An Atypical Presentation of Brucellosis in a Patient with Isolated Thrombocytopenia Complicated with Upper Gastrointestinal Tract Bleeding

A 59-year-old female patient was admitted to the emergency service with complaints of hematemesis and melena for the last few days. In laboratory tests, the platelet count was found to be /L. Intravenous or oral corticosteroid treatment was thought to be given for ITP but disclaimed due to upper GIS bleeding. On the 5th day of treatment, Brucella melitensis was isolated from blood culture before the results of Wright tube agglutination tests were reported positive as 1 : 80. On the second day of the anti-brucellosis treatment, the thrombocyte count was raised from 6000/mm3 to 110000/mm3, and on the 3rd day to 225000/mm3

Cytokine release syndrome

The field of immunotherapies including monoclonal antibodies and cellular therapies is rapidly evolving and cytokine release syndrome is an obstacle to deal with in this process. This syndrome is a kind of toxic condition caused by the pro-inflammatory cytokines released with the activation of the extreme immune response. In fact, up to some extent, the cytokine release may be an indicator of the antitumor effects of immune-based therapies. Therefore, the distinction between the level at which the efficiency of treatment is ensured and the point at which the life-threatening cytokine release syndrome starts is critically important. Recently, considerable developments have been achieved with regard to the prevention or control of this syndrome. In this review it is aimed to summarize the clinical approach to cytokine release syndrome and associated conditions. Keywords: Cytokine relase syndrome, Immunotherapy, Cell therapies, CAR T Cel

ANTIBODY RESPONSE AGAINST VACCINE ANTIGENS IN CHILDREN AFTER TCRαβ DEPLETED HAPLOIDENTICAL STEM CELL TRANSPLANTATION: IS IT SIMILAR TO RECIPIENTS WHO HAVE FULL-MATCHED DONORS.

ABS T R A C T Recipients of hematopoietic stem cell transplantation (HSCT) with HLA-mismatched donors are more immune suppressed than those with fully matched donors. The immunologic response to vaccines also may differ in HLA-mismatched haploidentical HSCT recipients. In this study, we aimed to evaluate the antibody response to vaccines in pediatric TCRab-depleted haploidentical HSCT recipients. This longitudinal study included a study group of 21 children who underwent haploidentical HSCT without CD19 depletion and with TCRab depletion and a control group of 38 children who underwent fully matched donor HSCT. Antibody levels were quantified by serologic tests before vaccination and after each dose against tetanus, diphtheria, pneumococcus, hepatitis B, hepatitis A, measles, rubella, mumps, and varicella. The median recipient age was significantly lower (P = .037) and the median donor age was significantly higher (P = .000) in the haploidentical group compared with the fully matched group. At the months 1, 3, 6, 9 and 12 post-transplantation, the median CD4, CD8, and CD19 cell counts and lym-phocyte counts were similar in the haploidentical and fully matched groups. The median natural killer cell count was higher in the haploidentical group at the months 1, 3, and 6 post-transplantation (P = .001, .006, and .004, respectively). The median time to first vaccination was similar in the 2 groups (12.5 [range, 11 to 14] months for the haploidentical group and 11 [range, 9 to 13] months for the fully matched group; P = .441). Seroprotection rates were 100% in both groups after the second and third doses of diphtheria vaccine, the third dose of tetanus vaccine, the third dose of hepatitis B vaccine, the second and third doses of pneumococcal conjugate vaccines (PCV13), and pneumococcal polysaccharide vaccine (PSPV23), although lower after the initial doses and before vaccination. Seroprotection for hepatitis A, rubella, and varicella was >90% in the fully matched group and 100% for the haploidentical group after the second doses. Measles and mumps seroprotection rates were >80% in the haploidentical group and approximately 70% for the fully matched group after the second dose. Antibody response and seroprotection rates against vaccine antigens were similar in the haploidentical group and the fully matched when revaccination was started at 12 months post-transplantation. These findings support the idea that TCRab- depleted haploidentical HSCT recipients can be revaccinated according to the same vaccination schedule as fully matched HSCT recipients. Revaccination earlier after transplantation and vaccine responses for recipients of dif-ferent types of HSCT should be evaluated in future studies. (c) 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved