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

Diagnosis of myelodysplastic syndromes in Poland: Polish Adult Leukemia Group (PALG) 2021 recommendations

Myelodysplastic syndromes (MDS) are a heterogeneous group of neoplastic diseases of the hematopoietic cells manifested by ineffective hematopoiesis and a tendency to transform into acute myeloid leukemia. MDS should be considered in the differential diagnosis of cytopenia, especially in the elderly. This article presents the recommendations of MDS experts of the Polish Adult Leukemia Group (PALG) for the diagnosis of myelodysplastic syndromes. We present current classifications and prognostic indices, as well as diagnostic examinations recommended for MDS: cytological, histopathological, immunophenotypic, cytogenetic and molecular tests. The aim of the study is to implement up-to-date knowledge about myelodysplastic syndromes into routine clinical practice, from the diagnosis of cytopenia to the specific diagnosis and prognosis in MDS patients.  Myelodysplastic syndromes (MDS) are a heterogeneous group of neoplastic diseases of the hematopoietic cells manifested by ineffective hematopoiesis and a tendency to transform into acute myeloid leukemia. MDS should be considered in the differential diagnosis of cytopenia, especially in the elderly. This article presents the recommendations of MDS experts of the Polish Adult Leukemia Group (PALG) for the diagnosis of myelodysplastic syndromes. We present current classifications and prognostic indices, as well as diagnostic examinations recommended for MDS: cytological, histopathological, immunophenotypic, cytogenetic and molecular tests. The aim of the study is to implement up-to-date knowledge about myelodysplastic syndromes into routine clinical practice, from the diagnosis of cytopenia to the specific diagnosis and prognosis in MDS patients.

Butyric acid in inhibition of diarrhoea in course of chemotherapy — case report

Biegunki stanowią istotny problem wśród pacjentów leczonych z powodu nowotworów, zwłaszcza tych poddawanych chemioterapii. Mają poważny przebieg i mogą prowadzić do zagrażającego życiu odwodnienia oraz głębokich zaburzeń elektrolitowych. Wymagają szerokiego, specjalistycznego postępowania diagnostycznego i terapeutycznego. W pracy przedstawiono przypadek pacjenta z chłoniakiem anaplastycznym, u którego po zabiegu autoprzeszczepienia komórek krwiotwórczych wystąpiły uciążliwe, trudne do opanowania biegunki. Po wykorzystaniu standardowych schematów postępowania zdecydowano o wprowadzeniu do diety pacjenta preparatu kwasu masłowego. Kwas masłowy jest substancją endogenną, w warunkach fizjologicznych produkowaną w jelicie grubym i stanowi źródło energii dla komórek nabłonka jelitowego, przyspiesza ich regenerację oraz zwiększa wchłanianie wody z jelita. Pacjent otrzymał preparat zawierający sól kwasu masłowego w postaci chronionej specjalną matrycą, umożliwiającą dotarcie substancji czynnej do dalszych odcinków przewodu pokarmowego. W ciągu kilku dni zaobserwowano subiektywną poprawę, zmniejszenie częstości biegunek i ustąpienie uciążliwych dolegliwości gastrycznych. Uwzględniając całą złożoność leczenia farmakologicznego i dietetycznego, wydaje się, że rola kwasu masłowego w hamowaniu biegunki w prezentowanym przypadku była znacząca. Onkol. Prak. Klin. 2011; 7, 1: 40–42Diarrhea is a crucial problem in cancer patients treated with , chemotherapy. The disease can threat patient’s life, lead to the dehydratation and the electrocytes disbalance. Patients need a complex, diagnostic and therapeutic treatment. Presented work describes anaplastic lymphoma case in which after autologous stem cell transplantation, a severe and difficult to control diarrhea was observed. After standard treatment failure, it was decided to introduce butyric acid to the patient’s diet. Butyric acid is naturally produced in the colon, and instantly taken up by epithelial cells as energy source. Butyric acid accelerates the epithelial cells regeneration and water absorption in intestine. The patient received microencapsulated butyric acid which provided slow release of active substance in the lower part of the gastrointestinal tract. Few days after the onset of butyric acid supplementation considerable improvement was observed, such as the decreased number of watery stools. Despite the complex pharmacotherapy and nutritional intervention, it seems that in the presented case the role of butyric acid did play an important role in the diarrhea inhibition. Onkol. Prak. Klin. 2011; 7, 1: 40–4

Post-transplant care after allogeneic hematopoietic stem cell transplantation

Around 25,000 people annually worldwide are subject to the procedure of allogeneic hematopoietic stem cell transplantation (HSCT). As the number of procedures has been on the rise, post-transplant care is becoming an essential part of work at transplant centres and general practitioners’ offices. Advances in technology and supportive therapies extend long-term survival of patients after HSCT, which increases the risk of complications resulting from exposure before, during and after transplant procedures. The complications may lead to significant morbidity, deteriorated quality of life, and late mortality in patients who have received hematopoietic stem cells. Statistical analyses have shown that the survival rate of post-HSCT patients is ca. 30% lower than expected, and that infections, organ failure and secondary cancers lead to mortality in this population of patients

The prevalence of anemia in people with chronic kidney disease after hematopoietic stem cell transplantation

AbstractThe hematopoietic stem cell transplantation (HSCT) is performed for various hematological diseases. Chronic kidney disease (CKD) occurs relatively often after HSCT. Anemia after HSCT may be due to CKD and/or other reasons. The aim of this study is to assess the prevalence of anemia and its possible relationship to the presence of CKD in patients at least 3 months after HSCT. The study included 156 patients who underwent allogeneic HSCT treatment in our center in the years 1998 to 2021 due to different hematologic pathologies (acute myeloid leukemia, acute lymphoblastic leukemia, lymphoma, and others). Anemia was diagnosed in 13% of women and 35% of men. Anemia was most common in people after HSCT due to a history of acute myeloid leukemia (55% women, 30% men). In 56% of women and 17% of men, anemia was associated with chronic kidney disease. In patients with anemia, age was related to the eGFR (r = –0.39, p < 0.001), in patients without anemia age was negatively related to eGFR (r = –0.56, p < 0.001), and hemoglobin was positively related to platelet count (r = 0.62, p < 0.001). Concluding, anemia, was relatively common in CKD after HSCT. In CKD, in particular with coexistent anemia, nephrology referral is to be taken into account to optimize therapy, including nephroprotection

Zastosowanie ruksolitynibu w leczeniu przewlekłej, opornej na glikokortykosteroidy choroby przeszczep przeciwko gospodarzowi

Chronic graft-versus-host disease (cGvHD) occurs in approximately 50% of recipients who undergo allogeneic stem-cell transplantation and is a leading cause of non-relapse-associated death. Glucocorticoids are the standard of care for cGvHD, but approximately 50% of patients are refractory to such treatment. The study describes a case of a 22-year-old patient with steroid-refractory GvHD, without improvement after multiple lines of immunosuppressive treatment, who was treated with an inhibitor of the JAK-STAT signalling pathway — ruxolitinib.Przewlekła choroba przeszczep przeciwko gospodarzowi (cGvHD) występuje u ponad połowy biorców allogenicznych komórek krwiotwórczych i jest najczęstszą przyczyną śmiertelnych powikłań niezwiązanych z nawrotem. Standardem w leczeniu cGvHD pozostają glikokortykosteroidy, ale ponad połowa chorych jest na nie oporna. W pracy przedstawiono przypadek 22-letniego chorego z ciężką steroidooporną cGvHD, bez poprawy po wielu liniach leczenia immunosupresyjnego, u którego zastosowano inhibitor szlaku sygnałowego JAK-STAT — ruksolitynib

Treatment recommendations developed by MDS experts of the Polish Adult Leukemia Group (PALG) for management of myelodysplastic syndromes (MDSs) and other MDS-related conditions in Poland for 2021

Myelodysplastic syndromes (MDS) comprise a heterogeneous group of malignant hematopoietic stem cell disorders that are characterized by ineffective blood cell production and a variable risk of transformation into acute myeloid leukemia. In recent years, significant progress in MDS biological research has allowed the addition of new drugs to the few existing therapeutic options. This article presents the recommendations of MDS experts of the Polish Adult Leukemia Group for the treatment of myelodysplastic syndromes, and for the management of conditions that are particularly common in patients with MDS i.e. infections, iron overload, and disease recurrence after hematopoietic cell transplantation. The aim of this study was to present a clear therapeutic algorithm to facilitate decision-making in everyday practice