Allogeneic hematopoietic cell transplantation in patients with chronic phase chronic myeloid leukemia in the era of third generation tyrosine kinase inhibitors : A retrospective study by the chronic malignancies working party of the EBMT

Peer reviewe

Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry

Introduction: COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods: This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results: The median age was 50.3 years (min – max; 1.0 – 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min – max; 0.0 – 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 – 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 – 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Discussion: Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death

KRONİK LENFOSİTİK LÖSEMİ&#8217;DE SERBEST HAFİF ZİNCİR DÜZEYLERİNİN PROGNOZ ÜZERİNE ETKİSİ

Kronik lenfositik lösemi (KLL) değişken bir klinik seyir sergilemektedir. Geriye dönük olarak planlanan bu çalışma, serum serbest hafif zincir (sSHZ) düzeyleri ve serbest hafif zincir oranının (SHZO) KLL prognozu üzerine etkisini incelemek amacıyla düzenlenmiştir. Ortanca 29(1-234) ay izlenen 101 KLL hastasının 55&#8217;inde (%54,5) sSHZ düzeyleri yüksekti. Otuz hastada (%29,7) anormal SHZO saptandı. Genetik risk grupları arasında sSHZ düzeyi ve SHZO açısından anlamlı farklılık izlenmedi (p>0,05). Yüksek sSHZ grubunda ilk tedaviye kadar geçen süre anlamlı kısa bulundu (p=0,02). Toplam sağkalım (OS) yüksek sSHZ (p=0,01) ve anormal SHZO (p=0,05) grubunda anlamlı kısa idi. Benzer şekilde, erken evre hastalarda, yüksek sSHZ (p=0,03) ve anormal SHZO (p=0,048) grubunda ortanca OS&#8217;nin anlamlı kısa olduğu gösterildi. Lojistik regresyon analizinde, sSHZ düzeyleri ve CD38 ifadelenmesi arasında istatistiksel anlamlı ilişki gözlendi (p=0,003; OR: 4,44; 95% CI: 1.66-11,8). Kronik lenfositik lösemi hücresinde CD38 ifadelenmesi arttıkça, uyarılan bir dizi tepkime sonucunda, SHZ sentezi de artmaktadır. Bu çalışma, sSHZ düzeyleri ve SHZO&#8217;nun KLL prognozu ve sağkalım üzerine olan olumsuz etkisini vurgulamaktadır. Bu olumsuz prognostik etkinin klinik uygulamaya geçirilebilmesi için ileriye dönük ve kapsamlı çalışmalara gereksinim vardır.Chronic lymphocytic leukemia (CLL) is characterized by a highly variable clinical course. This retrospective study was planned to assess the prognostic role of serum free light chain (sFLC) and FLC ratio (rFLC) in CLL. In a cohort of 101 patients with a median follow-up of 29(1-234) months, sFLC levels were found to be high in 55 patients (54,5%). An abnormal rFLC was found in 30 patients (29,7%). FISH based genetic risk groups did not differ significantly with respect to sFLC and rFLC (p>0,05). Median time to first treatment was shorter in patients with high sFLC levels (p=0,02). Median overall survival (OS) was shorter in patients with high sFLC levels (p=0,01) and abnormal rFLC (p=0,05). In patients with early stage disease, median OS was shorter in high sFLC (p=0,03) and abnormal rFLC groups (p=0,048). A relationship was observed between abnormal sFLC levels and CD38 positivity on logistic regression analysis (p=0,003; OR: 4,44; 95% CI: 1.66-11,8). Free light chain synthesis is stimulated through a series of cellular reactions as a result of higher expression of CD38. This study has highlighted the adverse prognostic impact of high sFLC levels and abnormal rFLC with regard to survival in CLL patients. Prospective studies are warranted to validate the adverse impact of sFLC and rFLC on clinical outcome

Hematopoietic Stem Cell Transplantation in a Very High Risk Group of Patients with the Support of Granulocyte Transfusion

WOS: 000293856200005PubMed: 22942564High risk patients with active fungal infection who had undergone hematopoietic stem cell transplantation (HSCT) with the support of granulocyte transfusions (GTX) as an adjunct to antifungal agents are reviewed retrospectively. Patients requiring immediate allogeneic HSCT for their primary hematological disorders (two severe aplastic anemia, one T cell acute lymphoblastic leukemia (ALL) in second complete remission, one acute myeloid leukemia (AML)-in first complete remission, one T-ALL in refractory relapse) but were denied by other transplant programs due to active invasive fungal infections had undergone HSCT with the support of GTX at the stem cell transplantation unit of Gazi University. Five patients who had undergone six transplants were included in the study and received a total of 38 (3-13) granulocyte transfusions during these six transplants. The median granulocyte concentration was 3.4 x 10(11) per apheresis bag. Full clinical and radiological recovery was achieved in three of the five high risk patients with active invasive fungal infection with the combination of antifungal agents and GTX. Even a very high risk patient with aplastic anemia who had undergone two consecutive transplants due to secondary graft failure was also cured of his primary disease despite the presence of multiple pulmonary fungus balls. Three of the five patients with very high risk features due to the underlying hematological disease and the associated active fungal infection were rescued with allogeneic HSCT performed with the support of GTX combined with antifungal agents. Despite the limitations of this report due to its retrospective nature, it suggests that GTX might be an alternative in patients with active fungal infections who otherwise are denied by the transplant programs. However, prospective randomized studies are required to draw a solid conclusion regarding the role of GTX in HSCT recipients in desperate situations such as active fungal infections