Recenti progressi in medicina最新文献

CAR-T therapy (chimeric antigen receptor T-cell) has revolutionized the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) that have relapsed or are refractory to conventional chemotherapies. In particular, patients who have relapsed or are refractory to two lines of therapy are patients who have a poor prognosis. The advent of CAR-T immunotherapy is an innovative approach with which we can give hope of recovery even in the case of refractory disease, even for patients who are not candidates for high-dose therapies, for example due to age. Here we present a clinical case of a 74-year-old patient at second relapse, refractory to two lines of chemotherapy and subjected to third-line CAR-T with axicabtagene ciloleucel, after a good response to bridge therapy with rituximab polatuzumab and bendamustine (RPB). Complete remission of the disease still persists eleven months after treatment. Tolerance to CAR-T was excellent, with grade 1 cytokine release syndrome (CRS), no neurological complications (ICANS-immune effector cell-associated neurotoxicity syndrome) and no infectious complications. Severe hypogammaglobulinemia persists eleven months after CAR-T reinfusion, for which he still performs immunoglobulin replenishment for prophylactic purposes.

Introduction: Pseudoprogression is a complication observed following CAR-T therapy that can mimic disease progression; however, its incidence is not well defined. This phenomenon is driven by a robust inflammatory response due to the recognition of CAR-T cells targeting the lymphoma. Misinterpreting pseudoprogression as true disease progression could result in unnecessary alterations to the treatment regimen.

Clinical case: Here, we present a case of a 69-year-old patient with diffuse large B-cell lymphoma (DLBCL) who received axicabtagene ciloleucel as fourth line therapy and exhibited pseudoprogression on Pet scans at 3 and 9 months after treatment. Two biopsies performed to investigate these findings were negative for lymphoma recurrence. The patient has been in complete metabolic remission for three years following the infusion.

Conclusions: Biopsy is crucial for distinguishing between pseudoprogression and disease progression in patients with DLBCL after CAR-T therapy. However, obtaining a biopsy may be challenging when lesions are closed to vital organs or major blood vessels, complicating the procedure and increasing the risk of complications.

Background: The admission criteria to the medical assistance in dying (MAID) procedures (Euthanasia - E; Physician Assisted Suicide - PAS) represent a much debated issue. In most of the jurisdictions where MAID is legal, the unbearable suffering due to a terminal illness constitues the main admission condition. In contrast, those suffering from either a mental disorder or an existential discomfort are excluded. Some consider the exclusion of the former group to be protective towards those deemed vulnerable because they are not able to make free and informed decisions, while the latter is excluded to align the legal approaches to the prevailing moral models. Others consider these stances discrimination.

Purpose: To prove that when someone requests MAID, his suffering should be first and foremost investigated not only and not so much for its causes, but, above all, for its key role played in understanding the MAID request.

Contents: After reviewing the specific aspects of suffering in relation to his three determinants - existential suffering, mental disorder, terminal illness - the article provides the evidence that: a) such a conditions, although completely different from each other, share the same psychological processes leading to the unbeaerable suffering and then to the request for MAID or to the suicide ideation/completion; b) there is no scientific data supporting a discrimination access to MAID on the basis of the presence/absence of a terminal illness.

Conclusions: Using the unbearable suffering due to a terminal illness as the sole criterion for admission to MAID violates the principle of autonomy, and, lacking scientific evidence, it does not clarify where the line is drawn between those who should be entitled to MAID and those who should not.

Chimeric Antigen Receptor T cell (CAR-T) therapy has revolutionized prognosis of patients with diffuse large B-cell lymphoma (DLBCL). Success of CAR-T treatment heavily relies on early referral to the CAR-T center, on a short time of infusion of CAR-T cells from the lymphocyte collection and on a reduced burden of disease. Here we describe the case of a patient with diagnosis of High-grade B-cell lymphoma with MYC and BCL6 rearrangements, transformed from marginal zone lymphoma, referred with a refractory and rapidly progressive disease. The patient received holding therapy, with the aim to control the disease before apheresis, and subsequently treated with a combined bridging therapy, achieving a metabolic complete remission. Patient is still in complete remission at 21 months from infusion. This report represents a case of a correct referral and a full collaboration between centers.

Post-Normal Science (PNS) was introduced about 30 years ago to address the changing relation between science and governance when science is called upon to provide inputs to policy-related issued. Originally concerned mainly with environmental risks, in the last decades the PNS approach has been applied to a growing and diversified number of issues. It is considered particularly appropriate in situations characterized by: uncertain facts, a plurality of potentially conflicting values, high stakes, and urgent decisions. The objective of this paper is to present a survey that will test the opinions of practitioners and stakeholders on the usefulness of the PNS approach for addressing three emerging issues within the field of radiation oncology: the high and growing number of expected patients, the number of sessions per radiotherapy cycle, and treatment in old age. Respondents will also be asked to indicate which of the typical PNS intervention tools - such as extended and inclusive dialogue, the use of hybrid tools, adaptability and flexibility, and transparency in decision-making -are most suitable, and to what extent. Professionals and stakeholders from one radiotherapy center in northern Italy and two centers in southern Italy will be interviewed.

In the period between March 2021 and December 2023, our Casa della Salute in Borgaretto (Torino) organized a clinic dedicated to vaccination against Covid-19 in its local and with its staff (medical, nursing and administrative). To try to inform the majority of the population about this activity, we used the social networks of the Casa della Salute (Facebook and website), the social networks of the Municipality of Beinasco and some of the local newspapers. The list of eligible subjects was shared with the ASL TO 3 and the invitation to vaccination was made via SMS from a dedicated platform, indicating the day and time of the appointment. All the actors involved participated in multiple organizational meetings to share the logistical aspect and the management of any critical events. 10.167 vaccines were administered, the vaccination sessions lasted 6 hours each, the vaccination days were 112, with an average of 90 patients per session. This vaccination campaign, albeit in an emergency context, was made possible by the good organization of all the Casa della Salute staff, integrated with the ASL TO 3 and the Municipality of Beinasco. None of the three entities, alone, would probably have been able to obtain the same result: the ability to integrate and the will to cooperate were fundamental.