Author Interviews, Hematology, NEJM, Sloan Kettering, Transplantation / 31.07.2014
More Children With SCID Are Now Transplant Candidates
MedicalResearch.com Interview with:
Richard J. O'Reilly, MD
Memorial Sloan Kettering Cancer Center
Medical Research: What are the main findings of the study?
Dr. O'Reilly:
1. In a comparison of the results of HLA-matched sibling transplants with other established transplant approaches, including T-cell depleted half-matched parental marrow grafts, unmodified transplants from matched unrelated donors and cord blood transplants in the current era (2000-2009), transplants from donors other than HLA-matched siblings had 5 year survival outcomes similar to those of matched siblings when applied to young infants (≤ 3.5 months of age) or infants of any age that were not infected at the time of transplants. Thus any child born with SCID can now be successfully transplanted.
2. Active infection at the time of transplant significantly reduced chances of long-term survival for all infants except those who received transplants from HLA-matched siblings. Thus, infection is a dominant determinant of transplant outcome. Control of treatable infections prior to transplant should be a major clinical objective.
3. Treatment with chemotherapy containing busulfan significantly enhances the likelihood of recovering a normal ability to make antibodies and fosters better recovery of T-cells that provide cell mediated immunity, and may be an acceptable risk in uninfected infants. However, use of any chemotherapy prior to transplant in an infant who is infected, greatly decreases chances of survival. In infected patients who lack a matched sibling, T-cell depleted transplants from half matched related donors had the best outcomes.
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alResearch.com Interview with:
David C. Johnson, MD, MPH
Department of Urology
University of North Carolina School of Medicine
Medical Research: What are the main findings of the study?
Dr. Johnson: The first main finding from this study is that the likelihood of benign pathology after surgical removal of a renal mass suspected to be malignant based on pre-operative is inversely proportionate to size. This concept is well-established, however we systematically reviewed the literature for surgical series that published rates of benign pathology stratified by size and combined these rates to determine a single pooled estimate of benign pathology of pre-operatively suspicious renal masses for each size strata. Using benign pathology rates from US studies only, we found that 40.4% of masses < 1 cm, 20.9% of masses 1-2 cm, 19.6% of masses 2-3 cm, 17.2% of masses 3-4 cm, 9.2% of masses 4-7 cm, and 6.4% of masses >7 cm are benign.
The more novel finding from this study was the quantification of a previously unmeasured burden of over treatment in kidney cancer. By combining the above mentioned rates of benign pathology with epidemiological data, we estimated that the overall burden of benign renal masses surgically removed in the US to approach 6,000 per year in 2009. This represented an 82% increase over the course of a decade. Most importantly, we found an overwhelmingly disproportionate rise in the surgical treatment of renal masses in the smallest size categories – those which were most likely to be benign. We found a 233%, 189% and 128% increase in surgically removed benign renal lesions < 1 cm, 1-2 cm, and 2-3 cm, respectively from 2000 – 2009 in the US.
edicalResearch.com Interview with
Steven M. Hill, Ph.D.
Professor, Structural & Cellular Biology
Edmond & Lily Safra Chair for Breast Cancer Research
Co-Director, Molecular Signaling Program, Louisiana Cancer Research Consortium
Director, Tulane Circadian Biology Center
Medical Research: What are the main findings of the study?
Dr. Hill: The main findings of our study are that exposure to even dim light at night can drive human breast tumors to a hyper metabolic state, activating key tumor cell signaling pathways involved in tumor cell survival and proliferation, leading to increased tumor growth, all resulting in a tumor which is completely resistant to therapy. Our work shows that this effect is due to the repression of nighttime melatonin by dim light at night. When nighttime melatonin is replace the tumors become sensitive to tamoxifen resulting in cell death and tumor regression.
