The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P = 0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P = 0.18), and for grades III–IV was 2.6% vs 11.6% (P = 0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P = 0.002) and extensive 5% vs 23.6% (P = 0.01). OS was 74% vs 76% for BM vs PBSCs (P = 0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P = 0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P = 0.005) respectively. In multivariate analysis, aGvHD II–IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1–5.6, P = 0.02) and aGvHD III–IV (HR 8.3 CI 3.4–20.2, Po0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patient

Recomendaciones para el descarte de productos de CPH/linfocitos criopreservados: consenso del Grupo Argentino de Trasplante de Médula Ósea (GATMO)

The cryopreservation and storage of hematopoietic stem cells (HSCs) is usually required in the autologous stem cells transplant setting and, in some cases, for allogenic products. The storage of these products has a validity defined by the storage characteristics, clinical utility and security conditions of the product. Here, we present recommendations elaborated by the Argentinian Group of Bone Marrow Transplantation (GATMO).El procedimiento de criopreservación y almacenamiento (CyA) de las células progenitoras hematopoyéticas (CPH) es requerido con frecuencia para la realización de un trasplante CPH autólogo y en algunas ocasiones se requiere la CyA de productos celulares alogénicos (CPH o linfocitos). El almacenamiento de estos productos celulares tiene una validez definida por el medio en el que se almacena, la utilidad clínica del producto y las condiciones de seguridad del producto que fue almacenado. Se presentan recomendaciones emitidas por el Grupo Argentino de Trasplante sobre el descarte de productos criopreservados y almacenados.

Utilidad clínica de la elevación del dímero-D a la admisión en pacientes con sospecha de COVID-19

Introduction: Studies associated increased D-dimer (DD) with severe COVID-19. Methods: Retrospective cohort of patients with suspicion of COVID-19 and DD measurement. Plasma levels of DD at first consultation and the DD peak during hospitalization were recorded (expressed in ng/mL FEU or as patient/age-adjusted expected ratio-P/AA DD-). COVID-19 positive and negative groups were compared. Factors associated with severity and death were evaluated in both groups. Results: Out of 723 patients included, 162 were diagnosed with SARS-CoV2 infection. COVID-19 patients had lower levels of DD [465(226-880) vs 691(295-1823) ng/mL,p500ng/mL at diagnosis was associated with an increased risk of severity, however it was not evidenced with  P/AA DD>1. In this group, DD at admission was not different in deaths compared with survivors. Deceased COVID-19-negative patients had higher levels of DD Conclusions: DD seems not to be a specific biomarker of COVID-19 infection, and its increase is more pronounced in patients who developed pneumonia from other etiologies. Considering age-adjusted DD reference values could avoid the overestimation of its prognostic value in COVID-19 patients.Antecedentes: Estudios asociaron el incremento del Dímero-D (DD) con neumonía COVID-19 grave. Materiales y métodos: Estudio retrospectivo de cohorte de pacientes consecutivos adultos con sospecha de COVID-19 a quienes se les determinó DD.  Se registraron los niveles de DD (primera consulta en el servicio de emergencias y pico en la internación) y otros biomarcadores (ferritina, Láctico deshidrogenasa-LDH-,  Proteína C-Reactiva-ultrasensible -PCRu-). El DD fue expresado en ng/mL FEU y ajustado por edad como razón Paciente / valor de DD esperable ajustado por edad (razón P/DD AE). Se compararon los grupos COVID-19 positivos y negativos y se evaluaron los factores asociados a severidad y muerte   Resultados: De los 723 pacientes incluidos, en 162 se confirmó COVID-19. Los pacientes con COVID-19 presentaron menor DD [465(226-880) vs 691(295-1823) ng/mL,p500 ng/mL al diagnóstico se asoció con mayor severidad [OR ajustado 10,73(IC95% 1,1-104,1), p=0,04], sin observarse cuando se utilizó el P/DDAE>1 [OR crudo 2,29 (IC95%0,84-6,24), p=0,10)]. En ese grupo, no hubo diferencias estadísticamente significativas en el DD entre fallecidos y sobrevivientes. Por el contrario, los pacientes COVID-19-negativos fallecidos tuvieron niveles significativamente más altos de DD (admisión y pico en internación) Conclusiones: DD no es un biomarcador específico de infección por SARS-CoV-2, y su incremento es más pronunciado en pacientes que desarrollan neumonías de otras etiologías. Considerar el DD ajustado por edad puede evitar una sobre-estimación en su valor pronóstico en los pacientes con COVID-19 en su evaluación en el departamento de emergencias

Temporal trends in hematopoietic stem cell transplantation in Argentina between 2009 and 2018: A collaborative study by GATMO-TC and INCUCAI

Special Article: Introduction: Hematopoietic stem cell transplantation is the only curative treatment for many disorders and international data shows a growing trend. Method: We aimed to evaluate the temporal trends in HSCT transplant rates in Argentina. A time-series analysis was performed for the period 2009 to 2018 using the national database from the National Central Coordinating Institute for Ablations and Implants. Crude and standardized transplant rates were calculated. A permutation joinpoint regression model analysis was used to identify significant changes over time. Results: Altogether, 8,474 transplants were reported to INCUCAI by 28 centers (autologous 67.5%); the main indication was multiple myeloma (30%). The WHO age-sex standardized HSCT rates for the entire country were 153.3 HSCT/10 million inhabitants (95% CI 141.7–165.8) in 2009 and 260.1 HSCT/10 million inhabitants (95% CI 245.5–275.5) in 2018. There was a large gap in HSCT rates among the states and regions. The transplant rate was higher for autologous transplants throughout the years. Within the allogeneic group, the related donor transplant rate was higher than the unrelated donor transplant rate. The joinpoint regression analysis of HSCT rates for the whole country over time showed an observed annual percentage change of 6.3% (95% CI 5.4-7.3; p < 0.01). No changes were observed for unrelated donors during the study period. Conclusions: Age-sex standardized HSCT rates in Argentina are increasing, mainly due to autologous and family donor allogeneic transplants. A wide variation across the country was found, demonstrating differences in the access to transplantation among Argentine regions