Clinical hematology international最新文献

Background: Cytomegalovirus (CMV) infection is a common and life-threatening complication following allogeneic haematopoietic stem cell transplantation (allo-HSCT). Letermovir (LET) has been the standard prophylaxis for adult recipients, but studies in children remain limited.

Methods: We retrospectively analyzed children with or without LET prophylaxis after haploidentical donor (HID) for the Beijing protocol or unrelated cord blood (UCB) transplantation.

Results: Of the 151 patients, 67 received LET, including 35 HID recipients and 32 UCB recipients. During the 180 days after transplantation, we found that the LET group had a lower incidence of clinically significant CMV infection (csCMVi) than the non-LET group (13.4% vs. 56.0%, P＜0.001). In the LET group, later LET administration was identified as a risk factor for the occurrence of csCMVi (HR: 1.07, 95% CI: 1.01 - 1.14, P=0.029). Further, the HID subgroup had a lower incidence of csCMVi during follow-up than the UCB subgroup (2.9% vs. 25.0%, P=0.009). In terms of safety, the incidence and severity of adverse events, overall survival, cumulative incidence of relapse, relapse free survival, nonrelapse mortality and graft versus host disease-free, relapse-free survival were similar between the two groups.

Conclusion: LET is effective and safe in preventing csCMVi among Chinese children undergoing allo-HSCT. Compared to UCB recipients, children undergoing HID transplantation for the Beijing protocol develop less scCMVi up to 180 days post-HSCT.

FLT3-mutated acute myeloid leukemia (AML) with central nervous system (CNS) involvement poses therapeutic challenges. We describe two cases and performed a systematic review evaluating the efficacy of therapeutic strategies in CNS involvement for both FLT3-mutated and wild-type (WT) AML. A MEDLINE, EMBASE, and Cochrane literature search identified relevant studies. Although CNS involvement in AML is associated with poor prognosis, routine CNS prophylaxis is not standard. Due to the uncertainty regarding the effect of intermediate doses of cytarabine on CNS involvement, we support a diagnostic lumbar puncture (LP) after achieving complete remission in patients with risk factors for CNS infiltration. Consolidation management should be modified depending on the result of the LP. The impact of total body irradiation (TBI) as a conditioning regimen in allogeneic stem cell transplantation on CNS AML outcomes remains ambiguous. Routine craniospinal irradiation is not recommended due to its associated higher morbidity rates, while cranial radiotherapy is preferred, particularly when combined with TBI. Fortunately, currently we can employ a FLT3 inhibitor with CNS penetrance in FLT3-mutated (either gilteritinib or sorafenib) or FLT3-WT (sorafenib) AML patients.

Treatment options for newly diagnosed multiple myeloma (NDMM) have expanded dramatically over the last two decades, resulting in remarkable improvements in response rates and median survival times. In eligible patients, autologous stem cell transplant plays the central role of an overall treatment strategy comprising induction, transplantation, consolidation, and maintenance. In this article, we draw from our own collective clinical experience of treating patients with NDMM in the Gulf region to discuss treatment strategies in both transplant-eligible and -ineligible patients, as well as in high-risk patients. We present position statements for these distinct patient populations specifically for treatment in the Gulf region, where patients with NDMM have a younger median age than and different comorbidity profile from Western populations. We discuss how the introduction of anti-CD38 agents, including daratumumab and isatuximab, have had a major impact on the frontline treatment landscape in MM, with daratumumab-based quadruplet and triplet regimens emerging as the new standard of care in transplant-eligible and -ineligible patients, respectively. In addition, we advocate aggressive quadruplet treatment of high-risk patients with NDMM, as part of a strategy including single or tandem transplant when eligible. Finally, we discuss the clinical and practical rationale behind our statements, which is intended to serve as a useful reference for hematologists treating physicians within the Gulf region and beyond.

High-quality peer review is a cornerstone of credible and impactful scientific and medical publishing. This manuscript provides a comprehensive overview of the best practices, responsibilities, and evaluation criteria for peer reviewers in clinical and translational research. By adhering to high standards of objectivity, rigor and professionalism, peer reviewers support the integrity of scientific research and contribute to the evolution of evidence-based medicine. We elaborate on the principles and structured processes that ensure a thorough, impartial review, aiming to guide reviewers in producing evaluations that enrich the scientific discourse and foster innovation in clinical practice.

Cytomegalovirus reactivation (CMV-R) is a frequent complication post-allogeneic hematopoietic stem cell transplantation (allo-HSCT), associated with poor outcomes. Previous studies have demonstrated the protective effect of CMV-R against relapse after allo-HSCT for acute myeloblastic leukemia (AML). However, this impact remains unclear in acute lymphoblastic leukemia (ALL). We conducted a retrospective study on 81 patients with ALL who received allo-HSCT after myeloablative conditioning regimen from matched sibling donors between 2016 and 2022. All patients underwent weekly monitoring for CMV-R by quantitative polymerase chain reaction assay from engraftment until day +100 post allo-HSCT, and received antiviral prophylaxis with acyclovir from day +1 to 6 months after allo-HSCT. Preemptive treatment was initiated when a viremia was higher than 150 copies/mL. The median age was 20 years (range, 5-50 years). After allo-HSCT, 35% of patients developed CMV-R after a median of 39 days (range, 19-100 days). After a median follow-up of 30 months (range, 1-93 months), CMV-R was an independent factor associated with lower cumulative incidence of relapse (CIR) (OR: 0.17; 95% CI [0.03 - 0.98], p = 0.04) without survival benefit. Further studies are needed to validate the protective effect of CMV-R on ALL relapse.

Background: Advanced Therapy Medicinal Products (ATMPs) for human use have advanced globally with the rapid adoption of Chimeric Antigen Receptor T-cell (CAR-T) therapies in haemato-oncology. CAR-T cell therapy and ATMPs have unique, significant acute and chronic toxicities, and appropriate patient care is crucial. Significant challenges, including the need for nurse education and training, accompany optimal patient success and benefits.

Objectives: This study aimed to describe nurses' training needs in relation to ATMP management and patient care.

Methods: A cross-sectional online survey was performed by the European Society for Blood and Marrow Transplantation, based on a previously tested questionnaire developed in the UK.

Findings: 109 complete responses from 86 different centers from 24 countries were returned (1207 distributed). Over 1/3 reported experience delivering licensed ATMPs (CAR-T). High-priority training areas included a general introduction to ATMPs, toxicity management, product-specific information, and regulatory frameworks for ATMPs. A clear need for ATMP-specific training exists and is regarded as important. Training prior to implementation is key and should be supported by ongoing competency maintenance. Counseling, patient support, and long-term follow-up are identified for future training and opportunities for nurse experience sharing in this rapidly evolving field.

not included as this is letter to the editor.