Transfusion and Apheresis Science最新文献

Objectives: In this study, we aimed to compare the engraftment days, graft versus host disease (GVHD) development, relapse and overall survival (OS) rates in patients using variable intensity conditioning regimens with two different post-transplant cyclophosphamide (PTCy) doses for hematological malignancies.

Material and methods: We retrospectively analyzed 162 patients who have had PTCy at a dose of 25 mg/kg × 2 and 50 mg/kg × 2 between 2018 and 2024. Patients were divided in 2 groups; PTCy dose with 25 mg/kg × 2 (Group 1, n = 45) and PTCy dose with 50 mg/kg × 2 (Group 2, n = 117). The engraftment days, GVHD, relapse and OS rates were compared across groups.

Results: All patients had myeloablative conditioning regimens and peripheral stem cell collected transplantation. 61.1 % of patients (n = 99) were alive at the end of the study (60 % (n = 27) in Group1 and 61.5 % (n = 72) in Group 2). In Group 1 the median follow-up was 6.9 months and in Group 2 this was 7 months; the median OS was 15.5 months in Group 1 and 49.5 months in Group 2 but this is not statistically significant (Log rank = 0.796). In Group 1, the engraftment times for platelets was 13 days, for neutrophils 17 days; in Group 2, for platelet this was 18 days; and for neutrophils 17 days; this was statistically significant for platelets but not for neutrophil engraftment (p: < 0.001 and p:0.839, respectively). Eighteen patients (40 %) in Group 1 and twenty-seven (23 %) patients in group 2 had acute GVHD (aGVHD). In Group 1 aGVHD rates were higher than Group 2 (p = 0.031). Seven patients (15.5 %) in Group 1 and 6 (5.12 %) patients in group 2 had chronic GVHD (cGVHD). In Group 1 cGVHD rates were also higher than Group 2 (p = 0.048). Twenty-five patients (55.6 %) in Group 1 and 19 patients (16.2 %) in Group 2 had relapsed disease (p < 0.001).

Conclusion: Our study showed that there were no differences in survival across the groups. The platelet engraftment time was shorter for the PTCy 25 mg/kg × 2 doses compared to the post-transplantation 50 mg/kg × 2 doses. Both aGVHD and cGVHD rates were higher in 25 mg/kg × 2 dose treated patients. Relapses occurred more commonly with 25 mg/kg × 2 PTCy dose.

Plasma exchange (PE) outcomes in patients with trigger-associated thrombotic microangiopathy (TMA) have not been comprehensively reviewed. Embase and MEDLINE® were searched on 03/14/2022 for English language articles published after 2007, alongside a congress materials search (2019-2022; PROSPERO: CRD42022325170). Studies with patients with trigger-associated TMA (excluding thrombotic thrombocytopenic purpura, 'typical' hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli, post-partum TMA, and TMAs with known genetic cause) who received PE or plasma infusion (PI) and reported treatment response (including measures), safety, patient-/caregiver-reported outcomes, or economic burden data were examined. The NICE quality appraisal checklist assessed bias risk. After screening 695 articles, 49 PE or PI studies were identified, of which 42 reported PE exclusively; most were retrospective observational studies (n = 37). The most common TMA trigger was transplantation (n = 12). The median number of PE sessions was 3.5-25.0. Outcomes following PE varied by trigger type. Treatment response rates and definitions varied (0-100 %; 24 studies); in studies of > 25 patients, response rates were 5-63 %. TMA relapse rates were 0-67 % (7 studies). Mortality was 10-91 % (23 studies). Progression to chronic kidney disease (CKD; 5 studies) and end-stage renal disease (ESRD; 6 studies) occurred in 0-93 % and 17-100 % of patients, respectively. Two serious adverse events were identified (transfusion-related injury, acute lung injury; 10 studies; 231 patients). Patients with trigger-associated TMA may experience a substantial burden in terms of mortality, relapse, and progression to CKD and ESRD following PE, leading to increased healthcare resource utilization. Additional interventions may be required.

Background and objective: SWOT and TOWS analysis is a strategic planning tool for identifying internal and external factors influencing a field. It helps to identify areas for improvement and growth by maximizing strengths and opportunities while minimizing weaknesses and threats. Transfusion medicine specialists can better understand the field's current status and plan potential growth using SWOT and TWOS strategic tools.

Methods: A cross-sectional questionnaire-based study using Google Forms, was conducted among Transfusion Medicine specialists in India. The authors formulated five open-ended questions for each of the S, W, O, and T categories to address and analyze the main aspects of Strengths, Weaknesses, Opportunities, and Threats. Descriptive statistics analyzed demographic details and keywords, extracting factors for SWOT and TOWS analysis to develop strategies.

Results: 71 specialists, across India: Central (8), East (7), North (18), South (31), and West (7) responded, achieving a 48 % response rate. Strengths focused on Immunohematology and blood safety. Conversely, weaknesses highlighted were limited clinical exposure and insufficient recognition within the medical fraternity. Fostering interdisciplinary collaboration and integrating emerging advancements were key opportunities identified. The prevailing concerns encompassed two primary threats: the potential overlap with related branches like pathology, and the emergence of artificial blood products. The SO, ST, WO, and WT strategies focused on apheresis, recruitment policy, clinical exposure, and newer developments, respectively.

Conclusion: This study highlights the application of SWOT and TWOS analysis as a valuable strategic tool for Transfusion Medicine specialists to address these factors proactively and to enhance the field's trajectory.

Objectives: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for hematological diseases, with success rates improving due to advancements in conditioning regimens and new anti-graft versus host disease (GVHD) drugs. Ruxolitinib, an oral selective Janus kinase (JAK) 1 and 2 inhibitor has been used to mitigate the effects of various inflammatory and myeloproliferative syndromes, given the JAK kinase pathway's central role in cytokine signaling during inflammatory and immune processes. In this study we aimed to assess ruxolitinib's efficacy in patients with chronic GVHD (cGVHD).

Material and methods: This retrospective observational multi-center study involved 50 patients diagnosed with cGVHD after allo-HSCT in Turkey, who were treated with ruxolitinib between April 2018 and March 2024.

Results: At the time of initiation of ruxolitinib treatment, most patients had severe cGVHD (n = 29, 58 %). The overall response rate at 6 months of ruxolitinib treatment was observed in 34 patients (68 %), including 6 patients (12 %) with complete responses and 28 patients (56 %) with partial responses, while 7 patients (14 %) experienced treatment failure. ECOG (2-4) performance status was established as an independent risk factor for adverse outcomes [p = 0.029, HR 3.492 (95 % CI: 1.139-10.705)]. At the two-year follow-up, the estimated survival rate was 52 %.

Conclusion: Ruxolitinib is safe and effective in the real-world setting for treating cGVHD, showing remission rates comparable to clinical trials. Further research with extended follow-up is necessary to confirm these findings, optimize dosing, and establish the best tapering strategies for responders.

Platelets are anucleate blood cells traditionally associated with hemostasis but now increasingly recognized for their multifaceted roles in immunity, inflammation, and tissue repair. Advances in platelet proteomics, employing high-throughput techniques such as mass spectrometry, have significantly enhanced our understanding of platelet biology and its clinical implications in transfusion medicine. Platelet proteomics offers a retrospective view of physiological and pathological changes over the platelet's 7-10-day lifespan, making it a unique tool for studying cumulative biological events. Recent applications include the identification of biomarkers for cardiovascular, infectious, autoimmune diseases and cancer. In neurodegeneration and aging, platelets have been explored for their shared molecular pathways with neurons, with findings implicating Tau, amyloid-beta, and alpha-synuclein as potential biomarkers. Proteomics is also emerging as an important factor in the development of evidence-based, tailor-made platelet-derived therapies. While promising, platelet proteomics requires further standardization and computational advances to support transitioning from research to routine clinical practice.

Objective: Vitamin D deficiency is common in adult patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). Since vitamin D is an important regulatory factor for the immune system, vitamin D deficiency may have effects on antitumor activity, relapse rates, graft versus host disease (GVHD) occurrence and infection rates in allo-HSCT. We aimed to investigate the effects of vitamin D levels on the outcome of allo-HSCT.

Material and methods: This study included 211 patients who underwent allo-HSCT at seven transplant centers in Türkiye. The impact of pretransplant vitamin D level on overall survival (OS), relapse rate, GVHD occurrence and engraftment times was analyzed retrospectively RESULTS: Pretransplant vitamin D levels were not related to the neutrophil engraftment day (p: 0.887), relapse rate (p: 0.433) and GVHD occurrence (p: 0.391). At a median follow-up of 14 months, OS was 84.8 % and median OS was not reached. Univariate Cox Regression analysis showed that higher levels of vitamin D (>12 ng/mL) affected the survival rates (p = 0.029) (HR: 0.392: 95 % CI: 10.170-0.907).

Conclusion: In our study, pretransplant vitamin D levels were not related to GVHD occurrence, relapse rate and engraftment times. However, we found that higher levels of pretransplant vitamin D levels (threshold is 12 ng/mL) were associated with increased survival. Further studies with a larger population are necessary to reveal the role of vitamin D in patients undergoing allo-HSCT.

Objective: Acute graft versus host disease (GVHD) occurs in 20-80 % of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Of these patients, 40 % will be resistant to steroids, which is the standard first-line approach. There is no standard second line treatment approach for patients with steroid refractory acute GVHD (SR-aGVHD). Alpha-1 antitrypsin is a protease inhibitor and has anti-inflammatory and immune regulatory properties. Here we report the outcomes and safety data of 17 patients treated with alpha-1 antitrypsin for SR-aGVHD.

Material and methods: Patients who received at least 2 lines of alpha-1 antitrypsin treatment for SR-aGVHD at five transplant centers in Türkiye were included in this retrospective study.

Results: The median number of alpha-1 antitrypsin treatment line patients received was 4 (range, 2-5). The median time between alpha-1 antitrypsin administration and response was 65 days (range, 10-138 days). Overall response rate was 70.6 %. When the first- and second-month response rates were compared according to GVHD organ involvement, we found that the response rates were similar in skin, liver and gastrointestinal system involvement (p = 0.281 and p = 0.305, respectively). No grade 3-4 anemia, thrombocytopenia or neutropenia was observed after alpha-1 antitrypsin treatment. Two patients had cytomegalovirus infection and 1 patient had pneumonia. At a median follow-up of 7 months, overall survival was 70.6 % and median overall survival was not reached.

Conclusion: In conclusion, alpha-1 antitrypsin is an effective and safe treatment option in patients with SR-aGVHD, with response rates of up to 70 % in patients with skin, liver and gastrointestinal system involvement. Larger studies are needed to establish a standard second and subsequent treatment approach in patients with SR-aGVHD.