Advances in Hematology最新文献

Blood transfusion is a vital medical procedure with the potential to save lives; however, it can have serious consequences if not carried out under rigorous principles. Sub-Saharan Africa (SSA) faces considerable challenges in ensuring the security of the transfusion process, particularly in the context of transfusion-transmissible infections (TTIs). These difficulties are principally associated with the elevated prevalence of TTI in the region, including viral (e.g., hepatitis B, HIV and hepatitis C), bacterial (e.g., syphilis), and parasitic (e.g., malaria) diseases, among others. Also, the family replacement donation system, economic and technological limitations and an insufficient donor pool constitute substantial obstacles. Various solutions are currently being recommended, implemented, or applied on a variable scale, depending on the specific country and subregion, to address the challenges above. For instance, it would be judicious to implement measures to prevent infections, such as rigorous donor selection, quality testing for the primary TTI, and pathogen inactivation. This would necessitate deploying innovative and adapted communication strategies to establish a sufficient pool of regular, unpaid voluntary donors and high-quality screening. Therefore, robust and coherent national or regional blood transfusion policies should support the previously outlined measures. These policies should include rigorous quality control and haemovigilance systems and reflect local epidemiological and economic realities.

Platelets form the nidus around which the primary hemostatic cascade is amplified and propagated. Desmopressin (DDAVP) has been shown to enhance platelet function through interaction with the endothelium. Evidence suggests that an alternative mechanism of action may exist. We aimed to determine the effect of DDAVP on platelet function and microclotting of plasma proteins in samples from healthy volunteers. We analyzed blood samples in 20 healthy volunteers with no coagulation abnormalities. Control and test samples were drawn from each participant. DDAVP was added in vitro to test samples. All samples were subjected to PFA-200, viscoelastic (VET) and fluorescence microscopy testing. DDAVP increased TEG MA and decreased K-time in experimental samples. There was no difference between the means in the clotting times in either of the PFA-200 groups. Fluorescence microscopy examining platelet activation and microclot formation showed significant increases in both parameters in the test samples. The results contrast current literature, which suggests that DDAVP has no effect on platelet function independent of the endothelium. This is the first study demonstrating an in vitro effect of DDAVP on platelets examined by VET and microscopy. We conclude that a relationship exists between DDAVP exposure, in vitro, platelet activation and microclot formation.

Aim: B-cell maturation antigen (BCMA) is a nontyrosine kinase receptor expressed during plasma cell differentiation. Binding of ligands such as APRIL and BAFF to BCMA on malignant plasma cells leads to proliferation of tumor cells and plays an important role in the pathogenesis of multiple myeloma. Recent studies have explored the role of serum-soluble BCMA (sBCMA) in assessing tumor load as well as monitoring of response. In this study, we aimed to detect serum sBCMA levels in newly diagnosed multiple myeloma patients as well as monitor the levels at follow-up to correlate with response to therapy.

Methods: This was a prospective, longitudinal study conducted between March 2023 and July 2024. We documented the routine disease characteristics along with sBCMA levels at baseline and followed up sBCMA levels as a marker of therapy response.

Results: Baseline sBCMA levels were significantly higher in patients presenting with anemia and hypercalcemia and in patients having high-risk cytogenetics. There was a trend toward correlation of sBCMA levels with bone marrow plasma cell percentage, β2-microglobulin, and thrombocytopenia. We also found significant association of the sBCMA level with both ISS and R-ISS staging. Furthermore, we assessed the response to therapy in terms of IMWG response criteria and sBCMA-based response. The response according to conventional response criteria correlated significantly with sBCMA-based response. We also found a significant association of decline in sBCMA levels to that of M band on response to therapy. There are certain advantages of using sBCMA as a response monitoring tool, such as in patients with renal impairment and in nonsecretory myeloma.

Conclusion: Our study provides an important insight into the relation of sBCMA to disease characteristics and the kinetics of decline in sBCMA on response to therapy.

Background: There is no strong evidence supporting brentuximab vedotine (BV) efficacy as a salvage regimen for relapsed/refractory Hodgkin's lymphoma (R/R HL) patients before autologous hematopoietic cell transplantation (auto-HCT).

Methods: We performed multicenter retrospective analysis of efficiency of treatment with the BV monotherapy as salvage regimen versus standard salvage chemotherapy (sCT) in 44 patients with R/R HL from a high-risk group.

Results: Twenty-six patients (59.1%) had primary refractory disease. Nineteen patients (43.2%) received BV salvage treatment before auto-HCT, and 12 (63.6%) achieved complete response (CR) that counts 27.3% of the whole study cohort. There was no difference in the CR rate, 2-year progression-free survival, and 2-year overall survival after BV salvage and sCT (63.2% vs. 60%, respectively, p = 0.35; 88.2% vs. 80.7%, p = 0.655; 94.1% vs. 100%, p = 0.735, respectively). There was no difference in neuropathy of all grades, including Grades 2-3 between groups.

Conclusions: The BV as a salvage treatment showed quite high efficiency. Despite a worse clinical characteristic of the BV group, there were no significant differences in the outcomes of the auto-HCT with respect to the salvage regimen (BV versus sCT) used before auto-HCT. Our results suggest that BV before auto-HCT in patients refractory to standard 2nd line treatment equalizes their prognosis to the patient sensitive to standard CT with the same tolerance and toxicity.

Long noncoding RNAs have recently emerged as major players in cancer by operating through complex structural and functional diversity in a wide range of cellular processes. Among these, certain lncRNAs, including MALAT1 and HOTAIR, have been in the limelight concerning AML for their important roles played in regulating gene expression that in turn influence the disease course of AML. This review summarizes the structure and classification of lncRNAs, mechanisms of action regarding cancer biology, and how lncRNAs such as MALAT1 and HOTAIR act as oncogenes or tumor suppressors. It also examines intricate correlations among these lncRNAs and the bone marrow microenvironment with regard to effects on AML cell proliferation, migration, and survival. In the current review, the key pathways in AML, through which MALAT1 and HOTAIR drive cellular proliferation and epigenetic processes, are discussed in detail to point out possible therapeutic targets. The interactions between MALAT1 and HOTAIR within the bone marrow microenvironment suggest the diverse involvement of lncRNAs in AML and support their applications in biomarker development and as novel avenues for targeted therapies. This review thus represents a broad overview with the intention of furthering our understanding of the lncRNA-mediated pathways in AML and their use as diagnostic and therapeutic tools.

Sodium-glucose Cotransporter 2 inhibitors (SGLT2i) are widely used and effective pharmacotherapeutic options that are first-line therapy for Type 2 diabetes mellitus (T2DM) and congestive heart failure. A major adverse effect of SGLT2i usage is diabetic ketoacidosis (DKA). SGLT2i-induced DKA commonly presents as euglycemic DKA (EDKA). The safety of empagliflozin in cancer patients is not well established. High intensity treatment of hematologic malignancy poses a unique set of risk factors for EDKA. Four cases of empagliflozin-associated EDKA in hematologic malignancy patients were identified through pharmacy adverse event reporting at a cancer research hospital. All patients were euglycemic except one patient who required CRS/ICANS treatment with dexamethasone, causing steroid-induced hyperglycemia. All four patients had weight loss due to reasons including, but not limited to, reduced oral intake, diarrhea, nausea, and pain. Infections and/or neutropenic fever were also commonalities throughout the four patients. In all patients, DKA contributed to iatrogenic ICU admissions and prolonged hospital stays. SGLT2i use in hematologic malignancy patients may increase the risk of DKA due to high risk of anorexia, weight loss, and infections, all highly associated with intensive treatment that can disrupt the availability and sensitivity to insulin. In patients receiving SGLT2i, clinicians should be aware of risk factors for DKA as well as potential euglycemic presentation to ensure close clinical and laboratory monitoring to facilitate rapid diagnosis and treatment of DKA.

Background: Anemia remains a significant public health issue, affecting populations worldwide, particularly in low-income countries. Despite its widespread prevalence, no comprehensive studies have been conducted to assess the prevalence of anemia or its associated factors among university students in Somalia. This study aimed to assess the prevalence of anemia and its associated factors among undergraduate students at SIMAD University, Mogadishu, Somalia.

Methodology: A cross-sectional study was conducted involving 264 participants from various faculties. Data on sociodemographic factors, medical and lifestyle factors, and hemoglobin (Hb) concentrations were collected. Statistical analysis including descriptive statistics, Pearson chi-square tests, and logistic regression was performed to determine associations between variables and anemia prevalence.

Results: The mean age of participants was 20.3 ± 2.5 years, with an equal distribution of male and female students. The overall prevalence of anemia was 48.1%. Higher rates of anemia were observed among females (p < 0.001) and those not engaging in regular exercise (p = 0.001). Logistic regression showed that being male (OR = 0.409, 95% CI: 0.249-0.671) and engaging in exercise (OR = 0.299, 95% CI: 0.168-0.532) were protective against anemia. History of hospitalization showed a nonsignificant association with increased anemia risk (OR = 1.523, p = 0.121). A knowledge assessment revealed that 64.4% of the participants had good knowledge of anemia.

Conclusion: Anemia was highly prevalent (48.1%) among undergraduate students, particularly among females and those not engaging in regular exercise. Male gender and physical activity were protective factors. Despite good knowledge levels, the burden remains significant. Targeted awareness campaigns, routine screening, and interventions promoting healthy lifestyles are essential to reduce anemia and its impact on students' health and academic performance. Further research should guide context-specific policy development.

Multiple myeloma (MM) is a heterogeneous hematologic malignancy, with high-risk cytogenetic abnormalities (HRCAs) such as del(17p), t(4; 14), t(14; 16), and gain(1q) contributing to poor prognosis in approximately 20%-25% of newly diagnosed patients. These abnormalities are associated with aggressive disease, frequent relapses, and inferior progression-free and overall survival. This review explores the evolving therapeutic landscape for high-risk MM, focusing on induction strategies for both transplant-eligible and transplant-ineligible patients, the role of autologous stem cell transplantation (ASCT), and the use of consolidation and maintenance therapies. Emerging modalities such as bispecific antibodies and chimeric antigen receptor T-cell (CAR-T) therapies are examined, particularly in the context of their integration into earlier lines of treatment. Quadruplet induction regimens incorporating proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies have shown promise in improving outcomes and are becoming a cornerstone of frontline therapy. The review also emphasizes the potential of personalized, risk-adapted approaches based on cytogenetic profiling and minimal residual disease (MRD) monitoring. Ongoing clinical trials investigating the early use of CAR-T cells and bispecific antibodies may further transform the standard of care for patients with high-risk MM.

Background: Duffy-null associated neutrophil count (DANC) causes neutropenia without clinical sequelae. 25%-50% of people of African ancestry in the United States are thought to have Fy(a-b-) status and are often erroneously identified as having pathologically low neutrophil counts. Results: We performed a retrospective chart review of new neutropenia referrals to the Hematology Clinic at Boston Medical Center (BMC) to evaluate diagnostic patterns for Fy(a-b-) status. 103 new referrals for neutropenia were made from 1/2020 to 2/2022, of which 78 were included for further analysis. DANC was the etiology for low neutrophil count in 64.1%, 82% of whom were African American or Black or were born in an African or Caribbean country. 66% of these patients underwent confirmatory blood bank testing, and 97% of patients tested were confirmed to have Fy(a-b-) status. The average cost of a laboratory visit for patients with typical neutrophil count with Fy(a-b-) status was on average lower, but not negligible, than those without ($363.82 vs. $737.93; p < 0.005). These patients were also statistically less likely to have a follow-up appointment (p=0.039). Conclusions: Expanded use of serological Fy(a,b) antigen testing for patients with chronic, asymptomatic neutropenia could reduce the cost of care and referrals to the hematology clinic.

Background: Malaria and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are widely recognized infectious diseases that pose serious public health challenges in Sub-Saharan Africa and around the globe. A key factor contributing to the rise in human deaths related to malaria and HIV/AIDS is how these diseases can change the hematological parameters in people who are infected with both. Despite the significant effect of malaria and HIV/AIDS on hematological parameters, there are limited data regarding hematological profiles among malaria-HIV coinfected cases. Therefore, this study aimed to determine the hematological profiles of HIV-malaria-coinfected adults receiving highly active antiretroviral therapy at Bonga Gebretsadik Shawo General Hospital. Methods: A hospital-based comparative cross-sectional study was conducted among 196 HIV-infected patients (98 HIV-infected and 98 HIV-malaria coinfected) at Bonga General Hospital from 13 June to 3 November 2022. Five milliliters of venous blood samples were collected to detect parasites, estimate parasite density, measure viral load, and perform a complete blood count. Sociodemographic data were collected using structured questionnaires. Data were analyzed using SPSS Version 25. Descriptive statistics, independent samples t-tests, and Spearman correlation tests were performed. A p value of < 0.05 was set as the cutoff for significance. Results: The study included 196 adults living with HIV. Statistical differences were observed in the mean ± SD values of red blood cells, hemoglobin, and hematocrit (p < 0.05) between HIV-infected and HIV-malaria coinfected study participants. In a total of study participants, significant negative correlations were found between viral load and total white blood cell count, neutrophils, lymphocytes, eosinophils, red blood cells, hemoglobin, hematocrit, mean cell volume, and platelet count. Anemia, leukopenia, and thrombocytopenia were present in 88 (44.9%), 77 (39.3%), and 50 (25.5%) of the 196 participants, respectively. In the HIV-malaria-coinfected group, there was a negative correlation between parasite density and red blood cell count, hemoglobin, hematocrit, and platelets. The prevalence of anemia, leukopenia, and thrombocytopenia among malaria and HIV-coinfected study participants was 60 (61.2%), 43 (43.88%), and 30 (30.6%), respectively. A statistically significant difference (p < 0.001) was observed in the prevalence of anemia between the two groups. Conclusion and Recommendations: The prevalence of anemia was significantly higher in HIV-malaria-coinfected participants than HIV monoinfected paricipants. Mean values of hematological profiles were significantly different in the two groups. Further studies with a larger sample size are needed to support future results.