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Introduction: Sufficient stem cell collection is mandatory for Autologous stem cell transplantation (ASCT). Peripheral CD34+ stem CD34 + stem cell counting by flow cytometry is the gold standard method in both the predicting and timing of successful stem cell collection. Large unstained cells (LUC) are large peroxidase-negative cells that are displayed on certain automatic cell counters and present large lymphocytes, virocytes, blasts, abnormal cells and hematopoietic stem cells. In this study, we evaluated the role of LUC parameters in the timing and prediction of successful stem cell collection., Methods: Patients with a diagnosis of multiple myeloma, lymphoma and testis tumor who proceed to ASCT were included in this study. Preapheresis LUC parameters were analyzed with Siemens ADVIA® 2120i system., Kruskal Wallis, Mann-Whitney U, Spearman Rho and receiver-operator curve (ROC) tests were used for analyses., Results: Ninety patients were evaluated. Peripheral CD34 + cell count was positively correlated with both LUC count (p = 0014) and LUC percentage (p = 0,01). LUC percentage in peripheral blood was positively correlated with mobilized stem cell count in the yield (p = 0.003). We found a LUC count of > 0.485 × 10 9 /L as a cut-off value for detecting > 20 × 10 6 /L CD34 +cells in the peripheral blood with a sensitivity of 64.6% and specificity of 75%. We defined > 2.15% as a cut-off value for LUC percentage to collect > 5 × 10 6 /kg of stem cells with a sensitivity of 64% and specificity of 63%. Additionally, total nucleated cell (TNC) count was negatively correlated with LUC percentage (p = 0.014) and positively correlated with LUC count (p = 0.001)., Conclusion: LUC parameters are readily available, simple and cheap tools that can be useful in both timing of CD34 count by flow cytometry in peripheral blood and in the prediction of successful mobilization. LUCs can also be an indicator of graft composition., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Backround and Aim: The benefit of pre-transplant consolidation in patients with acute lymphoblastic leukemia (ALL) who achieved first complete remission (CR1) has not yet been clearly demonstrated. Here, we aimed to investigate the relationship between the treatments received before transplantation and transplant outcome in Ph-ALL patients who underwent myeloablative allo-HSCT in CR1., Patients and Methods: A total of 55, 32 (58.2%) men and 23 (41.8%) women, who underwent allo-HSCT with the diagnosis of Ph-ALL were evaluated retrospectively. All patients underwent to allo-HSCT with myeloablative conditioning regimen in the 1st CR from the available donor., Results: In patients who received >2 consolidation, the 2-year and 3-year OS was 69% and 65%, respectively, while the 2-year and 3-year OS was 39% and 26%, respectively, in those who received < 2 consolidation (P =.03). RFS was similar in both groups (P = .8). One year- NRM was found 28% in patients who received ≥ 2 consolidations, and 37% in patients who received <2 consolidation (P =.06). L-asparaginase, high dose methotrexate, and cranial treatments given before transplantation had no effect on transplant outcomes (P > .05)., Conclusion: Contrary to the belief that pre-transplant consolidation is not beneficial in ALL patients who proceed with allo-HCST in CR1, our results showed that consolidation treatments reduce NRM and improve the survival., (Copyright © 2022. Published by Elsevier Inc.)

Allogeneic hematopoietic stem cell transplantation (AHSCT) is a promising strategy for treatment of heavily pretreated mycosis fungoides/Sezary syndrome (MF/SS). Herein, we aimed to evaluate the outcomes of AHSCT for heavily pretreated patients with MF/SS retrospectively. This analysis included consecutive 19 patients with MF/SS who received 20 AHSCT between 2012-2021 in our transplant center. Eight patients have been previously reported. Fifteen patients had diagnosis of MF and referred to SS in five patients. In our cohort, all cases had advanced disease (stages IIB: n = 1, IIIA: n = 7; IIIB: n = 4, IVA: n = 4, and IVB: n = 3). Nine patients (47.4%) had developed large cell transformation. Only two patients received AHSCT in complete response, one very good partial response and two partial response while the others had progressive disease (n = 15) before transplant. Seven (35%) patients were alive at the time of analysis, with a median follow up of 10.5 months (range, 0.3-113 months) after AHSCT. Nine patients (47.4%) died without disease relapse or progression. Non-relapse mortality was 35.9% at 1 year and 26.9% at 3 years and thereafter. For all patients the probability of overall survival was 48.5% and 32.3% at 1- and 5-year post-transplant, respectively. AHSCT for MF/SS resulted in an estimated progression free survival of 45.4% at 1 year. Given the poor prognosis of patients not receiving transplants and in the absence of curative non-transplantation therapies, our results support that AHSCT is able to effectively rescue 32.3% of the population of transplant eligible, heavily pretreated patients in 5 years., (© 2022 Wiley Periodicals LLC.)

Objective/background: Primary central nervous system lymphoma (PCNSL) is associated with worst prognosis compared with other aggressive non-Hodgkin's lymphomas. However, recent trials have demonstrated that long-term progression-free survival can be achieved by immunochemotherapy. Our goal is to present our experience in aggressive PCNSL in this study., Methods: We retrospectively evaluated the clinical features and management of 13 PCNSL patients who were diagnosed and treated between 2006 and 2015., Results: Nine patients received rituximab (R) 375mg/m 2 /day on Day 1, methotrexate (MTX) 3.5g/m 2 /day and cytosine arabinoside (ARA-C) 4.4g/m 2 /day on Day 2, as well as ARA-C 4.4g/m 2 /day on Day 3 every 28days, and underwent autologous stem cell transplantation. Two patients received procarbazine instead of ARA-C. One patient relapsed, and allogeneic hematopoietic stem cell transplantation was performed. All nine patients are followed in complete remission. Two of 13 patients received one course of MTX and 36-45Gy radiotherapy and died. One patient with renal transplantation had progressive disease and died. Grade 3-4 hematological toxicity was detected in 11 (85%), Grade 3-4 mucositis in 11 (85%), and febrile neutropenia in 12 (92%) patients. The median overall survival in the R-MTX-ARA-C/procarbazine group was 28±16months., Conclusion: R-MTX-ARA-C followed by autologous stem cell transplantation seems a promising strategy with high response rates in PCNSL., (Copyright © 2017 King Faisal Specialist Hospital & Research Centre. Published by Elsevier B.V. All rights reserved.)

Background: Haemorrhagic cystitis (HC) is usually a serious complication in allogeneic haematopoietic stem cell transplantation (allo-HSCT) recipients. In this study, our aim was to define risk factors and outcomes for patients with HC in an allo-HSCT setting., Methods: We retrospectively evaluated 249 allo-HSCTs performed between 2011 and 2016 in our centre., Results: HC was diagnosed in 98 patients (39%) at a median of 119 days (range 5-580) and 91 (93%) of the patients had late onset disease. In univariate analysis, HC was related to cytomegalovirus (CMV) reactivation (P<0.001) and BK viraemia (P<0.001); in multivariate analysis, the presence of CMV reactivation was determined to be an independent risk factor (odds ratio: 22.1; 95% CI 1.73, 282.44; P=0.017). There was no association detected between acute graft versus host disease and patients diagnosed with HC within 100 days of transplant. HC was significantly increased by the presence of myelo-ablative conditioning (odds ratio: 31.28; 95% CI 3.98, 246.87; P=0.001) and BK viraemia (odds ratio: 3.93; 95% Cl 1.10, 14.05; P=0.035) in patients with HC grade II and beyond. Forced hydration was recommended in all patients with grade I HC. Patients with HC and clots were treated with continuous bladder irrigation, and 14 of 44 patients with BK viraemia received cidofovir ± ribavirin. Eight of these patients (57%) responded to treatment. Refractory HC was detected in 17 patients (17%) and resolved by a variety of procedures., Conclusions: This study suggests that CMV reactivation is associated with increased risk of HC in multivariate analysis, however, this result is not confirmed in patients with HC grade II and beyond.

Cutaneous T cell lymphoma is a heterogeneous group of lymphoproliferative disorders with different clinical behavior and prognosis in which malignant T cells accumulate in the skin. In the relapsed/refractory stage, treatment strategy varies depending on clinical perspective. We retrospectively evaluated advanced stage relapse or refractory mycosis fungoides and Sezary syndrome patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at our hospital. The overall response rate was 25%, while the disease progressed and relapsed after transplant in 38% of patients. Allo-HSCT may be a reasonable treatment option in the relapsed/refractory stage.

Post-transplant erythrocytosis is an infrequent complication and has been reported after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in aplastic anemia, acute myeloid leukemia, and chronic myeloid leukemia. The pre-disposing factors and treatment are not clearly defined. We present 11 post-transplant erythrocytosis cases. More studies should be conducted to distinguish the pathogenesis and follow-up for this rare complication., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Allogeneic hematopoietic stem cell transplantation is a well-established approach for patients diagnosed with primary myelofibrosis and remains the only potentially curative treatment. Aims: To present the overall outcome of patients with myelofibrosis treated with allogeneic hematopoietic stem cell transplantation. Study Design: A retrospective cross-sectional study Methods: This study is a retrospective analysis of 26 consecutive patients with primary myelofibrosis who underwent transplantation at our center between January 2002 and January 2022. Disease and transplant variables contributing to outcomes were analyzed. Results: The median age at the time of transplantation was 52.5 (range, 32-63) years and the median time from diagnosis to allogeneic hematopoietic stem cell transplantation was 25 (range, 3.1-156.8) months. Myeloablative conditioning and reduced-intensity conditioning regimens were used in 8 (30.8%) and 18 (69.2%) transplantations, respectively. Neutrophil and platelet engraftment was achieved in 23 patients at a median follow-up of 21.2 months (range, 12 days to 234.8 months). Primary graft failure occurred in 1 of 23 patients (4.3%). Neutrophil and platelet engraftment occurred at a median of 16 (range, 12-39) days and 20 (range, 11-78) days, respectively. Acute graft-versus-host disease was seen in 11 of 22 patients engrafted allografts, of which 7 (31.8%) were grade 3-4 acute graft-versus-host disease. Eight patients (36.4%) developed chronic graft-versus-host disease, and three cases were extensive. Four patients (19%) relapsed after a median of 5.5 months, and three patients received donor lymphocyte infusion. The 3-year overall survival rate of the entire study population was 46.2%. The median overall survival was not reached in the myeloablative conditioning group; however, it was 11.9 months in the reduced-intensity conditioning group (p =0.3). According to the donor graft source, the median overall survival was 0.73 months in mismatched unrelated graft recipients, 12 months in matched sibling donors, and not reached in matched unrelated graft recipients (p = 0.03). The 3-year progression-free survival rate of patients who survived > 100 days was 74.7%. The effect of JAK-2 status, graft source, conditioning regimen or dynamic international prognostic scoring system on progression-free survival was not statistically significant. Conclusion: Given the poor prognosis of non-transplant recipients and the lack of non-transplant curative approaches, our results support the consideration of allogeneic hematopoietic stem cell transplantation for eligible patients with primary myelofibrosis. [ABSTRACT FROM AUTHOR]

Hemorrhagic cystitis (HC) is a serious and common complication of hematopoietic cell transplantation (HCT) affecting both allogeneic (alloHCT) and haploidentical HCT recipients.The aims of this study were to determine the incidence, risk factors, severity, morbidity pattern and toxicity of treatment, and outcome of HC in recipients of HSCT at a single tertiary transplant center. We analyzed all patients undergoing haploidentical (haploHCT) or MRD/MUD alloHCT at our bone marrow transplant unit from September 2012 through June 2019. In alloHCT group, 70% (n=205) of the patients received myeloablative conditioning consisted of Cy and only six patients (2%) received identical GVHD prevention with a post-transplant Cy-based regimen. Conversely; in haploHCT group, use of Cy-containing preparative regimen was not often (22.9 % (n=8)) but 77.1% (n=27) of the patients received post-transplant Cy. A total of 328 HSCTs were performed during the study period, of which 169 (51.5%) alloHSCT from MUD, 124 (37.8%) alloHCT from MRD and 35 (10.7%) haploHCT. Baseline characteristics of the patients were similar among two groups with regarding to age, diagnosis, disease status and intensity of conditioning. Hemorrhagic cystitis was diagnosed in 78 of 328 patients (23.8%) with a median follow up 7.4 months. Disease status at transplant, recipient age, cytomegalovirus antigenemia and the intensity of conditioning regimen were not associated with the development of HC. The incidence of HC was significantly higher in patients who received grafts from haploidentical donors compared to those receiving grafts from MRD/MUDs (54.3% (n=19) vs 20.1% (n=59), p<0.001). Interestingly, the incidence of Grade III-IV HC was higher in the alloHCT compared to the haploHCT groups (37.2% vs 2.1%, p<0.001). In multivariate analysis of risk factors associated with HC, receiving conditioning regimen including Cy and the use of a haploidentical donor was not significantly associated with HC. The incidence HC with BK viruria at the time of diagnosis of HC was higher in the cohort of patients receiving grafts from MRD/MUD donors (61% vs 47%, p=0.04) and BK viruria was not associated with HC severity. We identified no significant association between adenovirus, HHV-6 or CMV in HC patients comparing the onset and resolution of HC. Neither HC nor grades III-IV HC was associated with overall survival. Conditioning regimen is an important factor in the development of HC and its mechanism has been well described. In our study, we could not demonstrate the increased HC risk of conditioning regimens including cyclophosphamide. We also showed that cyclophosphamide in MAC had similar HC risk compared with RIC containing cyclophosphamide.In this retrospective analysis, BK virus was detected 45 patients out of 78 patients with HC and BK viruria was not associated with HC severity. [ABSTRACT FROM AUTHOR]

Several studies have attempted to describe the characteristics associated with Large granular lymphocytosis (LGL) lymphocytosis following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its clinical significance. The aim of current study to define the cumulative incidence of LGL lymphocytosis, to identify associations with transplant-related clinical parameters and to assess the impact on transplant related outcomes. During a 14-year follow up period (2005-2017) in this unicentric cohort study, we identified 19 patients (2.8%) with a significant LGL lymphocytosis, among 667 consecutive adult patients who underwent allo-HSCT. A total of 19 (Female/ male: 10 [52.6 %]/ 9 [47.4 %]) patients included into the study met the morphological criteria for LGL lymphocytosis. The median onset of LGL lymphocytosis was 11.5 (2.1- 55.7) months and median lymphocyte count at the time of diagnosis of LGL lymphocytosis was 5400/ mL (5170- 8700/ mL). None of the patient showed palpable splenomegaly, and none of them had typical signs or symptoms of an autoimmune disease. GvHD, viral infections, disease relapse and loss of donor chimerism were excluded during lymphocytosis. Flow cytometry studies confirmed a T cell phenotype of LGLs in the majority of patients (n=12). Two patients presented with LGLs consistent with NK cells and seven showed properties of a mixed NK/T-cell lineage. A monoclonal LGL population of T-cell origin was identified in eight (42.1%) of these patients. None of the 19 patients experiencing LGL lymphocytosis had shown unexplained fever, night sweats, weight loss or lymphadenopathy suggestive of lymphoproliferative neoplasms. In subgroup analysis, we compared the OS of monoclonal and oligoclonal LGL lymphocytosis and 1-year-OS was longer but non-significantly in monoclonal LGL lymphocytosis group; 75 ± 1.6% vs. 44.4 ± 2.2%, respectively. Median PFS was 28.8 months in oligoclonal LGL lymphocytosis group and 8.3 months in monoclonal LGL lymphocytosis group but the number of patients in this group does not provide enough statistical power to confirm whether the differences in PFS were statistically significant. At the time of this report, 2 of 3 patients died of TRM (10.5%). In conclusion, we observed LGL lymphocytosis in 2.8 % of a large cohort of post allo-HSCT survivors. Regardless of clonality, all patients were clinically asymptomatic with respect to LGL lymphocytosis. Our data indicate that, even if monoclonal, post-transplantation LGL expansion may be considered as an expression of chronic stimulation triggered by GVHD or relapse of the disease rather than the result of a malignant transformation. Whether the presence of LGL expansion is the expression of a balanced chronic immune response with a possible effect after allogeneic HSCT should be evaluated in a larger cohort of patients. [ABSTRACT FROM AUTHOR]

Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is widely used to treat malignant and non-malignant hematological diseases.The impact of ABO mismatch on outcome following transplantation remains controversial.In this study, our aim is to define effects of ABO mismatch on engraftment, graft vs host disease, relapse free survival (RFS) and overall survival (OS) in patients who underwent allo-HSCT. Patients and Methods Between 1988 and 2016, we retrospectively identified 1016 patients who underwent allo-HSCT at Ankara University School of Medicine, Department of Hematology.Chi-square and FisherÕs exact tests were used where appropriate in comparison.Cox regression model and Kaplan Meier curves were applied for survival analysis.P<0.05 was considered as statistically significant. Results The median follow-up period was 34.7 months (range, 0.2-229).In our cohort, there were 420 (41.3%) ABO-mismatched transplants occurred including 167 (16.4%) major, 197 (19.4%) minor and 55 (5.4%) bidirectional mismatches.The pre-transplant characteristics of patients are summarized in Table.Allo-HSCTs from unrelated donors and peripheral blood grafts were detected higher in ABO mismatched patients vs ABO matched patients (28% vs 11%, P <0.0001; 78% vs 67%, P <0.0001).The engraftment failure was higher in ABO mismatch group compared to ABO matched group (67 (16%) vs 70 (11%), P =0.05).Neutrophil and platelet engraftment rates were not statistically different in major, minor or bidirectional ABO mismatched vs matched donors.The acute graft vs host disease (GVHD) and chronic GVHD incidences did not alter in patients with ABO match and mismatch (44% vs 45%, P =0.78; 41% vs 39%, P =0.81). In ABO-mismatched group, hemolysis in graft infusion occurred in 50 patients (12%) whereas during engraftment in 35 patients (8%).Although not statistically significant, hemolysis were occurred higher in major ABO mismatch.Plasma exchanges were performed in 18 patients in the major ABO mismatched group due to high anti-donor type isoagglutinin titers (>1/128). Pure red cell aplasia was diagnosed in 5 (3%) major ABO mismatched patients.Major ABO mismatch (HR:1.46, 95% Cl:1.06-2.03; P =0.022) was found to be related with lower RFS and OS (HR:1.31, 95% Cl:1.06-1.62; P =0.013).3-year OS and 1-year RFS were lower with major ABO mismatch (38% vs 47%, P=0.02; 15% vs 24%; P=0.02) (Figure). Conclusion Engraftment failure was detected higher with ABO mismatch as well as major ABO mismatch was related with lower RFS and OS although the cohort is heterogeneous.Close monitoring and early treatment strategies for expectable complications would reduce the number fatal events by ABO mismatched allo-HSCT. [ABSTRACT FROM AUTHOR]