Bone marrow homing and engraftment defects of human hematopoietic stem and progenitor cells

Homing of hematopoietic stem cells (HSC) to their microenvironment niches in the bone marrow is a complex process with a critical role in repopulation of the bone marrow after transplantation. This active process allows for migration of HSC from peripheral blood and their successful anchoring in bone marrow before proliferation. The process of engraftment starts with the onset of proliferation and must, therefore, be functionally dissociated from the former process. In this overview, we analyze the characteristics of stem cells (SCs) with particular emphasis on their plasticity and ability to find their way home to the bone marrow. We also address the problem of graft failure which remains a significant contributor to morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Within this context, we discuss non-malignant and malignant hematological disorders treated with reduced-intensity conditioning regimens or grafts from human leukocyte antigen (HLA)-mismatched donor

Occurrence of immune thrombocytopenic purpura in a patient with essential thrombocythemia: How the immune system can overcome a neoplastic clone

Our case highlights the possible coexistence of essential thrombocythemia (ET) and idiopathic thrombocytopenic purpura (ITP), two pathological entities with opposite clinical and laboratory manifestations. It also underlines how an autoimmune attack has been temporarily able to overcome a neoplastic clone

Clinical course and features of persistent polyclonal B-cell lymphocytosis with BCL-6 amplification during pregnancy

Background: Persistent polyclonal B-cell lymphocytosis is a rare nonmalignant disorder characterized by mild persistent lymphocyte proliferation with possible evolution to aggressive lymphoma. Its biology is not well known, but it is characterized by a specific immunophenotype with rearrangement of the BCL-2/IGH gene, whereas amplification of the BCL-6 gene has rarely been reported. Given the paucity of reports, it has been hypothesized that this disorder is associated with poor pregnancy outcomes. Case report: To our knowledge, only two successful pregnancies have been described in women with this condition. We report the third successful pregnancy in a patient with PPBL and the first with amplification of the BCL-6 gene. Conclusions: PPBL is still a poorly understood clinical condition with insufficient data to demonstrate an adverse effect on pregnancy. The role of BCL-6 dysregulation in the pathogenesis of PPBL and its prognostic significance are still unknown. Evolution into aggressive clonal lymphoproliferative disorders is possible and prolonged hematologic follow-up is warranted in patients with this rare clinical disorder

Adherence to treatment in patients with solid and hematological cancers. Could spiritual and psychological support facilitate optimal adherence?

ABSTRACT – Objective: Cancer-related diseases pose a substantial public health challenge; however, recent treatments have enhanced patient outcomes. Adherence to therapy is crucial, and research focuses on elucidating the factors that influence it. Limited information exists on medication adherence in cancer patients. This study aims to identify risk factors for non-adherence in a cohort of people with solid and hematological tumors. Participants and Methods: This is a cross-sectional study in which participants were recruited from two Oncologic hospital units in Italy. The inclusion criteria were age ≥ 18 years, confirmed malignant neoplasm, and active treatment. Data included sociodemographic and clinical-oncological factors. Treatment adherence was assessed through a clinician-based dichotomous scale. Health-related quality of life (HRQoL) was evaluated with the Short Form Health Survey – 12 items (SF-12), satisfaction with care was measured using the Treatment Perception Questionnaire. Results: A total of 263 participants (132 females, 50.2%) was involved in this study. The mean age was 61.2±13.8. Non-adherence frequency was 9.9%. Factors associated with non-adherence were shorter time since care initiation (<6 months), receiving palliative care, having a solid cancer diagnosis. Non-adherence was higher in solid cancer (12.4%) compared to hematologic cancer (1.6%). In the combination of risk factors, a significant association was found between unemployment/high level of education and non-adherence. Conclusions: The study found a low non-adherence rate to oncological treatments, possibly due to strong psychological and spiritual support. However, individuals with higher education and unemployment showed specific non-adherence risk, necessitating attention to their emotional challenges while facing canc

Low adherence to therapy and co-morbid depressive episodes are independent determinants of early death in people with cancer

Objective: The demanding nature of oncological therapies may affect treatment motivation and adherence, leading to an increased risk of premature death. Exploring the interaction between depressive episodes and treatment adherence is essential, considering how depression may influence patients' willingness to continue treatment. This study aims to investigate the association between depressive episodes, low treatment adherence, and premature death in individuals with cancer. The study also assessed whether low adherence to therapy acted as a mediator in the relationship between depression and the risk of early death. Participants and Methods: This is a 9-month cohort study in which participants were enrolled in two Italian Oncology hospital units. The Patient Health Questionnaire (PHQ-9) was used for depression screening. Stratified analyses were conducted to explore the relationship between depression, low adherence, and premature death. Results: Out of 263 subjects, depressive episode frequency was 48.2% and low adherence was 9.9%. After 9 months, 13.7% had died. There was a significative association between experiencing a depressive episode (RR=2.14, 95% CI: 1.08-4.39) and low adherence (RR=2.2, 95% CI: 1.01-4.48) upon cohort entry and being deceased at month 9 of observation. The risk associated with depression was found to persist even after accounting for the level of adherence to therapy through standardization (MH-OR=3.11; 95% CI: 1.52-6.34). Conclusions: Individuals with cancer who experience a depressive episode or demonstrate low adherence to therapy are at risk for premature death. Early intervention targeting depressive symptoms and treatment adherence may improve oncological-related outcomes