Clinical hematology international最新文献

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.

Chronic graft-versus-host disease (cGVHD) represents a common long-term complication after allogeneic hematopoietic stem cell transplantation (HSCT). It imposes a significant morbidity burden and is the leading cause of non-relapse mortality among long-term HSCT survivors. cGVHD can manifest in nearly any organ, severely affecting the quality of life of a transplant survivor. While the mainstay of treatment has remained systemic immunosuppression with glucocorticoids, progress has been made within the last few years with approvals of three oral agents to treat steroid-refractory cGVHD: ibrutinib, ruxolitinib, and belumosudil. Iatrogenesis contributes a significant portion of the morbidity experienced by patients with cGVHD, primarily from glucocorticoids. This review highlights the myriad impacts of cGVHD, including and beyond the traditional organ systems captured by the National Institutes of Health Consensus Criteria, including iatrogenic complications of long-term immunosuppression. It presents the implications of cGVHD and its treatment on cardiovascular and metabolic health, bone density, endocrine function, sexual health, and ocular and pulmonary disease and outlines a framework around the comprehensive multidisciplinary approach for its evaluation and management.