Search

Despite its high effectiveness, hematopoietic stem cell transplantation (HSCT) can sometimes be associated with multiple peri-transplant complications requiring urgent intervention. Life-threatening complications in the transplantation unit affect non-relapse mortality. This article sets out a practical approach to the essential peri-transplant clinical conditions, divided into infectious complications and complications related to immune response and endothelial damage. An early diagnosis of life-threatening conditions, and prompt implementation of the best therapy, can save patients' lives. This is especially the case regarding infectious complications in neutropenic patients and in the advanced stages of immunological complications such as graft-versus-host disease, veno-occlusive disease, graft failure, diffuse alveolar hemorrhage, and thrombotic microangiopathy associated with HSCT. These emergencies are discussed below, along with their risk factors and a summary of the management of patients in the early post-transplant period. [ABSTRACT FROM AUTHOR]

Introduction: There is little iterature data regarding neutropenic enterocolitis (NE) development after autologous hematopoietic cell transplantation (auto-HCT) in non-Hodgkin lymphoma (NHL) patients. The aim of this study was to determine the incidence, risk factors, and clinical outcome of NE after auto-HCT in NHL patients with respect to the impact of multidrug-resistant Gram-negative bacteria (MDRG) and vancomycin-resistant enterococci colonization on the early outcome after auto-HCT. Material and methods: This retrospective single-center analysis included a total of 65 NHL patients who underwent auto-HCT after BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) conditioning (BEAM-auto-HCT). Results: NE was diagnosed in nine (13.8%) patients, a median four days after auto-HCT. In 6/9 (66%) patients, septic shock following NE was diagnosed. In univariate analysis, MDRG colonization before BEAM-auto-HCT was the only factor significant for NE development [odds ratio (OR) 2.4 (1.14-5.0), p = 0.027], although this was not confirmed in multivariate analysis. Additionally, NE [OR 5.2 (1.9-13.9), p = 0.001] and MDRG colonization prior to transplant [OR 2.7 (1.0-7.0), p = 0.041] were independent factors for septic shock development. Conclusions: Our findings suggest that NHL patients presenting with MDRG colonization before transplant should be kept under careful surveillance because of the high risk of the development of early severe infectious complications, including abdominal ones. [ABSTRACT FROM AUTHOR]

Introduction: Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT), with over 12,000 transplants per year in Europe. Due to low toxicity, an entirely outpatient procedure or an early discharge after ASCT can be considered as alternatives to inpatient transplantation. Thus, we launched an Early Discharge Program (EDP) for patients qualified for ASCT due to MM who were under 60 years of age, without significant comorbidities, who had a caregiver available 24/7, and who lived within a 60-minute drive of our hospital. Material and methods: Patients spent 72 hours in the hospital being administered melphalan 200 mg/m2 intravenous followed by an infusion of hematopoietic stem cells. They were eventually discharged and remained under outpatient care. The program was launched in September 2019 and was temporarily halted due to the coronavirus disease 19 (COVID-19) pandemic in early 2020. Five patients were enrolled to the EDP. Results: Non-hematological toxicity was mild and manageable in an outpatient setting. Only one patient was readmitted due to exacerbation of ulcerative colitis that was probably not related to ASCT. We observed neither infections nor bleeding. Due to hematological toxicity, three of the five patients received platelet transfusion on the 6th day after ASCT as outpatients. No packed erythrocytes were transfused. The EDP demonstrated lower costs compared to an inpatient approach. Conclusions: We believe that early discharge, which is an intermediate step to full at-home transplantation due to patients' wellbeing, reduction of infections caused by resistant microorganisms, and costs, will eventually replace a full inpatient procedure for a significant population of patients suffering from multiple myeloma and indeed other diseases. [ABSTRACT FROM AUTHOR]

Introduction: Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT), with over 12,000 transplants per year in Europe. Due to low toxicity, an entirely outpatient procedure or an early discharge after ASCT can be considered as alternatives to inpatient transplantation. Thus, we launched an Early Discharge Program (EDP) for patients qualified for ASCT due to MM who were under 60 years of age, without significant comorbidities, who had a caregiver available 24/7, and who lived within a 60-minute drive of our hospital. Material and methods: Patients spent 72 hours in the hospital being administered melphalan 200 mg/m2 intravenous followed by an infusion of hematopoietic stem cells. They were eventually discharged and remained under outpatient care. The program was launched in September 2019 and was temporarily halted due to the coronavirus disease 19 (COVID-19) pandemic in early 2020. Five patients were enrolled to the EDP. Results: Non-hematological toxicity was mild and manageable in an outpatient setting. Only one patient was readmitted due to exacerbation of ulcerative colitis that was probably not related to ASCT. We observed neither infections nor bleeding. Due to hematological toxicity, three of the five patients received platelet transfusion on the 6th day after ASCT as outpatients. No packed erythrocytes were transfused. The EDP demonstrated lower costs compared to an inpatient approach. Conclusions: We believe that early discharge, which is an intermediate step to full at-home transplantation due to patients' wellbeing, reduction of infections caused by resistant microorganisms, and costs, will eventually replace a full inpatient procedure for a significant population of patients suffering from multiple myeloma and indeed other diseases. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has caused the need to change the global standards for allogeneic hematopoietic cell processing for transplantation by routinely cryopreserving the transplant material. We analyzed the results of hematopoiesis reconstitution in a group of 50 patients who underwent transplantation with cryopreserved cellular material (group A) and in a group of 50 patients who underwent transplantation with non-cryopreserved cellular material (group B). The analysis included patients treated due to acute myeloid leukemia (AML) in the Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences. Statistical evaluation of neutrophil recovery indicates a required time of 19 for group A and 18 days in group B. The statistical analysis also show that tere were no statistically significant differences in the analyzed parameter (p = = 0.8563). The median white blond cell (WBC) reconstitution time in patients was 17 days in both groups. There were no statistical differences between groups (p = 0.8628). The time required to platelet engraftment (PLT >20 × × 109/L) was also evaluated. In both groups, the median number of days to restore platelet count was 14 days. Analysis showed that tere were no significant statistical differences between the groups (p = 0.8920). The time for patients to reach reference values of neutrophil and WBC was evaluated. The median time to reach the neutophil reference value was 22 and 21 days in group A and B, respectively. In contrast, the median time to reach the WBC reference value was 25 and 23 of in groups A and B, respectively. There were no statistically significant difference between the two groups in the parameters analyzed (p = 0.3895 for neutrophil; p = 0.3513 for WBC). In conclusion, transplantation of patients diagnosed with AML using cryopreserved cellular material does not affect the clinical parameters of hematopoietic recovery time of patients treated with transplantation. Cryopreservation of allogenic haematopoietic stem cell product, haematopoietics reconstitution recovery, processing of cells for transplantation. [ABSTRACT FROM AUTHOR]

The Department of Hematology and Bone MarrowTransplantation of Poznan University of Medical Sciences is the first center in Poland to be accredited to conduct CAR-T therapy and the center that has precced the most number of the advanced therapies in Poland so far. The material was obtained by non-stimulated apheresis from 9 patients treated in the Department. The largest group of patients were diagnosed with primary mediastinal large B-celllymphoma (4 patients; 45%), diffuse large B-cell lymphoma (3 patients; 33%) and acute lymphoblastic leukemia (2 patients; 22%). 7 patients received anadvanced therapy product. This paper present the analysis results of quantitative and qualitative parameters of 10 donation of autologous lymphocytes. Our experience consisted of collection, product preparation ― including cell cryopreservation and cell release to Kite/Gilead (8 products; 80%) and Novartis (2 products; 20%) manufacturer. Median age of patients was 30 years (range: 20-48). Median body weight [kg] of patients was 71 (range: 55-81). Median white blond cells count (×103/μL) and lymphocyte count (×103/μL) in patients blood on a collection day before apheresis was 2.78 (range: 0.7-8.46) and 0.64 (range: 0.11-2.03), respectivelly. Detailed parameters of collections products were also evaluated. The median volume [mL] of the product was 190 (range: 104-305). The median number of nuclear cells (×108) in the donation was 71.2 (range: 28.08-101.4). The products were collected between 2019 and 2022 (year ― number of products: 2019 ― 2; 2020 ― 4, 2021 ― 2, 2022 ― 2). The median storage time (number of days) of CAR-T products in the Department was 8 (range: 6-19). The above characteristics of both patients and autologous lymphocyte products dedicated for CAR-T therapy may be usefull to other center aiming to implement advanced cellular therapies. [ABSTRACT FROM AUTHOR]

Copyright of Acta Haematologica Polonica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)