Perioperative safety of emergency ovarian tissue cryopreservation for fertility preservation in hematological patients prior to hematopoietic stem cell transplantation.

Prevalence and Risk Factors of Antibodies to Class I and II Human Leukocyte Antigens in Haploidentical Allograft Candidates: A Prospective Study on 3805 Subjects

Refractoriness to transfusions of platelet concentrates (PC) adversely affects the conduct of complex therapy in hematological patients. Individual selection of platelets is recommended for such patients. In cases of high degree of alloimmunization with the formation of polyspecific antibodies, when individual selection is difficult, procedures plasmapheresis (PPs) is included in the treatment program.Aims: to evaluate the effectiveness of PC transfusions by individual selection in patients refractory to transfusions and the use of PPs as a second line therapy in combination with individual platelet selection.Materials and methods: from September 2015 to December 2017, 91 patients with refractory to PC transfusions from 1263 patients who received PC transfusion were observed in the center’s clinics. The median age was 43 (18–71) years. M/F – 38/53. Patients: 20 – aplastic anemia (AA), 17 – myelodysplastic syndrome (MDS), 45 – acute myeloid leukemia (AML), 9 – acute lymphoblastic leukemia (ALL). All patients underwent PC transfusion by individual selection (HLA/HPA) Immucor’s Capture-P solid phase technology. In 28 (30 %) of 91 patients, due to the inability to select, there was a need for PP as a second line therapy. Patients: AA – 4 (20 %); MDS – 8 (47 %); AML – 12 (26 %); ALL– 4 (44 %). The median age was 48 (23–71) years. M/F – 8/20. From 2 to 15 procedures were performed (on average – 6) for each patient. All patients received PC transfusions by individual selection by cross-matching immediately after the PP procedure. The efficacy of PC transfusions was assessed by Absolute Platelet Increment (API) and Corrected Count Increment (CCI), relief of hemorrhagic syndrome.Results: in 26 of 28 refractory to PC transfusions patients, in the absence of compatible donor platelets, carrying out PPs in combination with subsequent individual platelet selection promoted relief of hemorrhagic syndrome, increase in API from 3.3 × 109/L at 29.5 × 109/L and CCI from 1.3 to 10.7. Against the background of PPs, combined with individual selection, the degree of alloimmunization (the percentage of incompatible pairs) decreased on average: AA (n = 4) – from 91.7 to 50.2 %; MDS (n = 8) – from 89.6 to 31.6 %; AML (n = 12) – 86.0 to 40.5 % and ALL (n = 4) – from 91.7 to 37.7 %. In 2 patients with a high degree of alloimmunization and after carrying out PPs, it was not possible to select compatible platelets, PC transfusions were ineffective (API = 5 × 109/L, CCI = 1), and hemorrhagic syndrome was not completely managed, but its severity was reduced.Conclusions. With the development of refractoriness to PC transfusions and the ineffectiveness of individual platelet selection, PPs should be used as the second line of therapy, which, combined with individual selection, increases the likelihood of compatible donor-recipient pairs and increases the clinical efficacy of PC transfusions. When PPs is ineffective in combination with individual selection, it is necessary to exclude the syndrome of increased consumption and other mechanisms of refractoriness.

Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies

Efficacy and Safety of a FLAG-Sequential Regimen Followed By Hematopoietic Stem Cell Transplantation for Myelodysplasia or Acute Leukemia in Fanconi Anemia: A Franco-Brazilian Report

Extended Rhesus and Kell Phenotype-Matched Red Blood Cell (RBC) Transfusions Reduce RBC Alloimmunization and RBC Transfusion Burden in Patients with Myeloid Neoplasm

Fanconi anaemia (FA) is an autosomal recessive inherited disorder with progressive bone marrow failure, associated congenital malformation and solid and haematological malignancies. Acute myeloid leukemia is the commonest haematological malignancy followed by myelodysplastic syndrome in children with FA. FA transformed into acute lymphoblastic leukemia (ALL) is a rare phenomenon and one of the rarest haematological malignancies associated with this disorder. We are reporting a 13 years old girl with FA and positive chromosomal breakage. She required regular blood product transfusion. She was planned for haematopoietic stem cell transplantation (HSCT) but the sibling-matched donor was found to have chromosomal breaks as well. Later on, her peripheral smear showed blast cell. Bone marrow showed pre-B ALL. She was started on chemotherapy but died shortly due to complications of the treatment. For this rare condition conservative management is indeed essential, however, safe and appropriate chemotherapy regimen is needed.

Impact of anti-HLA antibodies on allogeneic hematopoietic stem cell transplantation outcomes after reduced-intensity conditioning regimens

Survival after acute paediatric (014 years), adolescent (15-19 years) and young adult (20-39 years) leukaemia has improved substantially over the last five decades, particularly for acute lymphoblastic leukaemia (ALL) and acute promyelocytic leukaemia, a subtype of acute myeloid leukaemia. This progress represents one of the most successful achievements in the history of medicine and has been attributed to the development of effective chemotherapy regimens, improvement in supportive care, better risk stratification, use of targeted therapies, and advances in haematopoietic stem cell transplantation. Currently, long-term survival for children diagnosed with acute lymphoblastic leukaemia is 80%-90% in developed countries. Strikingly, survival among adolescents and young adults with this disease is about 60% and 40% respectively. In addition, in these countries, 5-year survival for young patients with acute myeloid leukaemia (excluding acute promyelocytic leukaemia) remains approximately 60% in the modern era of treatment. This project aimed to evaluate how survival and, when appropriate, early death (death occurring within 30 days of diagnosis) after acute leukaemia varied during almost 25 years in California, the most populous and racially/ethnically diverse state in the United States (US). A second aim was to investigate the association between sociodemographic and selected clinical factors and outcomes. Using high-quality data from the California Cancer Registry, I evaluated survival trends from acute lymphoblastic leukaemia among patients aged 0-19 years, and survival and early death trends after acute myeloid leukaemia among patients aged 0-39 years. I also investigated whether early death has decreased among young patients after the approval by the US Food and Drug Administration of all-trans retinoic acid (ATRA) for the treatment of acute promyelocytic leukaemia. The overall results of this thesis showed improvement in survival over time for all age groups and subtypes of leukaemia. Early death after acute promyelocytic and myeloid leukaemias declined during the study period. However, these outcomes varied widely by age at diagnosis and were associated with sociodemographic and clinical factors. Racial/ethnical survival inequalities were identified and found to persist even after adjustment for other covariates. These inequalities were more marked among patients of Hispanic (acute lymphoblastic leukaemia) and black race/ethnicity (for acute lymphoblastic and myeloid leukaemias). Patients living in lower socioeconomic neighbourhoods had worse survival than those living in higher socioeconomic neighbourhoods (for acute lymphoblastic and myeloid leukaemias). Early death and worse survival were associated with initial care at hospitals not affiliated with National Cancer Institute-designated cancer centres (for acute myeloid leukaemia) and lack of health insurance (for acute myeloid and promyelocytic leukaemias). Intriguingly, over the 25-year study period, adolescents and young adults with acute leukaemia continued to have worse survival than children. These results suggest that lack of timely access to treatment and suboptimal care have influenced outcome among vulnerable patients. In conclusion, survival and early death after acute leukaemia has greatly improved among young patients in California. However, inequalities in outcomes remain and are likely a result of multiple factors. My studies highlight the importance of population-based data to reveal the actual burden of the disease in this population and help clinicians, policy makers, government, and researchers better understand the predictors of outcomes. I expect my work to contribute to the development of strategies aimed at improving survival from acute leukaemia, especially among

BackgroundFactors affecting the efficacy of platelet and red blood cell (RBC) transfusion in patients undergoing hematopoietic stem cell transplantation (HSCT) have not been studied extensively. We aimed to evaluate platelet and RBC transfusion efficacy by measuring the platelet corrected count increment and the hemoglobin increment, respectively, 24 h after transfusion in 105 patients who received HSCT.Methodology/Principal FindingsUsing retrospective analysis, we studied whether factors, including gender, time of transplantation, the compatibility of ABO group between HSC donors and recipients, and autologous or allogenic transplantation, influence the efficacy of blood component transfusion. We found that the infection rate of HSCT patients positively correlated with the transfusion amount, and the length of stay in the laminar flow room was associated with transfusion. We found that platelet transfusion performed during HSCT showed significantly better efficacy than that performed before HSCT. The effect of platelet transfusion in auto-transplantation was significantly better than that in allo-transplantation. The efficacy of RBC transfusion during HSCT was significantly lower than that performed before HSCT. The efficacy of RBC transfusion in auto-transplantation was significantly higher than that in allo-transplantation. Allo-transplantation patients who received HSCs from compatible ABO groups showed significantly higher efficacy during both platelet and RBC transfusion.ConclusionsWe conclude that the efficacy of platelet and RBC transfusions does not correlate with the gender of patients, while it significantly correlates with the time of transplantation, type of transplantation, and ABO compatibility between HSC donors and recipients. During HSCT, the infection rate of patients positively correlates with the transfusion amount of RBCs and platelets. The total volume of RBC units transfused positively correlates with the length of the patients’ stay in the laminar flow room.

Predictors of Disease Progression and Survival in Patients with Myelodysplastic Syndrome Secondary to Inherited Bone Marrow Failure Syndromes

Sequential Treatment with Chemotherapy and Reduced-Intensity Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation in Fanconi Anemia Patients with Acute Myeloid Leukemia or Myelodysplastic Syndrome.

Factors Affecting Transfusion Utilization in Acute Myeloid Leukemia (AML) Patients Undergoing Initial Therapy

Treatment of Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome (VOD/SOS) Post-Hematopoietic Stem Cell Transplantation (HSCT) in Patients with Acute Leukemias: A Subgroup Analysis from the Defibrotide Expanded-Access Program

Impact of Red Blood Cell and Platelet Transfusions in Acute Myeloid Leukemia (AML) Patients Undergoing Remission Induction Chemotherapy

Bone Marrow B cell Precursor Number after Allogeneic Stem Cell Transplantation and GVHD Development