta-Álvarez I
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- 2021
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48. Different outcomes for transplant-eligible newly diagnosed multiple myeloma patients in Latin America according to the public versus private management: a GELAMM study.
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Peña C, Riva E, Schutz N, Tarín-Arzaga L, Martínez-Cordero H, Bove V, Osorio R, Chandía M, Beltrán C, Schulz J, Cardemil D, Contreras C, Vergara CG, Donoso J, Espinoza M, La Rocca G, López-Vidal H, León P, Rojas Hopkins C, Soto P, Aranda S, Torres V, Roa M, Ochoa P, Duarte PJ, Remaggi G, Yantorno S, Corzo A, Zabaljauregui S, Shanley C, Lopresti S, Orlando S, Verri V, Quiroga L, García C, Fernández V, Ramirez J, Molina A, Pacheco M, Mite A, Reyes I, Sabando B, Ramírez F, Sossa C, Abello V, Idrobo H, Galvez Cardenas KM, Saavedra D, Quintero G, Gazitúa R, Gaviria L, Gomez R, Osuna M, Henao-Uribe A, Cantú-Martínez O, Gómez-Almaguer D, García-Navarrete YI, Cruz-Mora A, Cantero-Fortiz Y, Ruiz-Argüelles GJ, and Fantl D
- Subjects
- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Humans, Latin America epidemiology, Transplantation, Autologous, Treatment Outcome, Hematopoietic Stem Cell Transplantation, Multiple Myeloma diagnosis, Multiple Myeloma epidemiology, Multiple Myeloma therapy
- Abstract
The aim of this study was to describe clinical and survival characteristics of transplant-eligible multiple myeloma (MM) patients in Latin America (LA), with a special focus on differences between public and private healthcare facilities. We included 1293 patients diagnosed between 2010 and 2018. A great disparity in outcomes and survival between both groups was observed. Late diagnosis and low access to adequate frontline therapy and ASCT in public institutions probably explain these differences. Patients treated with novel drug induction protocols, followed by autologous stem cell transplantation (ASCT) and maintenance, have similar overall survival compared to that published internationally.
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- 2020
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49. Mélange intéressante : COVID-19, autologous transplants and multiple sclerosis.
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Olivares Gazca JC, Gómez Almaguer D, Gale RP, and Ruiz Argüelles GJ
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- Adult, Betacoronavirus immunology, COVID-19, Coronavirus Infections complications, Coronavirus Infections transmission, Coronavirus Infections virology, Cough diagnosis, Cough physiopathology, Cough virology, Cyclophosphamide therapeutic use, Dyspnea diagnosis, Dyspnea physiopathology, Dyspnea virology, Female, Fever diagnosis, Fever physiopathology, Fever virology, Headache diagnosis, Headache physiopathology, Headache virology, Humans, Male, Mexico, Middle Aged, Multiple Sclerosis complications, Multiple Sclerosis immunology, Multiple Sclerosis virology, Myeloablative Agonists therapeutic use, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral transmission, Pneumonia, Viral virology, Risk, Rituximab therapeutic use, SARS-CoV-2, Transplantation Conditioning methods, Transplantation, Autologous, Betacoronavirus pathogenicity, Coronavirus Infections immunology, Hematopoietic Stem Cell Transplantation, Multiple Sclerosis therapy, Pneumonia, Viral immunology
- Published
- 2020
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50. Up to half of patients diagnosed with chronic lymphocytic leukemia in México may not require treatment.
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Cruz-Mora A, Murrieta-Alvarez I, Olivares-Gazca JC, León-Peña A, Cantero-Fortiz Y, García-Navarrete YI, Sánchez-Valledor LF, Khalaf D, Ruiz-Delgado GJ, and Ruiz-Argüelles GJ
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Mexico, Middle Aged, Young Adult, Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
- Abstract
Introduction: Although therapeutic choices for patients with chronic lymphocytic leukemia (CLL) were once limited, treatment of this disease has vastly improved in the last decades. Patients and methods: Consecutive CLL patients diagnosed in a single institution were analyzed. Treatment was withheld in persons with CLL Rai stage 0 or 1, until progression and in persons with stages 2-4, with a negative expression of ZAP-70 until progression. Between 1983 and 1991, patients were give chlorambucil and prednisone (CP); after 1991 fludarabine and cyclophosphamide (FC) and after 1998, rituximab and FC (FCR). Results: 98 patients with CLL were identified; 49 were followed for >3 months. 21 persons (43%) did not require treatment nor progressed; 14 received CP, 6 FC, 7 FCR and one rituximab. Median overall survival (OS) has not been reached, being above 247 months; median OS for patients given CP was 115 months, for FC above 132 months and for FCR above 136 months ( p > 0.5). Conclusion: CLL seems to be less aggressive in Mexican mestizos than in Caucasians; 43% of patients do not need treatment at all.
- Published
- 2020
- Full Text
- View/download PDF
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