Hematology on Twitter

Twitter’s impact on information dissemination and the possibility of exchanging opinions between people around the world have made this social platform particularly appealing for hematologists. We have evaluated the potential use of Twitter in the field of hematology for both physicians and patients, and sought out direct examples of Twitter’s current application in medicine and hematology. With the use of the site https://followerwonk.com we have created a list of the most followed hematologists and hematological organizations and described their activity on Twitter

Letermovir use in children after hematopoietic cell transplantation: summary of reported data

Introduction: Letermovir (LMV) is approved for primary prophylaxis of cytomegalovirus infection (CMVi) in CMV-seropositive adult patients undergoing allogeneic hematopoietic stem cell transplantation. However, it is not registered for CMVi preemptive treatment, CMVi secondary prophylaxis, or the treatment of CMV disease. There is very limited data regarding LMV’s use in pediatric patients, as it has not been approved so far as any kind of treatment in children, with its use remaining off label. The aim of this study was to summarize reported data on the efficacy and safety of LMV in pediatric patients. Material and methods: Studies and case reports regarding LMV’s use in pediatric patients were searched in PubMed. Results: Overall, nine reports that fulfilled the search criteria, published between 2019 and 2022, were found and analyzed. The total number of cases involved in research was 46 with patient age ranging from 2–19 years; one child was counted twice due to another transplant. The most common serostatus of donor/recipient was D+/R+ (47%), followed by D–/R+ (42%), then D+/R– (2%), and then unknown (9%). Most patients had received the transplant from a matched unrelated donor (40%). There were 47 incidents of LMV administration as CMV management strategy. The analyzed patients received LMV as primary prophylaxis (74%), secondary prophylaxis (15%), pre-emptive therapy (6%), or treatment of CMV disease (4%). One patient received LMV as a treatment and then as a secondary prophylaxis. In 44/46 (95.6%) cases, no symptomatic CMVi occurred during LMV administration, with only transient CMV DNA-emia present on rare occasions. Conclusion: The use of LMV is safe in pediatric patients

Invasive fungal disease presenting as septic shock in immunocompromised pediatric and adult patients: summary of reported cases

Introduction: Septic shock is a very rare presentation of invasive fungal disease (IFD) in immunocompromised patients. The objective of this paper was to summarize reported cases of pediatric and adult patients with IFD presenting as septic shock in non-Candida infections. Literature data describing etiology, age, and outcome of septic shock as a presentation of IFD, is summarized. Material and methods: The available pediatric data included 23 patients, most of them with underlying non-hematological disease. Results: Only 6/23 (26.1%) were reported to survive this infection. Respective data in adults with invasive fungal disease presenting as septic shock were reported in 28 patients. Most of these patients were treated for acute leukemias (including three patients after hematopoietic cell transplantation); only 5/28 (17.9%) survived the infection. Conclusion: Invasive fungal disease presenting as septic shock in immunocompromised patients is a highly unusual presentation

Vaccinations following CAR-T cell therapy: summary of reported cases and state-of-the-art review of current recommendations

Introduction: Chimeric antigen receptor T-cell (CAR-T) therapy is a modern breakthrough technology used in the treatment of B-lineage lymphoid malignancies. These malignancies include acute lymphoblastic leukemia, non-Hodgkin lymphoma, and plasma cell disorders. CAR-T therapy combines cellular therapy, gene therapy, and individualized therapy. The objective of this paper was to review the latest clinical knowledge, and summarize the reported data pertaining to vaccinations in patients after CAR-T therapy. Material and methods: We carried out a review of published original studies as indexed in PubMed, and a review of abstracts presented during major hematology meetings. Results: Overall, 22 original studies were reviewed and considered suitable for analysis regarding the efficacy of vaccinations for patients who had received CAR-T therapy. Data was divided into three groupings: the efficacy of vaccination against coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the efficacy of vaccination against influenza; and the efficacy of post-CAR-T immunization persistence of vaccination performed before CAR-T therapy. Humoral and cellular response to SARS-CoV-2 vaccination was positive for 36.5% and 72.2% of patients, respectively. The positive response to the influenza vaccine was 40% when administered prior to CAR-T therapy, as opposed to 31% after. Seroprotection for vaccine-preventable infections within 3-6 months after CAR-T was comparable to that of the general population, although it was determined to be less effective against specific pathogens (S. pneumoniae, B. pertussis, H. influenzae) in most patients. Conclusions: In cases of incomplete immune reconstitution, there is a high likelihood of a limited response to vaccination. Regarding the SARS-CoV-2/COVID-19 vaccine, T-cell-induced protection is relatively significant. Therefore, B-cell aplasia is not a contraindication for vaccination in CAR-T patients. The consensus of European Society of Blood and Marrow Transplantation/European Hematology Association experts is that vaccination after CAR-T therapy is beneficial in order to reduce the rates of infection, and eventually to improve clinical course