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:
There is a new lecture online on the use of stem cells in neurology.
Download: 2017 Komórki macierzyste dla neurologów online
I have just returned from the EBMT 2017 conference. I have met with most prominent world scientist in field of HSCT – and I am truly amazed by the results that were presented. Here are the most important observations:
- CIDP in Chicago – dr Burt presented amazing results of CIDP HSCT trial from Chicago. The publication is pending… but „lame will walk” seems to be the case here (and those youtube videos do not lie). JUST TO GIVE YOU ONE SIMPLE NUMBER: pre HSCT 30% CIDP patients could walk without aid (and 25% were on wheel chair) – 5 years post HSCT 80% needed no assist in walking and NONE were on wheelchair – simply AMAZING. I just hope that neurologists will send their patients for HSCT as soon as they get to read that publication.
- MS – dr Atkins shared some insights from his Lancet paper from 2016 (http://thelancet.com/journals/laneur/article/PIIS1474-4422(08)70138-8/fulltext) – EDSS after HSCT did not progress after 2 years have passed from transplantation – in the timeframe of 13 years of post HSCT observation. In his study 40% of patients has sustainded EDSS improvement.
- SSc – the big news – this is the first autoimmune disease that reached level „I” of recommendations for HSCT – what does that mean? – the HSCT just becomes the standard treatment of progressive form of this disease – the guidelines should be published soon. The MS status in guidelines is also about to change…
- Breast cancer – the addition of HSCT into treatment of triple negative form of breast cancer improves greatly the survival of patients. This is not autoimmune disease but the results are also very intriguing.
I had a presentation on new clinical trial on central line infection prevention and use of different forms of G-CSF in mobilization.
Summarizing: I am very happy with the progress. Now we have to wait for HSCT to become a level “I” option in Multiple Sclerosis. CIDP and Systemic Slerosis patients finally will get option of curative treatment.
I wrote this post over a year ago but forgot to post it. Interesting study.
There is an interesting publication in BMJ on cancer screening. Although the cancer screening dose reduce the mortality from the specific cancer it does not have influence on overall mortality. This is quite interesting to read:
Recently I have reviewed the work by pioneers of bone marrow transplantation by Thomas and Storb – great publication and it gives a nice perspective on what we do today. You can read it here