[Hematopoietic stem cell transplantation. Indications, foundations and perspective]

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.

Personalizing Stem Cell Research and Therapy: The Arduous Road Ahead or Missed Opportunity?

The euphoria of stem cell therapy has diminished, allowing scientists, clinicians and the general public to seriously re-examine how and what types of stem cells would effectively repair damaged tissue, prevent further tissue damage and/or replace lost cells. Importantly, there is a growing recognition that there are substantial person-to-person differences in the outcome of stem cell therapy. Even though the small molecule pharmaceuticals have long remained a primary focus of the personalized medicine research, individualized or targeted use of stem cells to suit a particular individual could help forecast potential failures of the therapy or identify, early on, the individuals who might benefit from stem cell interventions. This would however demand collaboration among several specialties such as pharmacology, immunology, genomics and transplantation medicine. Such transdisciplinary work could also inform how best to achieve efficient and predictable stem cell migration to sites of tissue damage, thereby facilitating tissue repair. This paper discusses the possibility of polarizing immune responses to rationalize and individualize therapy with stem cell interventions, since generalized "one-size-fits-all" therapy is difficult to achieve in the face of the diverse complexities posed by stem cell biology. We also present the challenges to stem cell delivery in the context of the host related factors. Although we focus on the mesenchymal stem cells in this paper, the overarching rationale can be extrapolated to other types of stem cells as well. Hence, the broader purpose of this paper is to initiate a dialogue within the personalized medicine community by expanding the scope of inquiry in the field from pharmaceuticals to stem cells and related cell-based health interventions.

[Myelodysplastic syndromes]

A heterogeneous group of acquired clonal bone marrow diseases has been captured under the term of myelodysplastic syndromes (MDS) that occur predominantly at higher age and are characterized by peripheral cytopenias despite normal or increased cellularity of the bone marrow. The slowly evolving process of neoplastic transformation explains the clinical, morphological and prognostic heterogeneity which is not sufficiently addressed even in current classification systems. In the last decade, considerable progress has been made in dissecting the pathobiology of these complex disorders. Therapeutic measures have to consider the prognosis of MDS as well as individual factors of the patient. Whereas the early stages are treated with supportive care, iron chelators, hematopoietic growth factors and immunomodulatory agents, more advanced cases require the use of demethylating agents and cytotoxic chemotherapy with or without stem cell support. Allogeneic stem cell transplantation remains the only curative option in MDS.