This is very important statement from ASBMT (THE AMERICAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION) – which considers AHSCT a standard of care in Multiple Sclerosis. This is pivotal statement in the care of MS as for the first time AHSCT is acknowledged not as clinical option but as a proven standard.
“Review of recent literature identified eight retrospective studies, eight clinical trials, and three meta-analyses/systematic reviews. In aggregate, these studies indicate that AHCT is an efficacious and safe treatment for active relapsing forms of MS to prevent
clinical relapses, MRI lesion activity, and disability worsening, and to reverse disability, without unexpected adverse events. Based on the available evidence, the ASBMT recommends that treatment-refractory relapsing MS with high risk of future disability be considered a “standard of care, clinical evidence available” indication for AHCT.”
Opublikowałem dwa nowe wykłady dla lekarzy:
2019 02 Przeszczepianie szpiku w chorobach z autoagresji 2019 HSCT in AD – wykład na kursie specjalizacyjnym
2019 02 Odmiany transplantacji i techniki przeszczepiania 2019 Odmiany transplantacji i technika przeszczepiania – wykład na kursie specjalizacyjnym
After few decades of knowledge supported by many one-arm, non-randomised, one-center trials. Finally the randomised trial showing that AHSCT in better in MS than DMDs. Full text here: https://www.ncbi.nlm.nih.gov/pubmed/30644983
Great news for older patients (over 60) with AML – there is a new combination drug that improves the chances of cure and survival. The long term survival is almost twice as good as the survial after the standard chemotherapy. The full publication can be found in JCO: https://www.ncbi.nlm.nih.gov/pubmed/30024784
FDA Approval Summary: https://www.ncbi.nlm.nih.gov/pubmed/30541745
Many times I have been asked this question – and what if alternative medicine does work against cancer and we (the medical establishment) just block the results from surfacing? We do not. This study published in JAMA last year shows that refusing chemotherapy (or other forms of cancer treatment) and using alternative medicine does lead to lower chances of survival. On the other hand if you stick to chemotherapy (or any other cancer treatment) prescribed by oncologist and additionaly use alternative medicine – it does not influence the survival. So the conclusion is simple – alternative medicine generally does not work in cancer, and refusing standard treatments leads to increase in mortality.
Reference: JAMA https://jamanetwork.com/journals/jamaoncology/fullarticle/2687972
Problem based learning bases on solving defined problems found in trigger material. I thought about a way of simple implementation this strategy of learning into clinical practice of teaching my students. As patients are different every time I thought how I can approach the class so the students get the problems to solve which are always relevant to the patients they meet. They are used to the same scheme of asking about first symptoms, then treatment. The approach I proposed to the last batch of medical students this year is PATIENT PROBLEM BASED LEARNING. What is the difference? Each of the students is asked to find problems that the patient faces in different areas of life – medical, drugs and their side effects, psychological, financial, family, access to medical care and other. The problems are not predefined – but rather base on real life issues relevant to the patient. Actually for the first patient we use approach where students set the fields for problem searching – so they chose what they will look for. The students filled questionnaires and were to provide solutions – the ones that patients developed and the ones that they would suggest for the patient. For the teaching physician as me this is also an interesting experience to learn more about the patients. This is a small revolution to the way I teach medicine and we will see how it works next year.
During EBMT 2018 there were pivotal data presented that show that multiple sclerosis can be effectively treated with hematopoietic stem cell transplantation – and HSCT is effective as 1st, 2nd and 3rd line treatment. The most crucial data comes from study by Richard Burt – MIST trial that compared HSCT with best possible drugs as 2nd line treatment. This is is the first randomized trial that shows overwhelming advantage of HSCT. You can download presentation from here.
I have prepared (in polish) new presentation on news and progress in clinical use of cord blood. Time will tell what it will be used to – I am sure that there are some properties that are hard to replicate with adult stem cells – as you can read in this presentation.
2017 Cord Blood News
This is the moment which is important – the CART cells are finally acknowledged by FDA – which means that they can be used as treatment. The price – still too high for them to be used widely – hopefully can be reduced at least 100 times for all the patients that need this type of therapy.
Dr Leszek Kraj, a colleague from our department, has just presented results of a new very interesting study during the 2017 Annual Meeting of ASCO (American Society of Clinical Oncology). The study analyzed the outcomes of patients with pancreatic cancer. The pancreatic cancer has very bad prognosis. They analyzed the outcomes of patients with this cancer treated with chemotherapy and with calcium blockers (because of hypertension). There is a hint from laboratory trials that calcium blockers might improve the cytotoxic action of chemotherapy against cancer cells by blocking the cell pumps that are dependent on calcium and remove the drug from inside the cell. Once dr Kraj compared the group of 380 patients with pancreatic cancer who received the chemotherapy and calcium blocker with over 4000 of the patients treated with just chemotherapy the differences were more than evident. the calcium blocker had over double survival at 2 years (24% vs 11%). This is trully amazing and hopefully will lead to improved survival in this cancer. Congratulations on great work!
The abstract can be found here: