Circulating sCD138 and Some Angiogenesis-Involved Cytokines Help to Anticipate the Disease Progression of Early-Stage B-Cell Chronic Lymphocytic Leukemia

Syndecan-1 (CD138) is a transmembrane heparin sulfate proteoglycan expressed on distinct stages of differentiation of B-lymphoid cells. Its prognostic value in B-cell chronic lymphocytic leukemia (B-CLL) has not been evaluated so far. The serum concentration of sCD138 and some angiogenesis-involved cytokines: vascular endothelial growth factor (VEGF), basis fibroblast growth factor (bFGF), and endostatin were studied in 52 previously untreated patients with B-CLL. We found that bFGF and sCD138 levels were significantly higher in B-CLL patients than in controls. In patients with sCD138 level or endostatin level below the median value the lymphocyte count was higher than in patients with serum level of those cytokines above the median value. In patients with progressive disease bFGF level was significantly higher and sCD138 level significantly lower than in patients with stable one. Moreover, high sCD138 level was associated with longer lymphocyte doubling-free survival, and, on the limit of statistical significance, a high endostatin level was associated with shorter progression-free survival. We conclude that serum sCD138 level is increased in early stage B-CLL patients and may have a positive prognostic value as to the dynamics of the disease

Real-life experiences of letermovir prophylaxis for cytomegalovirus infection in patients after hematopoietic stem cell transplantation: Polish Acute Leukemia Group (PALG) analysis

Introduction: Letermovir (LMV) is a new, cytomegalovirus (CMV)-specific, antiviral drug, approved in 2018 for CMV prophylaxis in patients after allogeneic hematopoietic transplantation. The introduction of letermovir prophylaxis has changed the management of CMV infection: it has reduced the incidence of CMV infections and CMV-related complications, and also improved the overall survival in CMV seropositive patients. However, until recently, due to its high treatment cost, prophylaxis with letermovir has not beeen a standard of care in Poland. Material and methods: To confirm the effectiveness and safety of letermovir prophylaxis, we collected real-life data from eight Polish transplant centers, in which a total of 53 patients were treated with letermovir, including off-label use. Results: LMV is characterized by low toxicity and good tolerability. There were no reports of special adverse events caused by LMV. Conclusions: Our experiences confirm the effectiveness and safety of letermovir prophylaxis, and suggest that this prophylaxis should be started as soon as possible after the infusion of stem cells, preferably no later than day 14. Moreover, our findings indicate that some patients could benefit from extended letermovir prophylaxis beyond 100 days after transplant

Vaccination of hematopoietic cell transplantation adult recipients – guidelines of Infectious Diseases Working Group PALG

Infections are the most serious complications in patients undergoing hematopoietic cell transplantation (HCT). Vaccinations occur to be undeniably one of the most important prophylactic strategies and are routinely recommended in the post-transplantation period. Their use reduces the incidence of infections and infection-related mortality. In this paper, we present the current guidelines for active immunization after HCT for the Polish patient population as worked out by the Polish Adult Leukemia Group (PALG). The guidelines include the recommended vaccines, the optional vaccines and vaccination with live pathogens. The management in specific situations such as graft versus host disease and for HCT recipients travelling to exotic countries is clarified. We also present the proposal for organization of the vaccination program in transplant centers. The improvement in realization of the vaccination protocol is one of the key aspects of post-transplantation care in Poland

Plerixafor for patients who fail cytokine-or chemotherapy-based stem cell mobilization: Results of a prospective study by the Polish Lymphoma Research Group (PLRG)

Autologous hematopoietic stem cell transplantation (autoHSCT) requires collection of sufficient number of hematopoietic stem cells. The goal of this study was to evaluate efficacy of plerixafor used in patients with lymphoid malignancies failing conventional stem cell mobilization.This was a prospective, non-interventional study. All consecutive patients (n = 109) treated with plerixafor in 11 centers were reported. The drug was used either in case of previous mobilization failure (n = 67) or interventionally, in case of insufficient CD34 cell output during current mobilization (n = 42). Successful mobilization was defined as resulting in collection of ≥ 2 × 10 CD34 cells/kg for single autoHSCT or ≥ 4 × 10 CD34 cells/kg for double procedure.The overall rate of successful mobilization was 55% (55% for single and 56% for double autoHSCT). The median total number of collected CD34 cells/kg was 2.4 (range, 0-11.5) for patients intended for a single transplantation while 4.0 (0.6-16.9) for double procedure. The number of circulating CD34 cells increased after the use of plerixafor regardless of baseline values. The median fold increase was 3.3 (0.3-155). Data from this observational study confirm high efficacy of plerixafor used in routine clinical practice as salvage for patients with lymphoid malignancies failing conventional stem cell mobilization

Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation : lesson from the nationwide study

Incidence and outcome of microbiologically documented bacterial/viral infections and invasive fungal disease (IFD) in children and adults after hematopoietic cell transplantation (HCT) were compared in 650 children and 3200 adults in multicenter cross-sectional nationwide study. Infections were diagnosed in 60.8% children and 35.0% adults, including respectively 69.1% and 63.5% allo-HCT, and 33.1% and 20.8% auto-HCT patients. The incidence of bacterial infections was higher in children (36.0% vs 27.6%; p  21 days were risk factors for death from infection. In conclusion, pediatric patients have 2.9-fold higher incidence and 2.5-fold better outcome of infections than adults after HCT

Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia

Purpose: Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis. Material and methods: Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacrylate glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization. Results: The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 (p < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation (r = 0.8, p < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time – 27.0 vs. 7.2 days (r = 0.66, p < 0.05). Conclusions: Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate

The effect of lipegfilgrastim on hematopoietic reconstitution and supportive treatment after megachemotherapy with autologous peripheral blood stem cell transplantation in patients with lymphoproliferative malignancies

Megachemotherapy with autologous peripheral blood stem cell transplantation (auto-PBSCT) is a standard treatment option in patients below 70 years of age with multiple myeloma (MM) as well as with relapsed and refractory lymphomas. Recombinant granulocyte colony-stimulating factors (G-CSF) are commonly used to accelerate bone marrow recovery after chemotherapy and reduce the duration of severe neutropenia. Lipegfilgrastim is a glicopegylated G-CSF with prolonged action registered for adult patients with malignant neoplasms in order to reduce the duration of neutropenia and the incidence of febrile neutropenia (FN). So far, there is not enough data to confirm the effectiveness and safety of this drug in patients with hematological malignancies including those undergoing auto-PBSCT. The aim of this study was to determine the effect of lipegfilgrastim on hematopoietic regeneration and supportive care after auto-PBSCT in patients with lymphoproliferative malignancies. The study population consisted of 30 patients (12 female and 18 male; median age: 50 years ± 13), including 13 patients with MM, 5 with Hodgkin’s lymphoma (HL) and 12 with non-Hodgkin’s lymphoma (nHL). The median number of transplanted CD34+ cells was 3.96 ± 1.56 × 10^6/kg of body mass. On day +1 after auto-PBSCT, the patients received lipegfilgrastim in a single 6 mg subcutaneous injection. The control group consisted of 32 patients (13 female and 19 male; median age: 50 years ± 6.4), including 13 with MM, 8 with HL and 11 with nHL, who received subcutaneous filgrastim in a dose of 5 μg/kg/day from day +1 after transplantation and continued to an absolute neutrophil count (ANC) > 1.5 × 10^9/L. There was no significant difference in the time of regeneration ANC > 0.5 × 10^9/L which was 10.65 ± 1.00 vs. 11.51 ± 2.29 days respectively in the study and control group. Similar observations were noted regarding the duration of febrile neutropenia (2.16 ± 2.22 vs. 1.70 ± 4.17 days; p = 0.998), regeneration of platelets (PLT) > 20 × 10^9/L (12.41 ± 2.41 vs. 13.82 ± 4.48 days; p = 0.233) and demand for transfusion of red blood cells (0.76 ± 1.07 vs. 1.33 ± 2.33 units; p = 0.414) and platelets (11.5 ± 6.9 vs. 19.2 ± 17.7 units; p = 0.08). Different results were observed for the length of hospitalization, which was significantly shorter in the lipegfilgrastim group (16.14 ± 14 vs. 24.46 ± 6.79 days; p = 0.000). Lipegfilgrastim is as effective as filgrastim with regards to the regeneration of the hematopoietic system, duration of febrile neutropenia, demand for transfusion of blood products and significantly reduces hospitalization in patients with lymphoproliferative malignancies after auto-PBSCT