Hematology, transfusion and cell therapy最新文献

Objective: To evaluate the early detection of cardiotoxicity using echocardiography in children and adolescents with cancer treated with anthracyclines.

Methods: This cross-sectional study was conducted in a tertiary pediatric oncology center in Northeastern Brazil between January 2018 and December 2022. Eligible participants were under 19-year-old patients with cancer treated with anthracyclines presenting left ventricular ejection fraction ≥55% (assessed using the biplane Simpson's method) and abnormal left ventricular global longitudinal strain.

Results: A total of 45 patients meeting the inclusion criteria were included. Among them, 19 patients (42.2%) showed reduced ejection fraction or left ventricular global longitudinal strain (or both) compared with baseline values, and 57.9% were asymptomatic. The most prevalent cancer was leukemia (55.5%), followed by lymphoma (20.0%). A total of 75.6% of participants were undergoing cancer treatment at the time of diagnosis of cardiotoxicity. An isolated left ventricular ejection fraction reduction occurred in 26.3% of patients, isolated left ventricular global longitudinal strain reduction in 47.4% of patients, and both alterations were experienced by 26.3% of patients.

Conclusions: Anthracycline-induced cardiotoxicity is a relevant adverse effect in cancer treatment, especially in patients with leukemia and lymphoma. Echocardiography, especially the assessment of left ventricular global longitudinal strain, plays a critical role in the early and subclinical detection of cardiotoxicity in pediatric patients.

Background: Severe refractory alloimmune thrombocytopenia is a challenging and life-threatening complication in patients with hematologic disorders who are undergoing allogeneic hematopoietic stem cell transplantation. This study aimed to investigate the utility of continuous intravenous immunoglobulin and platelet transfusions as a therapeutic approach for alloimmune thrombocytopenia in patients undergoing allogeneic transplants.

Methods: A single-center retrospective analysis was conducted of ten adult allogeneic transplant patients hospitalized with transfusion-refractory alloimmune thrombocytopenia. Intravenous immunoglobulin (2 g/kg) was administered as a slow continuous infusion over 48 h along with a continuous apheresis platelet infusion (one apheresis unit over eight hours). Clinical response was defined as the resolution of bleeding or patients being able to undergo the required procedure without bleeding complications.

Results: The median time after the transplant was 27.5 (range: 7-299) days. Myeloablative and reduced-intensity conditioning were performed in 5 (50 %) and 5 (50 %) patients, respectively. The median platelet count at the time of infusion was 4.5 × 10⁹/L. All patients were able to achieve clinical response with the median maximum platelet count within ten days of the infusion being 41.0 × 10⁹/L. The median time to best response was three days with a median platelet count of 27.0 × 10⁹/L.

Conclusions: Continuous intravenous immunoglobulin and platelet infusions over 48 h may be able to overcome life-threatening refractory alloimmune thrombocytopenia in transplant patients and may provide a bridging measure until platelet engraftment or for life-threatening hemorrhage or invasive procedures with high bleeding risk.