BACKGROUND: Natalizumab was not shown to modify disability in progressive multiple sclerosis (MS). This matched observational study compared the effectiveness of autologous haematopoietic stem cell transplantation (AHSCT) with natalizumab in progressive MS. METHODS: Patients with primary/secondary progressive MS from seven AHSCT MS centres and the MSBase registry, treated with AHSCT or natalizumab, were matched on a propensity score derived from sex, age, Expanded Disability Status Scale (EDSS), number of relapses 12/24 months before baseline, time from MS onset, the most effective prior therapy and country. The pairwise-censored groups were compared on hazards of 6-month confirmed EDSS worsening and improvement, relapses and annualised relapse rates (ARRs), using Andersen-Gill proportional hazards models and conditional negative binomial model. RESULTS: 39 patients treated with AHSCT (37 with secondary progressive MS, mean age 37 years, EDSS 5.7, 28% with recent disability progression, ARR 0.54 during the preceding year) were matched with 65 patients treated with natalizumab. The study found no evidence for difference in hazards of confirmed EDSS worsening (HR 1.49, 95% CI 0.70 to 3.14) and improvement (HR 1.50, 95% CI 0.22 to 10.29) between AHSCT and natalizumab over up to 4 years. The relapse activity was also similar while treated with AHSCT and natalizumab (ARR: mean±SD 0.08±0.28 vs 0.08±0.25; HR 1.05, 95% CI 0.39 to 2.82). In the AHSCT group, 3 patients experienced febrile neutropenia during mobilisation, 9 patients experienced serum sickness, 6 patients required intensive care unit admission and 36 patients experienced complications after discharge. No treatment-related deaths were reported. CONCLUSION: This study does not support the use of AHSCT to control disability in progressive MS with advanced disability and low relapse activity.
- MeSH
- autologní transplantace * MeSH
- chronicko-progresivní roztroušená skleróza * farmakoterapie terapie MeSH
- dospělí MeSH
- imunologické faktory terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- natalizumab * terapeutické užití MeSH
- posuzování pracovní neschopnosti MeSH
- progrese nemoci MeSH
- transplantace hematopoetických kmenových buněk * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
Systémová mastocytóza (SM) je onemocnění charakterizované proliferací klonálních mastocytů. Biologická povaha SM zahrnuje celé spektrum, od relativně benigní indolentní formy až po mastocytární leukemii. Klinický obraz osciluje od téměř asymptomatických forem, přes různě vyjádřené stupně mediátorového syndromu, až po nádorový syndrom spojený s hepatosplenomegalií, lymfadenopatií a konstitučními příznaky. Diagnostika se opírá o morfologické a histologické zhodnocení kostní dřeně. Pacienti jsou na základě diagnostických nálezů a symptomatologie klasifikováni dle WHO a ICC klasifikace, od kterých se odvíjí typ onemocnění a následná terapie, která je přísně individualizovaná a zahrnuje symptomatickou, cílenou i cytoredukční terapii. Vzhledem k širokému spektru symptomů může pacient se SM kromě hematologů a alergologů navštívit ambulance specialistů většiny interních oborů. Proto je nutné, aby se tato diagnóza dostala do širšího povědomí lékařské společnosti. Nízká informovanost vede k oddálení diagnózy, dispenzarizace a případné terapie, což může u některých pacientů se sklonem k vážným alergickým až anafylaktickým reakcím vést v krajních případech k opakovanému výskytu život ohrožujících situací.
Systemic mastocytosis (SM) is a disease characterized by the proliferation of clonal mast cells. SM biologically include a wide spectrum, ranging from relatively benign indolent forms to mast cell leukemia. The clinical presentation varies from nearly asymptomatic forms, through various degrees of mediator syndrome, to a neoplastic syndrome associated with hepatosplenomegaly, lymphadenopathy, and constitutional symptoms. Diagnosis relies on morphological and histological evaluation of the bone marrow. Patients are classified based on diagnostic findings and symptomatology according to the WHO and ICC classifications, which determine the type of disease and subsequent therapy, which is strictly individualized and includes symptomatic, targeted, and cytoreductive therapy. Given the wide spectrum of symptoms, patients with SM may visit specialists in most internal medicine departments in addition to hematologists and allergologists. Raising awareness of this diagnosis within the medical community is crucial. Low awareness leads to delayed diagnosis and undertreatment, posing risks of life-threatening situations in patients liable to severe allergic reactions.
The plyometric method can be referred to as specific neuromuscular training, which may be used to optimize soccer players’ functional status and physical fitness levels. The development of functional strength, which can be repeatedly used under game conditions, is decisive for success in the games themselves. The paper aims to extend knowledge about the effects of plyometric training on running speed among soccer players. Twelve U19 soccer players from the MFK Ružomberok soccer club participated in the experiment. The control group consisted of twelve U19 soccer players from the FC Lokomotíva Košice soccer club. Both groups of soccer players performed 10-m, 30-m, and 50-m running tests and an agility T-test. From the viewpoint of determining the efficiency of the plyometric method, the testing also included tests aimed to assess ankle mobility and jump tests with and without countermovement performed with the use of Optogait. The soccer players from the experimental group participated in a 9-week intervention program that included two 30-minute training sessions per week. As regards the effects of plyometric training on running speed, soccer players improved their running speed levels in both acceleration speed and running speed with changes of direction. The results show that these changes are determined by ankle mobility and lower-body explosive power levels.
IMPORTANCE: Autologous hematopoietic stem cell transplant (AHSCT) is available for treatment of highly active multiple sclerosis (MS). OBJECTIVE: To compare the effectiveness of AHSCT vs fingolimod, natalizumab, and ocrelizumab in relapsing-remitting MS by emulating pairwise trials. DESIGN, SETTING, AND PARTICIPANTS: This comparative treatment effectiveness study included 6 specialist MS centers with AHSCT programs and international MSBase registry between 2006 and 2021. The study included patients with relapsing-remitting MS treated with AHSCT, fingolimod, natalizumab, or ocrelizumab with 2 or more years study follow-up including 2 or more disability assessments. Patients were matched on a propensity score derived from clinical and demographic characteristics. EXPOSURE: AHSCT vs fingolimod, natalizumab, or ocrelizumab. MAIN OUTCOMES: Pairwise-censored groups were compared on annualized relapse rates (ARR) and freedom from relapses and 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening and improvement. RESULTS: Of 4915 individuals, 167 were treated with AHSCT; 2558, fingolimod; 1490, natalizumab; and 700, ocrelizumab. The prematch AHSCT cohort was younger and with greater disability than the fingolimod, natalizumab, and ocrelizumab cohorts; the matched groups were closely aligned. The proportion of women ranged from 65% to 70%, and the mean (SD) age ranged from 35.3 (9.4) to 37.1 (10.6) years. The mean (SD) disease duration ranged from 7.9 (5.6) to 8.7 (5.4) years, EDSS score ranged from 3.5 (1.6) to 3.9 (1.9), and frequency of relapses ranged from 0.77 (0.94) to 0.86 (0.89) in the preceding year. Compared with the fingolimod group (769 [30.0%]), AHSCT (144 [86.2%]) was associated with fewer relapses (ARR: mean [SD], 0.09 [0.30] vs 0.20 [0.44]), similar risk of disability worsening (hazard ratio [HR], 1.70; 95% CI, 0.91-3.17), and higher chance of disability improvement (HR, 2.70; 95% CI, 1.71-4.26) over 5 years. Compared with natalizumab (730 [49.0%]), AHSCT (146 [87.4%]) was associated with marginally lower ARR (mean [SD], 0.08 [0.31] vs 0.10 [0.34]), similar risk of disability worsening (HR, 1.06; 95% CI, 0.54-2.09), and higher chance of disability improvement (HR, 2.68; 95% CI, 1.72-4.18) over 5 years. AHSCT (110 [65.9%]) and ocrelizumab (343 [49.0%]) were associated with similar ARR (mean [SD], 0.09 [0.34] vs 0.06 [0.32]), disability worsening (HR, 1.77; 95% CI, 0.61-5.08), and disability improvement (HR, 1.37; 95% CI, 0.66-2.82) over 3 years. AHSCT-related mortality occurred in 1 of 159 patients (0.6%). CONCLUSION: In this study, the association of AHSCT with preventing relapses and facilitating recovery from disability was considerably superior to fingolimod and marginally superior to natalizumab. This study did not find evidence for difference in the effectiveness of AHSCT and ocrelizumab over a shorter available follow-up time.
- MeSH
- dospělí MeSH
- fingolimod hydrochlorid terapeutické užití MeSH
- lidé MeSH
- natalizumab terapeutické užití MeSH
- relabující-remitující roztroušená skleróza * farmakoterapie MeSH
- roztroušená skleróza * MeSH
- transplantace hematopoetických kmenových buněk * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Cancer-related cognitive impairment (CRCI) is one of the most serious side effects of cancer that negatively impacts the quality of life of cancer patients and survivors. There is evidence of CRCI in Hodgkin lymphoma patients (HL); however, there is a lack of studies examining the presence of cognitive deficits before starting any treatment in HL patients. METHODS: Forty adult patients (N = 40) newly diagnosed with HL (with no previous cancer diagnoses) and 40 healthy controls (N = 40) matched for age, sex, education, and premorbid intellect completed the neuropsychological battery and subjective and objective measures of affective distress and quality of life. RESULTS: The results showed impairment in three out of six cognitive domains: verbal memory and learning, speed of processing/psychomotor speed, and abstraction/executive functions in the HL patients before the initiation of any treatment. The speed of processing/psychomotor speed domain is negatively correlated with depression. CONCLUSION: Cognitive deterioration in verbal memory and learning and abstraction/executive functions domains in HL patients seems to occur before the initiation of treatment independently of anxiety, depression, or physical symptoms. This suggests that HL itself may cause cognitive deficits in these cognitive domains. However, the underlying causes of CRCI still remain unclear.
- MeSH
- antikoagulancia škodlivé účinky terapeutické užití MeSH
- diseminovaná intravaskulární koagulace diagnóza etiologie terapie MeSH
- febrilní neutropenie terapie MeSH
- hemolytické anemie diagnóza klasifikace patologie terapie MeSH
- krevní nemoci * diagnóza klasifikace terapie MeSH
- krvácení chemicky indukované farmakoterapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- lidé MeSH
- lymfadenopatie * diagnostické zobrazování etiologie MeSH
- splenomegalie * diagnóza etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- chronická myeloidní leukemie * farmakoterapie patofyziologie terapie MeSH
- inhibitory tyrosinkinasy škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- chronická myelomonocytární leukemie diagnóza patologie terapie MeSH
- esenciální trombocytemie diagnóza etiologie terapie MeSH
- lidé MeSH
- myeloproliferativní poruchy * diagnóza etiologie klasifikace terapie MeSH
- polycythaemia vera diagnóza etiologie farmakoterapie MeSH
- primární myelofibróza diagnóza etiologie patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
