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Bahramloo M, Shahabi SA, Kalarestaghi H, Rafat A, Mazloumi Z, Samimifar A, Asl KD. CAR-NK cell therapy in AML: Current treatment, challenges, and advantage. Biomed Pharmacother 2024; 177:117024. [PMID: 38941897 DOI: 10.1016/j.biopha.2024.117024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024] Open
Abstract
Over the last decade, discovery of novel therapeutic method has been attention by the researchers and has changed the therapeutic perspective of hematological malignancies. Although NK cell play a pivotal role in the elimination of abnormal and cancerous cells, there are evidence that NK cell are disarm in hematological malignancy. Chimeric antigen receptor NK (CAR-NK) cell therapy, which includes the engineering of NK cells to detect tumor-specific antigens and, as a result, clear of cancerous cells, has created various clinical advantage for several human malignancies treatment. In the current review, we summarized NK cell dysfunction and CAR-NK cell based immunotherapy to treat AML patient.
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Affiliation(s)
- Mohammadmahdi Bahramloo
- Department of Medical Sciences, Student Research Committee, Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Sina Alinejad Shahabi
- Department of Medical Sciences, Student Research Committee, Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Hossein Kalarestaghi
- Research Laboratory for Embryology and Stem Cell, Department of Anatomical Sciences, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Rafat
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Zeinab Mazloumi
- Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arian Samimifar
- Department of Medical Sciences, Student Research Committee, Islamic Azad University, Tabriz Branch, Tabriz, Iran
| | - Khadijeh Dizaji Asl
- Department of Histopathology and Anatomy, Faculty of Medical Sciences, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
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Nevzati E, Kemp OA, Rhoads C, Witt JP, Finn M, Moser M, Spiessberger A. Biomechanical analysis of stabilization for thoracolumbar anterior spinal failure caused by osteolytic lesions, a finite element comparison of direct lateral corpectomy and posterior long segment instrumentation. Spine J 2024:S1529-9430(24)00892-1. [PMID: 39074736 DOI: 10.1016/j.spinee.2024.06.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND CONTEXT Osteolytic lesions caused by infection or metastatic disease of the spine can induce instability. Different surgical strategies are available to restore stability in this scenario, however little is known how various reconstruction techniques affect spinal biomechanics. PURPOSE To analyze and quantify the biomechanical effects of three different surgical reconstruction techniques in the treatment of a T12 osteolytic model. STUDY DESIGN/SETTING Finite element analysis of the thoracic spine with a T12 osteolytic lesion. METHODS Using CT scans from a 20-year-old man without structural deformity, simulation of an osteolytic lesion with a 50% defect at the posterior aspect of T12 vertebral body was created by a 490 N vertical force to T9. Next, three common instrumentation techniques treating the osteolytic lesion were modeled and biomechanically tested. These included: Model A, corpectomy with short segment fixation (T11-L1) and two long-segment instrumentations; Model B long segment fixation with triple rod construct; Model C long segment fixation with dual rod construct. A load of 480N was then applied on the spine models in vertically downward direction on T9. Von Mises stresses were measured (MPa) in the discs, vertebrae, and implants. RESULTS Model A demonstrated the lowest stress on construct material, adjacent vertebral bodies, and discs but increased stress on the instrumented vertebrae. Model B was more rigid and demonstrated lower construct stress compared to Model C. However, Model C had the lowest vertebral body stress in flexion, extension, and lateral bending in the most upper instrumented vertebral body, but the highest screw pull-out stress when compared to Model A and Model B. CONCLUSIONS This osteolytic T12 model provides unique biomechanical data that can help to tailor surgical strategies in select scenarios. While optimal outcomes are best achieved with a construct tailored to a specific patient's need for stabilization, our findings can be generalized for instances of cancerous lesions, low bone density, and infectious causes. CLINICAL RELEVANCE The results of this study can help with the choice of appropriate surgical reconstruction technique based on patient-specific characteristics.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, Basel 4056, Switzerland; Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA
| | - Oliver Ag Kemp
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Colin Rhoads
- Department of Orthopedic Surgery, Cleveland Clinic South Pointe Hospital, 20000 Harvard Rd, Warrensville Heights, OH 44122, USA.
| | - Jens-Peter Witt
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA
| | - Michael Finn
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 1635 Aurora, Aurora, CO 80045, USA
| | - Manuel Moser
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland; Department of Neurosurgery, Cantonal Hospital Graubuenden, Loëstrasse 170, Chur 7000, Switzerland
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Haraga I, Kosugi T, Sadashima E, Yumiba T, Kubo M, Ishikawa-Konishi A, Akiyoshi K. Effects of palliative intrathecal analgesia on patients with refractory cancer bone pain. J Anesth 2024; 38:405-411. [PMID: 38565691 DOI: 10.1007/s00540-024-03338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
This study examined the effects of intrathecal analgesia (ITA) using an extracorporeal pump with a subcutaneous port system in cancer patients with bone metastasis. Among the patients who died of cancer with bone metastasis at the palliative care unit of our institution, 11 who received ITA were selected. Changes in pain, opioid doses, the palliative prognostic index (PPI), and Eastern Cooperative Oncology Group Performance Scale after ITA were assessed. Pain, opioid doses, and PPI decreased after ITA (P = 0.002, 0.002, and 0.017). ITA for cancer patients with increased PPI due to refractory cancer bone pain decreased pain, opioid doses, and PPI.(100 words).
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Affiliation(s)
- Isao Haraga
- Department of Anesthesiology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan.
- Department of Anesthesiology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8561, Japan.
| | - Toshifumi Kosugi
- Department of Palliative Care, Saga-Ken Medical Center Koseikan, 400, Nakabaru, Kasemachi, Saga-shi, Saga, 840-8571, Japan
| | - Eiji Sadashima
- Medical Research Institute, Saga-Ken Medical Center Koseikan, 400Nakabaru, Kasemachi,, Saga-shi, Saga, 840-8571, Japan
| | - Tomoko Yumiba
- Department of Palliative Care, Saga-Ken Medical Center Koseikan, 400, Nakabaru, Kasemachi, Saga-shi, Saga, 840-8571, Japan
| | - Mayuko Kubo
- Department of Palliative Care, Saga-Ken Medical Center Koseikan, 400, Nakabaru, Kasemachi, Saga-shi, Saga, 840-8571, Japan
| | - Asako Ishikawa-Konishi
- Department of Palliative Care, Saga-Ken Medical Center Koseikan, 400, Nakabaru, Kasemachi, Saga-shi, Saga, 840-8571, Japan
- Tachikawa Home Care Clinic, 5-71-16, Saiwai-cho, Tachikawa-shi, Tokyo, 190-0002, Japan
| | - Kozaburo Akiyoshi
- Department of Anesthesiology, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan
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Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management. Cancers (Basel) 2023; 15:cancers15061796. [PMID: 36980681 PMCID: PMC10046378 DOI: 10.3390/cancers15061796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.
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Litak J, Czyżewski W, Szymoniuk M, Sakwa L, Pasierb B, Litak J, Hoffman Z, Kamieniak P, Roliński J. Biological and Clinical Aspects of Metastatic Spinal Tumors. Cancers (Basel) 2022; 14:cancers14194599. [PMID: 36230523 PMCID: PMC9559304 DOI: 10.3390/cancers14194599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Spine metastases are a common life-threatening complication of advanced-stage malignancies and often result in poor prognosis. Symptomatic spine metastases develop in the course of about 10% of malignant neoplasms. Therefore, it is essential for contemporary medicine to understand metastatic processes in order to find appropriate, targeted therapeutic options. Our literature review aimed to describe the up-to-date knowledge about the molecular pathways and biomarkers engaged in the spine’s metastatic processes. Moreover, we described current data regarding bone-targeted treatment, the emerging targeted therapies, radiotherapy, and immunotherapy used for the treatment of spine metastases. We hope that knowledge comprehensively presented in our review will contribute to the development of novel drugs targeting specific biomarkers and pathways. The more we learn about the molecular aspects of cancer metastasis, the easier it will be to look for treatment methods that will allow us to precisely kill tumor cells. Abstract Spine metastases are a common life-threatening complication of advanced-stage malignancies and often result in poor prognosis. Symptomatic spine metastases develop in the course of about 10% of malignant neoplasms. Therefore, it is essential for contemporary medicine to understand metastatic processes in order to find appropriate, targeted therapeutic options. Thanks to continuous research, there appears more and more detailed knowledge about cancer and metastasis, but these transformations are extremely complicated, e.g., due to the complexity of reactions, the variety of places where they occur, or the participation of both tumor cells and host cells in these transitions. The right target points in tumor metastasis mechanisms are still being researched; that will help us in the proper diagnosis as well as in finding the right treatment. In this literature review, we described the current knowledge about the molecular pathways and biomarkers engaged in metastatic processes involving the spine. We also presented a current bone-targeted treatment for spine metastases and the emerging therapies targeting the discussed molecular mechanisms.
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Affiliation(s)
- Jakub Litak
- Department of Clinical Immunology, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
| | - Wojciech Czyżewski
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4, 20-093 Lublin, Poland
| | - Michał Szymoniuk
- Student Scientific Association at the Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
| | - Leon Sakwa
- Student Scientific Society, Kazimierz Pulaski University of Technologies and Humanities in Radom, Chrobrego 27, 26-600 Radom, Poland
| | - Barbara Pasierb
- Department of Dermatology, Radom Specialist Hospital, Lekarska 4, 26-600 Radom, Poland
- Correspondence:
| | - Joanna Litak
- St. John’s Cancer Center in Lublin, Jaczewskiego 7, 20-090 Lublin, Poland
| | - Zofia Hoffman
- Student Scientific Society, Medical University of Lublin, Al. Racławickie 1, 20-059 Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
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Hallinan JTPD, Ge S, Zhu L, Zhang W, Lim YT, Thian YL, Jagmohan P, Kuah T, Lim DSW, Low XZ, Teo EC, Barr Kumarakulasinghe N, Yap QV, Chan YH, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A. Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression. Cancers (Basel) 2022; 14:cancers14174231. [PMID: 36077767 PMCID: PMC9454807 DOI: 10.3390/cancers14174231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from 101 patients who underwent spine MRI within 30 days, excluding 549 CT scans from 216 patients due to CT performed post-MRI, non-contrast CT, or a gap greater than 30 days between modalities. Reference standard MESCC gradings on CT were provided in consensus via two spine radiologists (11 and 7 years of experience) analyzing the MRI scans. CT scans were labeled using the original reports and by three radiologists (3, 13, and 14 years of experience) using dedicated CT windowing. Results: For normal/none versus low/high-grade MESCC per CT scan, all radiologists demonstrated almost perfect agreement with kappa values ranging from 0.866 (95% CI 0.787–0.945) to 0.947 (95% CI 0.899–0.995), compared to slight agreement for the reports (kappa = 0.095, 95%CI −0.098–0.287). Radiologists also showed high sensitivities ranging from 91.51 (95% CI 84.49–96.04) to 98.11 (95% CI 93.35–99.77), compared to 44.34 (95% CI 34.69–54.31) for the reports. Conclusion: Dedicated radiologist review for MESCC on CT showed high interobserver agreement and sensitivity compared to the current standard of care.
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Affiliation(s)
- James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
- Correspondence:
| | - Shuliang Ge
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Yi Ting Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Pooja Jagmohan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Nesaretnam Barr Kumarakulasinghe
- National University Cancer Institute, NUH Medical Centre (NUHMC), Levels 8–10, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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