JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY

RECOMMENDATIONS FOR COVID-19 PREVENTION AND TESTING FOR HEMATOPOIETIC CELL TRANSPLANT CENTERS IN BRAZIL

Tue, 17 Oct 2023 00:00:00 +0000

From February 2020 to May 2023, 37,625,916 cases of COVID-19 were recorded in Brazil, which led to 2,173,359 hospitalizations due to severe acute respiratory syndrome (SARS) with 703,291 deaths due to COVID-19. More than 14 million cases were registered in 2021 and 2022. However, there was a significant drop in the number of hospitalizations for SARS and the COVID-19 fatality rate in 2022, which certainly reflects the impact of mass vaccination in the country, started in February 2021.

STUDY OF THE ASSOCIATION OF EXPOSURE TO GENOTOXIC AGENTS AND MYELODYSPLASTIC SYNDROME OR SECONDARY ACUTE MYELOID LEUKEMIA IN PATIENTS ATTENDED AT AN AMBULATORY REFERENCE SERVICE IN CEARÁ

Wed, 27 Dec 2023 00:00:00 +0000

Objetivos

As síndromes mielodisplásicas (SMD) consistem em um grupo heterogêneo de doenças com características clínicas, laboratoriais e patogênese abrangentes, porém, têm em comum um defeito clonal nas células progenitoras hematopoiéticas. Caracterizam-se por citopenia no sangue periférico com medula óssea normocelular ou hipocelular com presenças de alterações displásicas (>10%) em uma ou mais linhagens hematopoiéticas. Estudos epidemiológicos têm demonstrado a associação entre a ocorrência de SMD e LMA e a exposição a fatores genotóxicos. Logo, o presente estudo tem como objetivo associar as alterações hematológicas em portadores de SMD e LMA com as condições de risco ambientais/ocupacionais associadas às mesmas em um serviço especializado em hematologia.

Métodos

O estudo foi aprovado pelo conselho de ética do HUWC.

Trata-se de um estudo observacional, prospectivo e retrospectivo, através de pesquisa em prontuário de pacientes. O estudo foi desenvolvido no principal serviço de referência em hematologia do estado, localizado no ambulatório de doenças onco-hematológicas do Hospital Universitário Walter Cantídio (HUWC), em Fortaleza, Ceará. A população deste estudo consistiu em adultos de ambos os sexos, com diagnóstico de SMD e/ou LMAs confirmado pela clínica e exames laboratoriais, em acompanhamento ambulatorial que foram atendidos no período de agosto de 2021 a junho de 2022, tendo sido recrutados 50 pacientes. Foram excluídos do estudo aqueles pacientes que não residem no Ceará, ou que possuíam diagnóstico de outra doença oncológica.

Resultados

A amostra coletada concentra 50 pacientes que estavam em atividades terapêuticas no Serviço de Hematologia do HUWC, com uma idade média de 67.8 anos. Dentre esses, 14 pacientes (28%) representavam o sexo masculino, enquanto 36 pacientes (72%), representavam o sexo feminino.

No que tange à situação de domicílio, 6 pacientes (12%) moram em zona rural, enquanto 44 pacientes (88%) moram em zona urbana. Nesse sentido, relatou-se que 30% desses pacientes moram em residências próximas a indústrias (14%) e áreas agrícolas (16%).

Dos pacientes entrevistados, 47 possuem diagnóstico de síndrome mielodisplásica; enquanto 3 possuem diagnóstico de leucemia mieloide aguda. Desses, 11 pacientes informaram ter relatos de doença hematológica semelhante na família. Dos 50 pacientes, 35 (70%) afirmaram ter tido contato com fatores genotóxicos; destes: agrotóxicos (30%), metais (6%), solventes (38%), tintas e vernizes (38%) e radiação ionizante (40%).

Discussão

Diante disso, foi visto que número considerável (30%) de pacientes moram em regiões de vulnerabilidade relacionadas à exposição a agentes genotóxicos, como indústrias, que tendem a despejar dejetos, possivelmente tóxicos, nas proximidades e como áreas agrícolas, que utilizam pesticidas, substâncias químicas comprovadamente cancerígenas. Além disso, foi descrita exposição de 70% da amostra a solventes, tintas e radiação, sendo esta última a mais relatada, contribuindo à hipótese do estudo.

Conclusão

Portanto, foi encontrada associação relevante de fatores ocupacionais e ambientais com a etiologia da SMD e LMA, contribuindo, assim, para o conhecimento sobre fatores desencadeantes de tais doenças hematológicas, possibilitando melhor percepção da conjuntura de exposição dos pacientes da região. Reforça-se a necessidade de mais estudos, de caráter multicêntrico, com grandes amostras de pacjentes, visando ao maior conhecimento sobre medidas profiláticas e estratégias terapêuticas individualizadas.

Use of InflammaDry® for MMP-9 detection in ocular graft versus host disease

Wed, 27 Dec 2023 00:00:00 +0000

Abstract:

Background: InflammaDry® is a point-of-care test that can detect matrix metalloproteinase-9 (MMP-9), an inflammatory biomarker that is elevated in ocular surface stress and desiccation, such as in ocular graft-versus-host disease (oGVHD).

Objectives: To characterize MMP-9 levels in patients diagnosed with oGVHD and to assess InflammaDry® ability to detect ocular surface disease in patients diagnosed with oGVHD.

Methods: A retrospective chart review was completed on 74 patients who have undergone a hematopoietic stem cell transplantation (HSCT) and have been diagnosed with oGVHD. Date of chronic GVHD diagnosis; date of ocular symptoms onset; oGVHD NIH grade on day of InflammaDry® testing; InflammaDry® results; and interventions used to treat ocular symptoms were collected on each patient. Percent positivity, positivity rate and accuracy of InflammaDry® was calculated.

Results: The positivity rate of InflammaDry® showed an increasing trend in relation to increasing oGVHD severity as well as an overall percent positivity of 87.16% and accuracy of 88.36%.

Conclusion: InflammaDry® has demonstrated to be a promising tool that may be used as a screening tool to detect the development of oGVHD onset. However, before InflammaDry® can be implemented into Hematology/Oncology clinics, the rate of positivity of InflammaDry® in patients pre-HSCT must first be determined.

Repositioning autologous stem cell transplantation in the management of newly diagnosed multiple myeloma

Edvan Crusoe, Luciano Costa — Wed, 27 Dec 2023 00:00:00 +0000

A RETROSPECTIVE STUDY OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW IN MULTIPLE MYELOMA PATIENTS

Wed, 27 Dec 2023 00:00:00 +0000

Background: Multiple myeloma is a malignant hematological neoplasm, whose treatment involves the use of bisphosphonates and monoclonal antibodies, which may be related to medication-related osteonecrosis.

Objective: The present study aims to verify the presence of medication-related osteonecrosis of the jaws in patients undergoing treatment for multiple myeloma who used chemotherapy associated or not with bisphosphonates and/or monoclonal antibodies. Beyond this, to trace the epidemiological profile of patients who developed medication-related osteonecrosis.

Methods: This 15-year retrospective observational study consisted of evaluating 461 medical records of patients diagnosed with multiple myeloma from the oncology referral hospital in Brazil, Erasto Gaertner Hospital.

Results: It was observed that both the group that developed osteonecrosis and the group that did not develop, no statistically significant difference when evaluated separately regarding sex, bone marrow transplant and ethnicity. However, the group with osteonecrosis showed a higher frequency in the use of bisphosphonates, did not progress to death, were non-smokers, the mandible was the most affected anatomical site, and the type of bone exposure spontaneously was the most observed.

Conclusions: The combined use of pentoxifylline and tocopherol was responsible for the successful resolution of cases of medication-related osteonecrosis. Isolating the underlying disease allowed for greater control and knowledge regarding the medications used for the treatment of medication-related osteonecrosis.

Access to Hematopoietic Stem Cell Transplantation in Brazil: facing our challenges.

Wed, 27 Dec 2023 00:00:00 +0000

At the Session HSCT for all in SBTMO 2023 the main current challenges for the transplant in Brazil were discussed with panelists an the cordinator of National Transplant System. This article has the objective of reporting the main aspects of the discussion for future actions. Access to beds for adult and pediatric patients, better distribution througout the country, acces to critical medications such as antiviral drugs and imunnessupressors for GVHD phrophylaxis and therapy were discussed. The need for data managers at the centers fostering the transplant data registry was also pointed out. Extension of this discussion among transplant centers and goverment is very important in order to find solutions for improvement in HSCT in Brazil.

Challenges to achieving BMT in the treatment of AML in Brazil

Wed, 27 Dec 2023 00:00:00 +0000

Introduction: Acute myeloid leukemia is a heterogeneous aggressive leukemia with a poor prognosis. The standard remission induction regimen for medically eligible patients consists of a backbone of cytarabine & anthracycline. Objective: This study assessed the efficacy and safety of cytarabine and anthracycline in a public health center in Salvador, Brazil. Methods: It is a retrospective analysis of 45 non-promyelocytic AML patients diagnosed between 2018 and 2022. Subgroups analyzed included patients having FTL3 and NPM1 mutations, leukocyte count (>10,000 or <10,000), platelets count (>20,000 or <20,000), and transplanted patients. Kaplan-Meier methods were used to determine overall survival (OS) and progression-free survival (PFS). Results: The median age at diagnosis was 43 years (16-69 years), and 62% were females. FLT3-ITD and NPM1 mutations were found for 17.8% and 13.3% of patients, respectively. 85% of the patients had a normal karyotype. For efficacy, 52% of patients were eligible for the next treatment after complete remission. Refractory patients were 20%. Early mortality was 28.8%. Median values of PFS and OS were 3.6 and 8.2 months, respectively. Patients presenting FLT3 mutation and stem cell transplantation had PFS and OS of 20 and 43 months, respectively. Conclusion: The outcomes were consistent with the literature. Waiting time was not critical for treatment outcomes.

CONFRONTING DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN VIRAL REACTIVATION AFTER ALLOGENEIC TRANSPLANTATION

Wed, 27 Dec 2023 00:00:00 +0000

BACKGROUND. Despite recent advances of allogeneic hematopoietic stem cell transplantation (HSCT), viral infections are still a significant complication and remain a frequent cause of morbidity. OBJECTIVE. To evaluate the profile of viral infection in patients undergoing HSCT in a Brazilian reference hospital. STUDY DESIGN. This is a retrospective, descriptive, analytical and quantitative study. Allogeneic transplants performed in the last 5 years, in patients aged 16 years or older, were analyzed. RESULTS. A total of 117 allo-HCT recipients were included. Of these, 50.43% were women and 49.57% were men, with a median age of 36 years. Acute myeloid leukemia was the most frequent underlying disease (27,35%). 88,33% of the patients had some virus detected (in any value) during the post-BMT period. There was a prevalence of viral reactivation in haploidenticals, with 90.91% of detection. CMV reactivation was the most frequent. We found a prevalence of CMV infection after allo-HSCT (70.94%) with 62 patients (52.99%) above the cut-off of 1,000 IU/mL and 21 (17.95%) below this value. EBV was the second virus with the highest reactivation rate. CONCLUSIONS. CMV remains in the first place among viral reactivations. CMV and EBV were predominant in unrelated transplants, while BKV and HHV6 predominated in haploidentical.

Barriers to access of hematopoietic stem cell transplantation

Wed, 27 Dec 2023 00:00:00 +0000

Introduction: Hematopoietic stem cell transplantation is a therapy for which even countries with universal health systems face challenges to ensure its access to the population. Barriers to access can be characterized as geographic, organizational, socioeconomic and of information. Objective: To conduct an integrative review of barriers to access of hematopoietic stem cell transplantation. Methods: Databases chosen were BVS, PubMed and Scopus. Population and phenomenon were established, respectively as “hematopoietic stem cell transplantation” and “barriers to access” with descriptors in Portuguese and English. 22 articles, published between 2012 and 2022, were selected. Results: Access was hampered by the distance to transplant center, in more populous regions, with high demand for services and transportation difficulties. There was better access in countries with higher GDP per capita, more installed transplant centers and for the population with higher income. Insurance coverage, support by public policies, assistance in academic centers, organized regulation and prioritization of emergencies facilitated access. The understanding of the diseases, the adherence to the treatments, the perception of survival by the patients and the skills of the professionals improved the access. Conclusion: All categories of access barriers were addressed, with multifactorial and interrelated origins, with the vulnerable population being the most affected.

PLERIXAFOR FOR HEALTHY PERIPHERAL BLOOD HEMATOPOIETIC STEM CELL DONORS IN PEDIATRIC ALLOGENEIC HSCT.

Aditya Kumar Gupta, Dr, Narendra Tiwary, Rachna Seth, Poonam Coshic — Wed, 27 Dec 2023 00:00:00 +0000

Data on use of plerixafor for peripheral blood stem cell(PBSC) mobilization in children with cancer undergoing autologous hematopoietic stem cell transplantation(HSCT) is there in literature. The use of plerixafor for normal healthy allogeneic donors is not reported much, especially in the pediatric setting. In this retrospective analysis from a single tertiary care centre in India, we report the efficacy and safety of the use of plerixafor in five healthy allogeneic PB-HSC donors and compare the outcomes with five others allogeneic HSCT’s in which plerixafor was not used. Ten allogeneic HSCT were included in the analysis, 5 in which the donor received plerixafor and in the other five the donor did not get it. In all the HSCT, PB HSC were the product.

No significant difference in terms of recipients age and weight; donors age and weight and the CD- 34 count in PB before plerixafor were there between the two groups. However, the CD-34 HSC count in the harvested product was significantly higher in the group that received plerixafor (p=0.032). The stem cell dose transfused to the patient was also higher when the donor got plerixafor, although the difference was not significant. None of the donors suffered any side effects and underwent the subsequent apheresis uneventfully.

The use of plerixafor in healthy stem cell donors (both pediatric and adult) for allogeneic stem cell transplant allowed a better yield of stem cells. In our experience the use of plerixafor was safe for the donors.

Second Hematopoietic stem cell transplantation in acute leukemias: Evaluating Success and Challenges

Alessandra Aparecida Paz — Wed, 27 Dec 2023 00:00:00 +0000

The immunological effect of high-dose chemotherapy in multiple myeloma

Abrahão Elias Hallack Neto — Wed, 27 Dec 2023 00:00:00 +0000