Postsurgery outcomes in patients with polycythemia vera and essential thrombocythemia: a retrospective survey

A multicenter retrospective analysis was performed to estimate the frequency of thrombosis and hemorrhage after surgical procedures in patients with polycythemia vera (PV) and patients with essential thrombocythemia (ET). Data from 105 patients with PV and 150 patients with ET were analyzed, for a total of 311 surgical interventions. An emergency procedure was performed in 25 (8.1%) patients; 194 surgeries were done under general anesthesia, and 21 (23%) of 91 abdominal interventions were done under laparoscopy; 155 (50.1%) were major surgeries. Subcutaneous heparin was administered in 169 (54.3%) of 311 cases and antiplatelet therapy in 48 (15.4%) of 311 case interventions. One hundred eighty-eight (74%) of 255 patients were on cytoreductive therapy before surgery. No events were observed in 259 (83.2%) of 311 procedures during 3 months of follow-up; there were 12 arterial and 12 venous thrombotic events, 23 major and 7 minor hemorrhages, and 5 deaths. Arterial thromboses were more frequent in ET (5.3% vs 1.5%; P = .08), venous events were more frequent in PV (7.7% vs 1.1%; P = .002). There was not a correlation between bleeding episodes and the type of diagnosis, use of antithrombotic prophylaxis, or type of surgery. A high proportion of PV and ET surgeries was complicated by vascular occlusion (7.7%) or by a major hemorrhage (7.3%). Prospective investigations analyzing the optimal prophylaxis in these patients are suggested

Primary treatment response rather than front line stem cell transplantation is crucial for long term outcome of peripheral T-cell lymphomas.

Outcome of systemic peripheral T-cell lymphomas (PTCL) is unsatisfactory and no controlled clinical study guides the therapy. Phase II studies suggest to consolidate response achieved after front-line treatment with stem cell transplant (SCT). We retrospectively evaluate the impact of front-line SCT consolidation in a single Center cohort of 209 patients treated during the last two decades. Median age was 49 years (range 15-85) with a prevalence of male sex (61%), advanced stage (68%) while IPI was >2 in 44%. Primary treatment was MACOP-B (39%) CHO(E)P (39%), intensive regimens (18%) or others (4%). Complete response to primary treatment (i.e. before SCT) was 60% (5% partial remission). Forty-four patients further proceeded to SCT while 92 did not receive consolidation. Outcome of primary responders was good, with a 3-year overall survival of 74% (82% in ALCL ALK+ and 69% for the other histologies). By multivariate analysis a better overall survival was significantly associated with IPI<2 (P=0.001), primary response (P=0.000), and ALCL ALK+ (P=0.012). The multivariate analysis performed on responders, showed that only IPI was predictive of a better survival while ALCL ALK+ and undergoing SCT were not. Response to primary treatment rather than post-remission programs is the crucial determinant of PTCL outcome

Patients Characteristics.

<p>Legend:</p><p>* N = 179;</p><p>** N = 120;</p><p>*** N = 59;</p><p><i>PTCL-NOS</i>: <i>Peripheral T-Cell Lymphoma Not Otherwise Specified; ALCL</i>: <i>Anaplastic Large-Cell Lymphoma; ALK</i>: <i>Anaplastic Large Cell Lymphoma Kinase; EATL</i>: <i>Enteropathy-Associated T-cell Lymphoma; AITL</i>: <i>Angioimmunoblastic T-cell Lymphoma; Others</i>: <i>includes hepatosplenic T-cell lymphoma (N = 3) and extranodal T/NK-cell lymphoma nasal type (N = 2);IPI</i>: <i>International Prognostic Index; PIT</i>: <i>Prognostic Index for PTCL-NOS</i></p><p>Patients Characteristics.</p

Overall survival (A), progression-free survival (B) and disease free survival (C) in the whole cohort according to histologic subgroup.

<p>Overall survival according to primary treatment response (E). ALCL: anaplastic large cell lymphoma; ALK: anaplastic large cell lymphoma kinase; CR: complete remission; PR: partial remission; NR: no response, including stable and progressive disease.</p

Multivariate analysis for overall survival of the whole cohort.

<p>Multivariate analysis for overall survival of the whole cohort.</p

Multivariate analysis for overall survival of the responders^*.

<p><i>Legend</i>:</p><p><i>* excluding 3 patients treated with allogeneic SCT</i></p><p>Multivariate analysis for overall survival of the responders^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121822#t005fn002" target="_blank">*</a>}.</p

Multivariate analysis for overall survival of the responders^* (excluding ALCL ALK+).

<p><i>Legend</i>:</p><p><i>* excluding 3 patients treated with allogeneic SCT</i></p><p>Multivariate analysis for overall survival of the responders^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121822#t006fn002" target="_blank">*</a>} (excluding ALCL ALK+).</p

Treatments and Outcome.

<p>Legend: <i>Others</i>: <i>includes MetAspDex regimen</i>, <i>ACVBP or ACOD; CR</i>: <i>Complete Remission; PR</i>: <i>Partial Remission; SD</i>: <i>Stable Disease; PD</i>: <i>Progressive Disease; SCT</i>: <i>Stem Cell Transplant</i>. <i>Early death indicates patients deceasing <6 months from diagnosis</i>.</p><p>Treatments and Outcome.</p

Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series

Neurological complications (NCs) represent a diagnostic and clinical challenge in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. We retrospectively analyzed NC incidence, etiology, timing, characteristics, outcome, and long-term effects in 2384 adult patients transplanted in seven Italian institutions between January 2007 and December 2019. Ninety-three (3.9%) patients were affected by 96 NCs that were infectious (29.2%), immune/inflammatory (26%), drug-related (12.5%), cerebrovascular (5.2%), metabolic (3.1%), related to central nervous system disease relapse (11.5%) and malignancy (3.1%), or undefined (9.4%). Six patients (6.4%) had neurological manifestations of chronic graft-versus-host disease (GVHD). NCs occurred on average at day +128 (from -5 to +4063). Early (&lt; day +120) and late NCs had similar frequencies (46.9% vs 53.1%, p = 0.39). Thirty-one patients (33.3%) were affected by acute or chronic GVHD at the NC onset. With a median follow-up of 25.4 (0.4-163) months, the overall mortality due to NCs was 22.6%. The median time between NC onset and death was 36 (1-269) days. Infectious NCs were the main cause (61.9%) of NC-related mortality. A persistent neurological impairment occurred in 20.4% patients, 57.9% of whom being affected by immune/inflammatory NCs. This study highlights the rare, yet severe impact of alloHSCT-associated NCs on patient survival and long-term functional ability

phase ii study of sequential infusion of donor lymphocyte infusion and cytokine induced killer cells for patients relapsed after allogeneic hematopoietic stem cell transplantation

Abstract Seventy-four patients who relapsed after allogeneic stem cell transplantation were enrolled in a phase IIA study and treated with the sequential infusion of donor lymphocyte infusion (DLI) followed by cytokine-induced killer (CIK) cells. Seventy-three patients were available for the intention to treat analysis. At least 1 infusion of CIK cells was given to 59 patients, whereas 43 patients received the complete cell therapy planned (58%). Overall, 12 patients (16%) developed acute graft-versus-host disease (aGVHD) of grades I to II in 7 cases and grades III to IV in 5). In 8 of 12 cases, aGVHD developed during DLI treatment, leading to interruption of the cellular program in 3 patients, whereas in the remaining 5 cases aGVHD was controlled by steroids treatment, thus allowing the subsequent planned administration of CIK cells. Chronic GVHD (cGVHD) was observed in 11 patients (15%). A complete response was observed in 19 (26%), partial response in 3 (4%), stable disease in 8 (11%), early death in 2 (3%), and disease progression in 41 (56%). At 1 and 3 years, rates of progression-free survival were 31% and 29%, whereas rates of overall survival were 51% and 40%, respectively. By multivariate analysis, the type of relapse, the presence of cGVHD, and a short