Brian D. Adkins, J. Jacobs, Garrett S. Booth, Bipin N Savani, Laura D. Stephens
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
{"title":"Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review","authors":"Brian D. Adkins, J. Jacobs, Garrett S. Booth, Bipin N Savani, Laura D. Stephens","doi":"10.46989/001c.94135","DOIUrl":"https://doi.org/10.46989/001c.94135","url":null,"abstract":"Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"114 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Karasek, Maciej Majcherek, Bartłomiej Kuszczak, A. Szeremet, Olga Chyrko, Tomasz Wróbel, A. Czyż
Cyclosporine A (CSA) is a commonly used immunosuppressive agent for the prophylaxis of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). While tachycardia is a known adverse effect of CSA, bradycardia remains a phenomenon rarely described in the literature. We conducted a retrospective evaluation of the incidence of bradycardia in patients after alloHSCT treated with CSA between January 2020 and February 2023 at our center. Out of 206 patients, sinus bradycardia following the administration of CSA was observed in 6 (2.9%), comprising 3 women and 3 men, with the median age of 55 years (range: 20-65). The underlying diseases were myeloid malignancies in 4 and aggressive lymphoma in 2 patients. The patients received grafts from a matched unrelated (n=5) or a haploidentical family donor (n=1) following various conditioning regimens. Coexisting cardiovascular disorders were found in 5 of the 6 patients. All patients experienced symptomatic bradycardia within 1-4 days (median 2 days) after CSA introduction, which persisted until CSA withdrawal. One patient required treatment with atropine. All patients continued their immunosuppressive therapy with tacrolimus, which was well-tolerated Our study indicates CSA as a causative factor of sinus bradycardia in a small percentage of alloHSCT patients receiving CSA as graft-versus host disease (GvHD) prophylaxis. Importantly, these patients did not experience any cardiac complications when switched to tacrolimus. Although further research on the effects of CSA on heart automatation is needed, our single-center experience can help prompt diagnosis and therapeutic intervention in daily clinical practice.
{"title":"Sinus bradycardia as a rare adverse event in patients receiving cyclosporine A after allogeneic hematopoietic stem cell transplantation.","authors":"M. Karasek, Maciej Majcherek, Bartłomiej Kuszczak, A. Szeremet, Olga Chyrko, Tomasz Wróbel, A. Czyż","doi":"10.46989/001c.94362","DOIUrl":"https://doi.org/10.46989/001c.94362","url":null,"abstract":"Cyclosporine A (CSA) is a commonly used immunosuppressive agent for the prophylaxis of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). While tachycardia is a known adverse effect of CSA, bradycardia remains a phenomenon rarely described in the literature. We conducted a retrospective evaluation of the incidence of bradycardia in patients after alloHSCT treated with CSA between January 2020 and February 2023 at our center. Out of 206 patients, sinus bradycardia following the administration of CSA was observed in 6 (2.9%), comprising 3 women and 3 men, with the median age of 55 years (range: 20-65). The underlying diseases were myeloid malignancies in 4 and aggressive lymphoma in 2 patients. The patients received grafts from a matched unrelated (n=5) or a haploidentical family donor (n=1) following various conditioning regimens. Coexisting cardiovascular disorders were found in 5 of the 6 patients. All patients experienced symptomatic bradycardia within 1-4 days (median 2 days) after CSA introduction, which persisted until CSA withdrawal. One patient required treatment with atropine. All patients continued their immunosuppressive therapy with tacrolimus, which was well-tolerated Our study indicates CSA as a causative factor of sinus bradycardia in a small percentage of alloHSCT patients receiving CSA as graft-versus host disease (GvHD) prophylaxis. Importantly, these patients did not experience any cardiac complications when switched to tacrolimus. Although further research on the effects of CSA on heart automatation is needed, our single-center experience can help prompt diagnosis and therapeutic intervention in daily clinical practice.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"55 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140080749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A lack of factor VIII (FVIII) or factor IX (FIX) results in hemophilia, a blood-clotting illness. The mode of inheritance is chromosome X-linked and recessive. The primary symptom of severe hemophilia is spontaneous and recurrent bleeding into joints, muscles, and soft tissues. Unpreventable bleeding may cause arthropathy, chronic discomfort, and muscular atrophy. Therefore, joints’ functional loss affects the functional and walking ability. The aim of this study was to determine the walking ability by measuring the 50-m walk test time in severe hemophilic patients, as compared to the normal population. Sixty subjects (males) in the 18-30 year age group were selected and comprised 30 hemophiliacs and 30 in a control group. The 50-m walking ability was measured in seconds. The results showed a normative value of 36.6 sec in the control and 67.2 sec in the hemophilic group. Statistical analysis of the data showed that the walking ability was significantly reduced in the hemophilic group. These normative values illustrate a useful, simple, reproducible, rapid assessment of walking disability in adults with hemophilic arthropathy, and also aid the planning of treatment.
{"title":"Walking ability in adults with severe hemophilia: A cross-sectional study","authors":"Malika Jhandai, Dimple Choudhry, Sudhir Kumar Atri, Pankaj Bhardwaj, Kusum Yadav","doi":"10.46989/001c.94374","DOIUrl":"https://doi.org/10.46989/001c.94374","url":null,"abstract":"A lack of factor VIII (FVIII) or factor IX (FIX) results in hemophilia, a blood-clotting illness. The mode of inheritance is chromosome X-linked and recessive. The primary symptom of severe hemophilia is spontaneous and recurrent bleeding into joints, muscles, and soft tissues. Unpreventable bleeding may cause arthropathy, chronic discomfort, and muscular atrophy. Therefore, joints’ functional loss affects the functional and walking ability. The aim of this study was to determine the walking ability by measuring the 50-m walk test time in severe hemophilic patients, as compared to the normal population. Sixty subjects (males) in the 18-30 year age group were selected and comprised 30 hemophiliacs and 30 in a control group. The 50-m walking ability was measured in seconds. The results showed a normative value of 36.6 sec in the control and 67.2 sec in the hemophilic group. Statistical analysis of the data showed that the walking ability was significantly reduced in the hemophilic group. These normative values illustrate a useful, simple, reproducible, rapid assessment of walking disability in adults with hemophilic arthropathy, and also aid the planning of treatment.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140081199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mervat Mattar, Ali Bazarbachi, Omar Abduljalil, Bassam Francis, Arif Alam, Vivian Blunk
Globally, multiple myeloma (MM) ranks 24th among the most common cancers. The Middle East and Africa are affected by an increasing trend in MM incidence, owing to several underlying factors. This systematic review aims to assess the epidemiology, patient characteristics, and treatment outcomes associated with MM in selected countries in the Middle East and Africa. An electronic search was performed in the PubMed/MEDLINE database. Abstracts presented at the annual meetings of the American Society of Clinical Oncology, American Society of Hematology, and European Society for Medical Oncology and the GLOBOCAN registry were searched. Qualitative analysis was performed. A total of 412 articles were screened, and 14 were selected. The five-year prevalence per 100,000 gathered from country-wise GLOBOCAN data ranged between 155 in Kuwait and 5,625 in North Africa. The identified treatment options were proteasome inhibitors such as bortezomib, drugs such as thalidomide, lenalidomide, dexamethasone, melphalan, and cyclophosphamide, and newer drugs such as daratumumab. Improved diagnostic capability has increased the incidence of MM in this region. However, advanced drugs and treatment regimens remain unaffordable in many countries of these regions. Therefore, understanding the trends of the disease and improving healthcare settings are imperative.
{"title":"Epidemiology, Treatment Trends, and Outcomes of Multiple Myeloma in the Middle East and Africa: A Systematic Review","authors":"Mervat Mattar, Ali Bazarbachi, Omar Abduljalil, Bassam Francis, Arif Alam, Vivian Blunk","doi":"10.46989/001c.92555","DOIUrl":"https://doi.org/10.46989/001c.92555","url":null,"abstract":"Globally, multiple myeloma (MM) ranks 24th among the most common cancers. The Middle East and Africa are affected by an increasing trend in MM incidence, owing to several underlying factors. This systematic review aims to assess the epidemiology, patient characteristics, and treatment outcomes associated with MM in selected countries in the Middle East and Africa. An electronic search was performed in the PubMed/MEDLINE database. Abstracts presented at the annual meetings of the American Society of Clinical Oncology, American Society of Hematology, and European Society for Medical Oncology and the GLOBOCAN registry were searched. Qualitative analysis was performed. A total of 412 articles were screened, and 14 were selected. The five-year prevalence per 100,000 gathered from country-wise GLOBOCAN data ranged between 155 in Kuwait and 5,625 in North Africa. The identified treatment options were proteasome inhibitors such as bortezomib, drugs such as thalidomide, lenalidomide, dexamethasone, melphalan, and cyclophosphamide, and newer drugs such as daratumumab. Improved diagnostic capability has increased the incidence of MM in this region. However, advanced drugs and treatment regimens remain unaffordable in many countries of these regions. Therefore, understanding the trends of the disease and improving healthcare settings are imperative.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Lucena, Kelly J. Gaffney, Theresa A. Urban, Catherine Forbes, Pavithra Srinivas, N. Majhail, E. Cober, S. Mossad, Lisa Rybicki, B. Hamilton
Febrile neutropenia (FN) is an oncologic emergency frequently encountered in hematopoietic cell transplant (HCT) and chimeric antigen receptor (CAR) T-cell therapy patients, which requires immediate initiation of broad-spectrum antibiotics. Data regarding antibiotic de-escalation (DE) in neutropenic patients are limited, and guideline recommendations vary. A clinical protocol for antibiotic DE of broad-spectrum agents was implemented if patients were afebrile after 72 hours and had no clinical evidence of infection. The primary endpoint was the difference in the number of antibiotic therapy days between the pre-and post-DE protocol implementation group. Secondary endpoints included rates of subsequent bacteremia during index hospitalization, 30-day mortality, and hospital length of stay. Retrospective chart reviews were conducted to assess outcomes for patients who received allogeneic HCT, autologous HCT, or CAR T-cell therapy under the antibiotic de-escalation protocol (post-DE) compared to those who did not (pre-DE). The pre-DE group underwent HCT/CAR T-cell from February 2018 through September 2018 (n=64), and the post-DE group from February 2019 through September 2019 (n=67). The median duration of antibiotics was significantly lower in the post-DE group (6 days; range 3-60 days) compared to the pre-DE group (8 days; range 3-31 days) (p=0.034). There were no differences in any secondary endpoints. We conclude that antibiotic DE in neutropenic HCT or CAR T-cell therapy patients treated with broad-spectrum antibiotics for at least three days who are afebrile and without documented infection appears to be a safe and effective practice. Adopting it significantly reduces the number of days of antibiotics without compromising patient outcomes.
发热性中性粒细胞减少症（FN）是造血细胞移植（HCT）和嵌合抗原受体（CAR）T 细胞治疗患者经常遇到的一种肿瘤急症，需要立即使用广谱抗生素。有关中性粒细胞减少患者抗生素降级（DE）的数据有限，指南建议也各不相同。如果患者在 72 小时后无发热且无临床感染证据，则采用广谱抗生素降级的临床方案。主要终点是抗生素治疗天数在实施前和实施后两组之间的差异。次要终点包括指数住院期间的后续菌血症发生率、30 天死亡率和住院时间。我们对病历进行了回顾性分析，以评估根据抗生素降级方案接受异基因造血干细胞移植、自体造血干细胞移植或CAR T细胞治疗的患者（DE后）与未接受治疗的患者（DE前）的治疗效果。DE前组从2018年2月至2018年9月接受了HCT/CAR T细胞治疗（n=64），DE后组从2019年2月至2019年9月接受了HCT/CAR T细胞治疗（n=67）。与DE前组（8天；范围3-31天）相比，DE后组的抗生素中位持续时间显著缩短（6天；范围3-60天）（P=0.034）。任何次要终点均无差异。我们得出的结论是，对于接受广谱抗生素治疗至少三天且无发热和感染记录的中性粒细胞移植或 CAR T 细胞治疗患者，抗生素 DE 似乎是一种安全有效的做法。在不影响患者预后的情况下，采用这种方法可大大减少抗生素的使用天数。
{"title":"Early de-escalation of antibiotic therapy in hospitalized cellular therapy adult patients with febrile neutropenia","authors":"M. Lucena, Kelly J. Gaffney, Theresa A. Urban, Catherine Forbes, Pavithra Srinivas, N. Majhail, E. Cober, S. Mossad, Lisa Rybicki, B. Hamilton","doi":"10.46989/001c.94105","DOIUrl":"https://doi.org/10.46989/001c.94105","url":null,"abstract":"Febrile neutropenia (FN) is an oncologic emergency frequently encountered in hematopoietic cell transplant (HCT) and chimeric antigen receptor (CAR) T-cell therapy patients, which requires immediate initiation of broad-spectrum antibiotics. Data regarding antibiotic de-escalation (DE) in neutropenic patients are limited, and guideline recommendations vary. A clinical protocol for antibiotic DE of broad-spectrum agents was implemented if patients were afebrile after 72 hours and had no clinical evidence of infection. The primary endpoint was the difference in the number of antibiotic therapy days between the pre-and post-DE protocol implementation group. Secondary endpoints included rates of subsequent bacteremia during index hospitalization, 30-day mortality, and hospital length of stay. Retrospective chart reviews were conducted to assess outcomes for patients who received allogeneic HCT, autologous HCT, or CAR T-cell therapy under the antibiotic de-escalation protocol (post-DE) compared to those who did not (pre-DE). The pre-DE group underwent HCT/CAR T-cell from February 2018 through September 2018 (n=64), and the post-DE group from February 2019 through September 2019 (n=67). The median duration of antibiotics was significantly lower in the post-DE group (6 days; range 3-60 days) compared to the pre-DE group (8 days; range 3-31 days) (p=0.034). There were no differences in any secondary endpoints. We conclude that antibiotic DE in neutropenic HCT or CAR T-cell therapy patients treated with broad-spectrum antibiotics for at least three days who are afebrile and without documented infection appears to be a safe and effective practice. Adopting it significantly reduces the number of days of antibiotics without compromising patient outcomes.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"57 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Approximately 90% of patients with multiple myeloma experience significant pain from osseous involvement during their lifetime. Untreated osseous involvement results in vertebral compression fractures, leading to negative consequences for quality of life. Vertebral augmentation procedures, including percutaneous vertebroplasty and kyphoplasty, offer better and faster pain control and likely lower morbidity compared with non-operative interventions. Our review provides an up-to-date summary of the indications, contraindications, timing, outcomes, and potential complications of vertebral augmentation procedures to guide practicing oncologists in effectively managing bone disease in patients with multiple myeloma.
{"title":"The Role of Vertebral Augmentation Procedures in the Management of Multiple Myeloma","authors":"N. Thalambedu, Mudassar Kamran, Samer Al-Hadidi","doi":"10.46989/001c.92984","DOIUrl":"https://doi.org/10.46989/001c.92984","url":null,"abstract":"Approximately 90% of patients with multiple myeloma experience significant pain from osseous involvement during their lifetime. Untreated osseous involvement results in vertebral compression fractures, leading to negative consequences for quality of life. Vertebral augmentation procedures, including percutaneous vertebroplasty and kyphoplasty, offer better and faster pain control and likely lower morbidity compared with non-operative interventions. Our review provides an up-to-date summary of the indications, contraindications, timing, outcomes, and potential complications of vertebral augmentation procedures to guide practicing oncologists in effectively managing bone disease in patients with multiple myeloma.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"181 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140447649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wolfgang P Rennert, Jenna Smith M, Katie Cormier, Anne E Austin
Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another’s life. They deserve comprehensive supportive care to accompany them throughout the donation process.
对造血干细胞受者的支持性护理需求进行了研究。但对干细胞捐献者的护理需求了解较少。在选择捐献者、准备捐献、捐献过程以及近期和长期的术后护理中，都会遇到护理方面的挑战。我们分析了2018年1月至2023年8月期间乔治敦大学医学院附属医院（MedStar Georgetown University Hospital）1831名连续骨髓和外周干细胞捐献者的护理需求，以支持对当前文献的回顾。在选择过程中，有亲属关系的捐献者可能会遇到影响其积极性的心理压力，而捐献中心可能愿意接受这些捐献者的并发症，这可能会排除无亲属关系的同行捐献。对于骨髓捐献，重要的是不仅要根据最佳基因匹配标准选择捐献者，还要根据合适的捐献者/受捐者体重比例选择捐献者，以促进足够的干细胞产量。在捐献准备阶段，对于外周细胞捐献者，必须预计并处理与干细胞刺激有关的副作用和并发症；而对于骨髓捐献者，则应仔细评估自体血捐献的利弊。干细胞捐献程序本身也有潜在的副作用和并发症。外周细胞捐献者可能需要中央管路，并可能出现低钙血症、血小板减少和贫血。骨髓捐献者则面临麻醉、失血和疼痛等风险。术后护理的重点是疼痛控制、血细胞恢复和恢复高质量生活所需的心理支持。造血干细胞捐献者为挽救他人的生命献出了自己的一部分。在整个捐献过程中，他们应该得到全面的支持性护理。
{"title":"Supportive Care of Hematopoietic Stem Cell Donors","authors":"Wolfgang P Rennert, Jenna Smith M, Katie Cormier, Anne E Austin","doi":"10.46989/001c.92460","DOIUrl":"https://doi.org/10.46989/001c.92460","url":null,"abstract":"Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another’s life. They deserve comprehensive supportive care to accompany them throughout the donation process.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"374 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140447925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Standing on the Shoulders of the Giants: Dr. Kenneth Anderson","authors":"M. Mohty, Kenneth C. Anderson","doi":"10.46989/001c.92692","DOIUrl":"https://doi.org/10.46989/001c.92692","url":null,"abstract":"","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"9 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139802823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Standing on the Shoulders of the Giants: Dr. Kenneth Anderson","authors":"M. Mohty, Kenneth C. Anderson","doi":"10.46989/001c.92692","DOIUrl":"https://doi.org/10.46989/001c.92692","url":null,"abstract":"","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"179 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139862867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Paviglianiti, Tânia Maia, Joël-Meyer Gozlan, E. Brissot, F. Malard, Anne Banet, Zoé Van de Wyngaert, T. Ledraa, R. Belhocine, S. Sestili, Antoine Capes, Nicolas Stocker, Agnès Bonnin, A. Vekhoff, Ollivier Legrand, M. Mohty, R. Duléry
Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) < 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p < 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.
{"title":"Human herpesvirus type 6 reactivation after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide and antithymocyte globulin: risk factors and clinical impact","authors":"A. Paviglianiti, Tânia Maia, Joël-Meyer Gozlan, E. Brissot, F. Malard, Anne Banet, Zoé Van de Wyngaert, T. Ledraa, R. Belhocine, S. Sestili, Antoine Capes, Nicolas Stocker, Agnès Bonnin, A. Vekhoff, Ollivier Legrand, M. Mohty, R. Duléry","doi":"10.46989/001c.92525","DOIUrl":"https://doi.org/10.46989/001c.92525","url":null,"abstract":"Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) < 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p < 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.","PeriodicalId":503947,"journal":{"name":"Clinical Hematology International","volume":"62 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139869911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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