Although the use of ovarian tissue cryopreservation and transplantation has lead to 13 live births in women with lymphoma or solid tumors, this method of fertility preservation may be unsafe for patients with leukemia, according to a recent study published online in Blood, the journal of the American Society of Hematology. The method involves removing and freezing ovarian tissue before the patient undergoes aggressive chemotherapy and radiotherapy, and then reimplanting the tissue once the cancer has been brought under control. One major concern with leukemia patients is the risk that their frozen-thawed ovarian tissue might harbor malignant cells that could induce a recurrence of the disease after reimplantation.
"Our study provides clear evidence that cancer cells in women with acute and chronic leukemias can contaminate the ovaries," said Marie-Madeleine Dolmans, MD, professor at the Universite Catholique de Louvain in Brussels and lead author of the study. "If this tissue is reimplanted in these women when they're ready to have children, there's a good possibility that the cancer will come back."
As most acute lymphoblastic leukemia (ALL) patients are diagnosed with the disease at a young age, consideration of the preservation of their fertility is especially important. In fact, according to the National Cancer Institute, 71 percent of those diagnosed with ALL are less than 35 years old, as are nearly 10 percent of those with chronic myelogenous leukemia (CML)(1). In 2010, it is estimated that 2,180 women will be diagnosed with ALL and 2,070 with CML(1).
As aggressive chemotherapy and radiotherapy are damaging to the reproductive organs, the researchers wanted to examine the safety of using ovarian tissue cryopreservation to safeguard the fertility of patients with leukemia. In this study, researchers examined the implications of the technique in 12 women with ALL, a fast-growing cancer of the white blood cells, and six women with CML, a slowly progressing bone marrow cancer. The 18 patients included in this study were between 2 and 31 years of age when their ovarian tissue was cryopreserved (from 1999 to 2008). The mean age of the patients with ALL was 14.5 years and 24.7 years for those with CML.
Although initial microscopic examination did not reveal any cancerous cells in the ovarian tissue samples collected from each patient, by using a technique called real-time quantitative polymerase chain reaction (RT-qPCR), the scientists found cancerous cells in the ovarian tissue of 70 percent of the ALL patients and 33 percent of the CML patients. For further analysis, the researchers engrafted the ovarian tissue samples into 18 healthy mice for an observational period of six months. In the mice who received tissue from CML patients, the grafts looked normal and did not appear to contain any cancerous cells. In contrast, four of the mice who received ovarian tissue from ALL patients developed tumors. Through use of RT-qPCR and the mouse model, the researchers demonstrated the viability and malignant potential of leukemic cells present in the frozen ovarian tissue, especially from ALL patients.
"Given our findings, further research is needed to develop safer options for fertility preservation in patients with acute and chronic leukemias," said Jacques Donnez, MD, professor at the Universite Catholique de Louvain in Brussels and co-author of the study.
"Leukemia patients can benefit from fertility preservation techniques," added Brandon Hayes-Lattin, MD, the Director of the Adolescent and Young Adult Center at the Knight Cancer Institute in Portland, Oregon. "But the strategies offered must be both effective and safe. Among its other strengths, this work emphasizes that molecular methods can be successfully applied to assessments of safety."
Source: American Society of Hematology
вторник, 27 декабря 2011 г.
вторник, 20 декабря 2011 г.
Rushing Mandatory HPV Vaccinations A 'Mistake,' Opinion Piece Says
Although much of the "resistance" to state efforts to mandate vaccination against human papillomavirus is "misguided," mandating the vaccine would be a "mistake at the present time," Arthur Allen -- a Washington, D.C.-based writer and author of the book "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver" -- writes in Washington Post opinion piece (Allen, Washington Post, 4/8). Merck's HPV vaccine Gardasil in clinical trials has been shown to be 100% effective in preventing infection with strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains. FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine (Kaiser Daily Women's Health Policy Report, 4/5). According to Allen, "the fact that HPV is sexually transmitted is no reason to keep children from being vaccinated against it." Allen writes that a "controversial" decision in 1992 to vaccinate infants and adolescents against hepatitis B "has clearly shown that public health campaigns can prevent disease without causing moral turpitude," adding that HPV "is not linked to risky sexual behavior" and is "as common as influenza." In addition, "as long as the HPV vaccine is not required, the people who need it most probably won't get it." However, Allen writes that he has "reservations" about mandating HPV vaccination because of cost concerns, the vaccine's lack of a "track record" and its current lack of "credibility." According to Allen, only Merck and "a few" advocates are calling for mandates. The "rickety" pediatric vaccination system is a "three-legged stool whose stability relies on the participation" of drug companies, the government and parents, according to Allen. "In failing to include two legs of the system, those pushing for immediate mandatory vaccination are risking it's collapse," Allen writes, concluding, "The HPV vaccine may do great things, but we shouldn't rush it" (Washington Post, 4/8).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
View drug information on Gardasil.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
View drug information on Gardasil.
вторник, 13 декабря 2011 г.
Lack Of Investment In Maternal, Infant Health In Afghanistan, Worldwide Is 'Tragedy,' Letter To Editor Says
Given that healthy women "deliver not just babies but paychecks and economic growth," it is a "mystery why maternal and newborn health still receives inadequate international attention and funding," Jill Sheffield, president of Family Care International, writes in a Washington Post letter to the editor.
According to Sheffield, Afghanistan's "devastated health care system" has contributed to one of the world's highest maternal mortality rates. "The sad truth is that if the Afghan government and its U.S. backers had invested in things that keep pregnant women alive -- such as emergency care facilities and training and security for paramedics, including midwives -- the country would now have at least a bare bones health care system," Sheffield writes.
"Pregnancies don't take timeouts to await solutions to political struggles, and meanwhile, every generation loses 10 million women worldwide," Sheffield writes, concluding, "It's a real tragedy, and not only in Afghanistan" (Sheffield, Washington Post, 7/5).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
According to Sheffield, Afghanistan's "devastated health care system" has contributed to one of the world's highest maternal mortality rates. "The sad truth is that if the Afghan government and its U.S. backers had invested in things that keep pregnant women alive -- such as emergency care facilities and training and security for paramedics, including midwives -- the country would now have at least a bare bones health care system," Sheffield writes.
"Pregnancies don't take timeouts to await solutions to political struggles, and meanwhile, every generation loses 10 million women worldwide," Sheffield writes, concluding, "It's a real tragedy, and not only in Afghanistan" (Sheffield, Washington Post, 7/5).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
вторник, 6 декабря 2011 г.
Hormone-replacement Therapy Causes Hearing Loss, Study Finds
The largest study ever to analyze the hearing of women on hormone-replacement therapy has found that women who take the most common form of HRT have a hearing loss of 10 to 30 percent more compared to similar women who have not had the therapy. The results are being published on-line this week by the Proceedings of the National Academy of Sciences.
It's as if the usual age-related hearing loss in women whose HRT included progestin, a synthetic form of the hormone progesterone, was accelerated compared to women taking estrogen alone or women not taking HRT. On average, women who received progestin had the hearing of women five to 10 years older.
The results of the study involving 124 women confirm results from a smaller study that the same group reported in 2004 at the annual meeting of the Association for Research in Otolaryngology. The new results also identify progestin as the component of HRT doing possible damage.
"Whether a woman goes on HRT is certainly her decision, and she should discuss the options with her doctor," says senior author Robert D. Frisina, Ph.D. "In light of these findings, we feel that hearing loss should be added to the list of negative things to keep in mind when talking about HRT. Women especially who already have a hearing problem should weigh this decision carefully. Women on HRT should consider having a thorough hearing check-up done every six months."
Frisina is part of one of the world's leading groups in hearing research, the International Center for Hearing and Speech Research (ICHSR), which includes scientists from the University of Rochester Medical Center and the National Technical Institute for the Deaf at Rochester Institute of Technology. The center, funded by the National Institutes of Health, is a collaboration of two leading groups of scientists just down the road from each other: scientists at RIT/NTID who have extensive experience with research with people, and their counterparts at a top neuroscience program, including the Department of Otolaryngology, at the university.
In the study published in PNAS, a team of scientists, nurses and audiologists compared the hearing of healthy women ages 60 to 86 who were divided into three groups. Thirty women had taken a form of HRT that included only estrogen; 32 women had taken both estrogen and progestin; and 62 women had never been on HRT. Each group contained women whose health histories and other characteristics closely matched those of the women in the other groups.
Each of the women was tested with a battery of hearing tests. A standard "pure tone" test - a common hearing test where a person raises her hand or presses a button when she hears a tone - was used to measure which frequencies each woman could hear. In addition, the team did two sophisticated tests in which a sound was sent into each woman's ear, and then the echo coming back out was measured. These tests tell scientists how healthy a person's inner ear is, particularly the hair cells that convert noise to electrical signals that the brain interprets as sound. Finally, each woman underwent a "hearing in noise" test that measures how well the brain sorts out the multitude of signals traveling from the ear to the brain. Most of the painstaking tests are available only at a few major medical centers and other institutions that focus on hearing research.
By all measures, women whose HRT included progestin - the most common type of HRT - had worse hearing than the other groups. The tests showed that women who had received progestin had problems both in the inner ear and in the portions of the brain used for hearing.
The results also show no benefit to hearing for women who take a form of HRT that includes estrogen alone, a surprise to researchers who thought that estrogen might help hearing.
"It's long been thought that estrogen is good for nerve cells, so we wanted to see if women on estrogen as part of HRT had better hearing than women not on HRT," said Frisina, a neuroscientist at the University of Rochester Medical Center and Distinguished Researcher in Biological Sciences at Rochester Institute of Technology. "We were very surprised to find not only that women on estrogen did not hear better than other women, but that the women who were also on progestin actually heard worse."
The team asked the question about hormones as part of a wider research project into age-related hearing loss, or presbycusis, which is one of the chief complaints of older people. In past research the team has found that the problem stems not only from degradation of the inner ear but also from an aging brain that loses its ability to process and filter information as the years go by. As in most people with age-related hearing loss, the team, whose work is supported by the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders, found that women on progestin had problems with both systems.
The group is continuing its studies, trying to figure out the exact effects of progestin on the ears and brain. Those effects are likely felt to some degree by all women, since progesterone is a natural hormone that enables a woman to carry a pregnancy. Other scientists have found that a woman's hearing can worsen slightly when her progesterone levels are high, during the latter portion of the monthly cycle.
The team also plans to study women who have gone off HRT, to see if the hearing loss might be reversible. And they say that women on the birth control pill, which includes progesterone, should also be studied.
The first author of the PNAS paper is Patricia Guimaraes, M.D., of the University's Department of Otolaryngology, who did much of the testing. Also part of the study were research nurse Susan Frisina of the University, who worked with the research subjects at the National Technical Institute for the Deaf; research audiologist Frances Mapes of NTID, who tested many of the subjects; Frisina's father, D. Robert Frisina, Ph.D., founding director of NTID, who directs the hearing research center; and otolaryngologist Sherif Tadros, M.D., of the University of Rochester.
Frisina, professor of Otolaryngology at the University of Rochester Medical Center, also has appointments in the departments of Biomedical Engineering and Neurobiology and Anatomy at the university.
Contact: Tom Rickey
University of Rochester Medical Center
It's as if the usual age-related hearing loss in women whose HRT included progestin, a synthetic form of the hormone progesterone, was accelerated compared to women taking estrogen alone or women not taking HRT. On average, women who received progestin had the hearing of women five to 10 years older.
The results of the study involving 124 women confirm results from a smaller study that the same group reported in 2004 at the annual meeting of the Association for Research in Otolaryngology. The new results also identify progestin as the component of HRT doing possible damage.
"Whether a woman goes on HRT is certainly her decision, and she should discuss the options with her doctor," says senior author Robert D. Frisina, Ph.D. "In light of these findings, we feel that hearing loss should be added to the list of negative things to keep in mind when talking about HRT. Women especially who already have a hearing problem should weigh this decision carefully. Women on HRT should consider having a thorough hearing check-up done every six months."
Frisina is part of one of the world's leading groups in hearing research, the International Center for Hearing and Speech Research (ICHSR), which includes scientists from the University of Rochester Medical Center and the National Technical Institute for the Deaf at Rochester Institute of Technology. The center, funded by the National Institutes of Health, is a collaboration of two leading groups of scientists just down the road from each other: scientists at RIT/NTID who have extensive experience with research with people, and their counterparts at a top neuroscience program, including the Department of Otolaryngology, at the university.
In the study published in PNAS, a team of scientists, nurses and audiologists compared the hearing of healthy women ages 60 to 86 who were divided into three groups. Thirty women had taken a form of HRT that included only estrogen; 32 women had taken both estrogen and progestin; and 62 women had never been on HRT. Each group contained women whose health histories and other characteristics closely matched those of the women in the other groups.
Each of the women was tested with a battery of hearing tests. A standard "pure tone" test - a common hearing test where a person raises her hand or presses a button when she hears a tone - was used to measure which frequencies each woman could hear. In addition, the team did two sophisticated tests in which a sound was sent into each woman's ear, and then the echo coming back out was measured. These tests tell scientists how healthy a person's inner ear is, particularly the hair cells that convert noise to electrical signals that the brain interprets as sound. Finally, each woman underwent a "hearing in noise" test that measures how well the brain sorts out the multitude of signals traveling from the ear to the brain. Most of the painstaking tests are available only at a few major medical centers and other institutions that focus on hearing research.
By all measures, women whose HRT included progestin - the most common type of HRT - had worse hearing than the other groups. The tests showed that women who had received progestin had problems both in the inner ear and in the portions of the brain used for hearing.
The results also show no benefit to hearing for women who take a form of HRT that includes estrogen alone, a surprise to researchers who thought that estrogen might help hearing.
"It's long been thought that estrogen is good for nerve cells, so we wanted to see if women on estrogen as part of HRT had better hearing than women not on HRT," said Frisina, a neuroscientist at the University of Rochester Medical Center and Distinguished Researcher in Biological Sciences at Rochester Institute of Technology. "We were very surprised to find not only that women on estrogen did not hear better than other women, but that the women who were also on progestin actually heard worse."
The team asked the question about hormones as part of a wider research project into age-related hearing loss, or presbycusis, which is one of the chief complaints of older people. In past research the team has found that the problem stems not only from degradation of the inner ear but also from an aging brain that loses its ability to process and filter information as the years go by. As in most people with age-related hearing loss, the team, whose work is supported by the National Institute on Aging and the National Institute on Deafness and Other Communication Disorders, found that women on progestin had problems with both systems.
The group is continuing its studies, trying to figure out the exact effects of progestin on the ears and brain. Those effects are likely felt to some degree by all women, since progesterone is a natural hormone that enables a woman to carry a pregnancy. Other scientists have found that a woman's hearing can worsen slightly when her progesterone levels are high, during the latter portion of the monthly cycle.
The team also plans to study women who have gone off HRT, to see if the hearing loss might be reversible. And they say that women on the birth control pill, which includes progesterone, should also be studied.
The first author of the PNAS paper is Patricia Guimaraes, M.D., of the University's Department of Otolaryngology, who did much of the testing. Also part of the study were research nurse Susan Frisina of the University, who worked with the research subjects at the National Technical Institute for the Deaf; research audiologist Frances Mapes of NTID, who tested many of the subjects; Frisina's father, D. Robert Frisina, Ph.D., founding director of NTID, who directs the hearing research center; and otolaryngologist Sherif Tadros, M.D., of the University of Rochester.
Frisina, professor of Otolaryngology at the University of Rochester Medical Center, also has appointments in the departments of Biomedical Engineering and Neurobiology and Anatomy at the university.
Contact: Tom Rickey
University of Rochester Medical Center
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