La prévention anti infectieuse au cours des greffes de cellules souches hématopoïétiques

Les infections bactériennes, fongiques ou virales sont des complications fréquentes au cours des procédures de greffes de cellules souches hématopoïétiques, aussi bien au cours des autogreffes qu’au cours des allogreffes en hématologie. Ces infections, en particulier les sepsis ou les infections fongiques, telles que les aspergilloses in­vasives,sont responsables d’un taux élevé de décès durant les phases d’aplasie post conditionnement, en particulier myéloablatif. Afin de diminuer la morbi-mortalité des infections, l’introduction du traitement préventif des infections a permis de réduire de façon significative le taux de mortalité lié à la procédure. Par ailleurs, le groupe coopératif européen des greffes EBMT a mis en place un orga­nisme qui permet d’accréditer les activités des centres de greffe au vu des protocoles et des procédures qu’ils ont mis en place

La prévention anti infectieuse au cours des greffes de cellules souches hématopoïétiques

Les infections bactériennes, fongiques ou virales sont des complications fréquentes au cours des procédures de greffes de cellules souches hématopoïétiques, aussi bien au cours des autogreffes qu’au cours des allogreffes en hématologie. Ces infections, en particulier les sepsis ou les infections fongiques, telles que les aspergilloses in­vasives,sont responsables d’un taux élevé de décès durant les phases d’aplasie post conditionnement, en particulier myéloablatif. Afin de diminuer la morbi-mortalité des infections, l’introduction du traitement préventif des infections a permis de réduire de façon significative le taux de mortalité lié à la procédure. Par ailleurs, le groupe coopératif européen des greffes EBMT a mis en place un orga­nisme qui permet d’accréditer les activités des centres de greffe au vu des protocoles et des procédures qu’ils ont mis en place

Bone marrow graft versus peripheral blood graft in haploidentical hematopoietic stem cells transplantation: a retrospective analysis in1344 patients of SFGM-TC registry.

peer reviewedThe use of peripheral blood (PB) or bone marrow (BM) stem cells graft in haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis remains controversial. Moreover, the value of adding anti-thymoglobulin (ATG) to PTCy is unknown. A total of 1344 adult patients received an unmanipulated haploidentical transplant at 37 centers from 2012 to 2019 for hematologic malignancy. We compared the outcomes of patients according to the type of graft, using a propensity score analysis. In total population, grade II-IV and III-IV acute GVHD (aGVHD) were lower with BM than with PB. Grade III-IV aGVHD was lower with BM than with PB + ATG. All outcomes were similar in PB and PB + ATG groups. Then, in total population, adding ATG does not benefit the procedure. In acute leukemia, myelodysplastic syndrome and myeloproliferative syndrome (AL-MDS-MPS) subgroup receiving non-myeloablative conditioning, risk of relapse was twice greater with BM than with PB (51 vs. 22%, respectively). Conversely, risk of aGVHD was greater with PB (38% for aGVHD II-IV; 16% for aGVHD III-IV) than with BM (28% for aGVHD II-IV; 8% for aGVHD III-IV). In this subgroup with intensified conditioning regimen, risk of relapse became similar with PB and BM but risk of aGVHD III-IV remained higher with PB than with BM graft (HR = 2.0; range [1.17-3.43], p = 0.012)

Predictive factors of thrombosis during autologous stem cell transplantation in multiple myeloma: Experience from EHU Oran (Algeria)

Introduction-The objectives of our work are to measure the incidence of thrombosisand identify predictive factors during the procedure of autologous hematopoieticstem cells, during real life, in the University Hospital of Oran (Algeria).Methods-This is a retrospective study covering a period from 2009 to 2019. The diagnosisof thrombosis is made on the basis of clinical signs and symptoms of thrombosisand confirmed by a Doppler ultrasound of the site of location concerned oran angio-scanner, in the case of suspicion of arterial embolism, as well as D-Dimerelevation. The study focused on the overall incidence of thrombosis and the identificationof predictive factors during the autograft procedure. Thepredictive factorsstudied are: age, co-morbidities, use of IMiDs, use of Granocyte colony stimualingfactor in mobilization, the central venous catheter insertion site, cytapheresiscount, CD34+ perfused, and finally deep venous thrombosis prophylaxis by a lowmolecular weight heparin .The statistical analysis focused on a univariate study,followed by a multivariate analysis using binary logistic regression.Results-Among 411 patients with MM underwent autologous transplantation ofwhich 249 were male with a sex ratio of 1,53. The overall incidence of thrombosiswas estimated at 18,49% (76 patients). The associative factors found in univariateanalysis in our study are the use of IMiDs (p = 0,0006), the femoral KTC insertion site(p = 0,021) and its duration (p = 0,018), the level of G-CSG≥ 15μg/kg (0,014) duringHSC mobilization and aplastic phase, the number of perfused CD34 +> 5x106/kg (p= 0,035) and prophylaxis with low molecular weight heparin (LMWH)(p = 0,029).Inmultivariate analysis, only the absence of LMWH prophylaxis was an independentpredictor of thrombosis (p=0.001).Conclusion-Despite the similarity of the overall incidence of thrombosis with the literature,its prophylaxis with LMWHs was the only independent factor of its risk inAlgeria, which would have restricted it in daily practice of autografts in multiplemyeloma

The proportion of different BCR-ABL1 transcript types in chronic myeloid leukemia. An international overview

There are different BCR-ABL1 fusion genes that are translated into proteins that are different from each other, yet all leukemogenic, causing chronic myeloid leukemia (CML) or acute lymphoblastic leukemia. Their frequency has never been systematically investigated. In a series of 45503 newly diagnosed CML patients reported from 45 countries, it was found that the proportion of e13a2 (also known as b2a2) and of e14a2 (also known as b3a2), including the cases co-expressing e14a2 and el 3a2, was 37.9% and 62.1%, respectively. The proportion of these two transcripts was correlated with gender, e13a2 being more frequent in males (39.2%) than in females (36.2%), was correlated with age, decreasing from 39.6% in children and adolescents down to 31.6% in patients >= 80 years old, and was not constant worldwide. Other, rare transcripts were reported in 666/34561 patients (1.93%). The proportion of rare transcripts was associated with gender (2.27% in females and 1.69% in males) and with age (from 1.79% in children and adolescents up to 3.84% in patients >= 80 years old). These data show that the differences in proportion are not by chance. This is important, as the transcript type is a variable that is suspected to be of prognostic importance for response to treatment, outcome of treatment, and rate of treatment-free remission