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Acute myeloid leukemia (AML) has an aggressive course and a historically dismal prognosis. For many patients, hematopoietic stem cell transplantation (HSCT) represents the best option for cure, but access, utilization and health inequities on a global scale remain poorly elucidated.To describe patterns of global HSCT use in AML for a better understanding of global access, practices, and unmet needs internationally.Estimates of AML incident cases in 2016 were obtained from the Global Burden of Disease (GBD) 2019 study. HSCT activities were collected from 2009-2016 by the Worldwide Network for Blood and Marrow Transplantation (WBMT) through its member organizations. The primary endpoint was global and regional use (number of HSCT) and utilization of HSCT (number of HSCT/ number of incident cases) for AML. Secondary outcomes included trends from 2009 to 2016 in donor type, stem cell source and remission status at time of HSCT.Global AML incidence has steadily increased, from 102,000 (95% uncertainty interval (UI): 90,200-108,000) in 2009 to 118,000 (104,000-126,000) in 2016 (+16.2%). Over the same period, a +54.9% increase from 9,659 to 14,965 HSCT/year was observed globally, driven by an increase in allogeneic (+64.9%) with a reduction in autologous (-34.9%) HSCT. While the highest numbers of HSCT continue to be performed in high-resource regions, the largest increases were seen in resource-constrained regions [+94.6% in Africa/East Mediterranean Region (AFR/EMR); +34.7% in America-Nord Region (AMR-N)]. HSCT utilization was skewed towards high-resource regions [in 2016: AMR-N 18.4%, Europe (EUR) 17.9%, South-East Asia/Western Pacific Region (SEAR/WPR) 11.7%, America-South Region (AMR-S) 4.5% and AFR/EMR 2.8%]. For patients70 years of age, this difference in utilization was widened; AMR-N had the highest allogeneic utilization rate, increasing from 2009 to 2016 (30.6% to 39.9%) with continued low utilization observed in AFR/EMR (1.7% to 2.9%) and AMR-S (3.5% to 5.4%). Across all regions, total HSCT for AML in 1HSCT remains a central curative treatment modality in AML. Allogeneic HSCT for AML is rising globally but there are marked variations in regional utilization and practices, including types of graft source. Resource-constrained regions have the largest growth in HSCT use, but utilization rates remain low with a predilection for familial related donor sources and are typically offered in CR1. Further studies are necessary to elucidate the reasons, including economic factors, to understand and address these health inequalities and improve discrepancies in use of HSCT as a potentially curative treatment globally.

The contribution of related donors to the globally rising number of allogeneic haematopoietic stem cell transplantations (HSCT) remains increasingly important, particularly because of the growing use of haploidentical HSCT. Compared with the strict recommendations on the suitability for unrelated donors, criteria for related donors allow for more discretion and vary between centres. In 2015, the donor outcome committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) proposed consensus recommendations of suitability criteria for paediatric and adult related donors. This Review provides updates and additions to these recommendations from a panel of experts with global representation, including the WBMT, the European Society for Blood and Marrow Transplantation donor outcome committee, the Center for International Blood and Marrow Transplant Research donor health and safety committee, the US National Marrow Donor Program, and the World Marrow Donor Association, after review of the current literature and guidelines. Sections on the suitability of related donors who would not qualify as unrelated donors have been updated. Sections on communicable diseases, clonal haematopoiesis of indeterminate potential, paediatric aspects including psychological issues, and reporting on serious adverse events have been added. The intention of this Review is to support decision making, with the goal of minimising the medical risk to the donor and protecting the recipient from transmissible diseases.

Purpose of review The aim of the article is to review recent recommendations on the management of Strongyloidiasis and Chagas disease (ChD) in the context of stem-cell or solid-organ transplantation. Recent findings An update on laboratory screening, detection of acute disease or reactivation and recommended preventive or therapeutic options in the transplant recipients and donors is presented. Recent epidemiological data showing new estimates on the worldwide burden of both diseases and changes in the classical distribution around the globe should increase awareness and will impact the evaluation and management of transplant recipients and donors in endemic and nonendemic regions. Summary Strongyloidiasis and ChD are potentially life threatening if unnoticed in the context of stem-cell or solid-organ transplantation and should be considered in endemic and nonendemic areas. Effective strategies for detection, monitoring, prevention and management are available for both diseases.

Hematopoietic cell transplantation (HCT) is a highly complex procedure that requires a dedicated multidisciplinary team to optimize its safety. In addition, institutions may have different needs regarding indications based on regional disease prevalence or may have an interest in developing specialized services. Yet, structured recommendations are not commonly available. Here, the Transplant Center and Recipient Issues Standing Committee for the Worldwide Network for Blood and Marrow Transplantation (WBMT) organized a structured review of all pertinent elements to establish a transplant program. First, we solicited components from committee members and grouped them in domains (infrastructure, staff, cell processing laboratory, blood banking, laboratory, radiology, pharmacy, HLA testing, ancillary services and quality). Subsequently, reviewers scored all elements on a 7-point scale, from an absolute requirement (score of 1) to not required (score of 7). An independent group of five experienced transplant physicians reviewed the rankings. Minimum requirements to establish any HCT program were identified among elements with mean score of ≤ 2.0, and specific elements for allogeneic and autologous HCT were identified. Mean scores > 2.0 to 4.0 were classified as preferred recommendation, and mean scores of > 4.0 to ≤ 7.0 were considered ideal recommendations for advanced and complex types of transplantation. This structured set of recommendations guides the prioritization of minimum requirements to establish a transplant program and to set the path for expansion and further development.

Hematopoietic cell transplantation (HCT) is a highly complex procedure that requires a dedicated multidisciplinary team to optimize safety. In addition, institutions may have different needs regarding indications based on regional disease prevalence or may have an interest in developing specialized services. Structured recommendations are not commonly available, however. The Transplant Center and Recipient Issues Standing Committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) organized a structured review of all pertinent elements for establishing a transplantation program. First, we solicited components from committee members and grouped them into domains (infrastructure, staff, cell processing laboratory, blood banking, laboratory, radiology, pharmacy, HLA testing, ancillary services, and quality). Subsequently, reviewers scored each element on a 7-point scale, ranging from an absolute requirement (score of 1) to not required (score of 7). An independent group of 5 experienced transplantation physicians reviewed the rankings. The minimum requirements for establishing any HCT program were identified among elements with mean score of ≤2.0, and specific elements for allogeneic and autologous HCT were identified. Mean scores of >2.0 to 4.0 were classified as preferred recommendation, and mean scores of >4.0 to ≤ 7.0 were considered ideal recommendations for advanced and complex types of transplantation. This structured set of recommendations guides the prioritization of minimum requirements to establish a transplantation program and set the stage for expansion and further development.

A total of 5642 hematopoietic cell transplants (HCT) in 5445 patients (2196-40% allogeneic and 3249-60% autologous) were reported by 127 teams in 14 Latin American countries that answered the 2018 LABMT/WBMT Global Transplant Activity survey. The transplant rate (defined as the number of first transplants per 10 million inhabitants per year) was 85 (51 autologous and 34 allogeneic) in 2018. The main indications for allogeneic HCT were acute leukemias (60%), while plasma cell disorders and lymphomas were the most common conditions warranting autologous HCT (50 and 36%, respectively). In the allogeneic HCT, HLA-identical siblings were the main type of donor (44%) followed by related mismatched/haploidentical donors (32%). Peripheral blood stem cells were used in 98% of the autologous and in 64% of the allogeneic transplants. From 2012 to 2018, there was a 64% increase of reported HCT (54% in autologous and 80% in allogeneic). In the allogeneic setting, the most pronounced increase in donor type was observed in haploidentical relatives (from 94 procedures in 2012 up to 710 in 2018), surpassing unrelated donors as of 2017. Significant trends detected in Latin America include rising numbers of the procedures reported, a faster increase in allogeneic HCT compared with autologous HCT and a significant increase in family mismatched/haploidentical donors. The LABMT/WBMT activity survey provides useful data to understand the HCT activity and trends in Latin America.

The Worldwide Network of Blood and Marrow Transplantation (WBMT) pursues the mission of promoting hematopoietic cell transplantation (HCT) for instance by evaluating activities through member societies, national registries and individual centers. In 2016, 82,718 first HCT were reported by 1,662 HCT teams in 86 of the 195 World Health Organization member states representing a global increase of 6.2% in autologous HCT and 7.0% in allogeneic HCT and bringing the total to 1,298,897 procedures. Assuming a frequency of 84,000/year, 1.5 million HCT were performed by 2019 since 1957. Slightly more autologous (53.5%) than allogeneic and more related (53.6%) than unrelated HCT were reported. A remarkable increase was noted in haploidentical related HCT for leukemias and lymphoproliferative diseases, but even more in non-malignant diseases. Transplant rates (TR; HCT/10 million population) varied according to region reaching 560.8 in North America, 438.5 in Europe, 76.7 in Latin America, 53.6 in South East Asia/Western Pacific (SEA/WPR) and 27.8 in African/East Mediterranean (AFR/EMR). Interestingly, haploidentical TR amounted to 32% in SEA/WPR and 26% in Latin America, but only 14% in Europe and EMR and 4.9% in North America of all allogeneic HCT. HCT team density (teams/10 million population) was highest in Europe (7.7) followed by North America (6.0), SEA/WPR (1.9), Latin America (1.6) and AFR/EMR (0.4). HCT are increasing steadily worldwide with narrowing gaps between regions and greater increase in allogeneic compared to autologous activity. While related HCT is rising, largely due to increase in haploidentical HCT, unrelated HCT is plateauing and cord blood HCT is in decline.

Hematopoietic cells transplants are technically complex and expensive imposing a huge burden on health care systems, especially those in developing countries and regions. In 2017 > 4500 transplants were done in 13 Latin American countries with established transplant programmes. We interrogated data on transplant rate, cost, funding source, hospital type, Gini coefficient and the United Nations Development Programme Inequality-Adjusted Human Development Index to determine co-variates associated with transplant development. Transplant rates varied almost 30-fold between the 13 countries from 345 in Uruguay to 12 in Venezuela with a regional transplant rate 7–8-fold lower compared with the US and EU. We found significant correlations between higher transplant cost, public funding, transplants in private hospitals with transplant rate. Low cost per transplant regardless of payor and transplants done in public hospitals were associated with low transplant rates. In contrast, high cost per transplant funded by the government and transplants done in private hospitals were associated with high transplant rates. Surprisingly, we found transplant rates were higher when transplants cost more, when they were done in private for-profit hospitals and payed for with public funds. These data give insights how to increase transplant rates in Latin America and other developing regions.

Highlights • The COVID-19 pandemic has a major impact on the field of hematopoietic stem cell transplantation. • SARS-CoV-2 testing strategy in stem cell donors has been implemented but was not available in every center from the early beginning of the pandemic. • Changes in daily routine (e.g. freezing of unrelated stem cell products) became necessary. • Limited available data in COVID-19 infected donors and patients show no increase in severe events and adverse reactions due to concomitant G-CSF administration and no virus transmission of positive tested donors., SARS-CoV-2 has spread rapidly worldwide, but the full impact of the COVID-19 pandemic on the field of hematopoietic cell transplantation (HCT) remains unknown. To understand this better, an 18-item online survey was disseminated by the Worldwide Network for Blood & Marrow Transplantation with questions exploring SARS-CoV-2 testing algorithms, mobilization, and cryopreservation strategies and COVID-19 infections in allogeneic related and autologous hematopoietic progenitor cell (HPC) donors. The aim of this survey was to assess the impact of the outbreak on policies relating to HPC mobilization, collection, and processing with respect to changes in daily routine. A total of 91 individual responses from distinct centers in 6 continents were available for analysis. In these centers, the majority (72%) of allogeneic related and autologous donors are routinely tested for SARS-CoV-2 before HPC collection, and 80% of centers implement cryopreservation of allogeneic HPC grafts before commencing conditioning regimens in patients. Five related and 14 autologous donors who tested positive for COVID-19 did not experience any unexpected adverse events or reactions during growth factor administration (eg, hyperinflammatory syndrome). These data are limited by the small number of survey respondents but nonetheless suggest that centers are following the recommendations of appropriate scientific organizations and provide some preliminary data to suggest areas of further study.

Introduction: Cardiovascular disease is the leading cause of death, in Uruguay it corresponds to 30%. To the known risk factors, the use of QT and RT are added. The improvement in response and overall survival of hematologic patients allow a longer time to develop cardiovascular complications. Cardiotoxicity has been extensively studied in the context of breast cancer and the use of anthracyclines; however, there are very few data on hematopoietic stem cell transplantation (HSCT). Objective: Assess subclinical myocardial damage by measuring biomarkers and echocardiography and identify patients at high risk of developing cardiotoxicity after HSCT. Methods: This is a prospective, single-center study between April 2017 and November 2020. Population: adult patients admitted in the British Hospital Transplant Unit, Montevideo Uruguay to receive either an autologous or allogeneic HSCT. Measurement: cardiac biomarkers (pro-BNP, Troponin T, Troponin I and CPK) at admission, D1, D14 and D30. Echocardiograms were performed on admission and at D30 by the same team of 3 echocardiographers with the same machine. It was repeated at D100 if some alteration was seen. Results: We included 158 transplants: 148 autologous and 10 allogeneic. The characteristics of the population and results are shown in Table 1. 126 raised some biomarker during the first 100 days (79.7%). Pro-BNP is the biomarker that most frequently rises after admission until day 100: 125/158 (79.1%). The kinetics of the biomarkers are shown in Figure 1. Regarding echocardiograms, there were no patients with a cardiotoxicity criterion defined by: a decrease in LVEF of more than 10% to a value less than 53%. Regarding myocardial deformability, there was a reduction in strain between the initial echocardiogram and D30 in 76 patients of 116 patients with both determinations (65.5%). A reduction of 15% or more was evidenced in 18 (11.3%). Of them, 13 (72.2%) had elevated biomarkers in the first 100 days. Of the patients who did not have strain changes, 78.6% had elevated biomarkers. No statistically significant relationship was found between strain reduction and the presence or absence of elevated biomarkers in the first 100 days. With a median follow-up of 23.3 months (0.89-48.62), 11 (7%) developed clinical cardiotoxicity: hypertension 6, arrhythmia 4, pulmonary embolism 1, sudden death 1. We have strain data of 6/11 patients, and there was no reduction of 15%. Of the 11, 90.9% raised some biomarker during the 100 days. Median development time of cardiotoxicity: 10.3 months (0.03-36.6). 133 had one year follow up so, the incidence of clinical cardiotoxicity at 1 year is 4.5%. There were no differences in elevated biomarkers in the first 100 days and use of Melphalan (p = 0.096) however, there was a difference with BEAM versus other plans, p = 0.035. The reduction in strain at day 30 was not influenced by Melphalan or BEAM. Patients with subclinical myocardial damage were older than those without it: mean age: 56.7 +/- 11.2 versus 44.1 +/- 13.1, p = 0.0001. There was no statistically significant difference between patients who had elevated biomarkers in the first 100 days versus those who did not in relation to a history of diabetes, hypertension, dyslipidemia, heart disease or previous use of anthracyclines. Either in patients with a 15% reduction in strain versus those without. This is one of the first studies worldwide that comprehensively evaluates cardiovascular function during HSCT. Given the small number of observed cardiac complications, greater follow-up of this subpopulation with elements of subclinical cardiotoxicity is required to determine if they are indeed predictive parameters of cardiovascular complications in the future in the transplant setting. Conclusions: Subclinical cardiotoxicity is common in transplantation: Pro-BNP is the biomarker that most frequently rises after admission until day 100: 79.1%. Strain reduction of 15% or more occurs in 11,3%. Subclinical myocardial damage parameters were not associated with type of conditioning, previous use of anthracyclines, comorbidities and clinical cardiotoxicity at 1 year. Clinical cardiotoxicity post HSCT is low, 4,5% at 1 year. We must do a longer-term follow-up in order to evaluate whether the combination of pro-BNP associated with strain reduction can be predictive factors of clinical cardiotoxicity. Figure 1 Figure 1. Disclosures Oliver: Roche: Other: conference support and fees ; Abbvie: Other: conference support and fees .

Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006–2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013–2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.

Haematopoietic cell transplant activity in the 28 countries comprising Latin America is poorly defined. We conducted a voluntary survey of members of the Latin American Bone Marrow Transplantation Group regarding transplant activity 2009-2012. Collated responses were compared with data of transplant rates from the Worldwide Network for Blood and Marrow Transplantation for other geographic regions. Several socio-economic variables were analysed to determine correlations with transplant rates. In total, 94 teams from 12 countries reported 11 519 transplants including 7033 autotransplants and 4486 allotransplants. Annual activity increased from 2517 transplants in 2009 to 3263 in 2012, a 30% increase. Median transplants rate (transplant per million inhabitants) in 2012 was 64 (autotransplants, median 40; allotransplants, median 24). This rate is substantially lower than that in North America and European regions (482 and 378) but higher than that in the Eastern Mediterranean and Asia Pacific regions (30 and 45). However, the Latin America transplant rate is 5-8-fold lower than that in America and Europe, suggesting a need to increase transplant availability. Transplant team density in Latin America (teams per million population; 1.8) is 3-4-fold lower than that in North America (6.2) or Europe (7.6). Within Latin America, there is substantial diversity in transplant rates by country partially explained by diverse socio-economic variables including per capita gross national income, health expenditure and physician density. These data should help inform future health-care policy in Latin America.

Background: Multiple myeloma (MM), is a clonal plasma cell neoplasm characterized by destructive bony lesions, anemia, and renal impairment. MM is a global disease - worldwide in 2016, there were 138509 incident cases with an age standardized incidence rate (ASIR) of 2.1 per 100 000 persons, with a 126% global increase in incident cases from 1990 to 2016 (Cowan AJ et al JAMA Oncology 2018). Access to effective care, including proteasome inhibitors, immunomodulatory agents, and autologous hematopoietic stem cell transplantation (HSCT) is largely limited to high-income sociodemographic index (SDI) countries. SCT remains the standard of care for eligible patients, and in general is more affordable and accessible worldwide than novel therapies. We sought to evaluate the rates and utilization of ASCT globally from 2006-2015 to better characterize access to SCT for patients with MM. Methods: This was a new analysis of a retrospective survey of WBMT sites, conducted annually between 2006-2015, as described previously (Niederwieser et al BMT 2016). Incidence data estimates were reported from the Global Burden of Disease study (Institute for Health Metrics and Evaluation. 2019 'GBD Results Tool.' Global Health Data Exchange. Seattle WA: University of Washington. Accessed 1 June 2019). South Asia and East Asia regions were combined for this analysis. Outcome measures included total number of autologous and allogeneic stem cell transplants by World Bank (WB) regions, and percentage of newly diagnosed MM patients who underwent ASCT, calculated by the number of transplants per region in calendar year / gross annual incidence of MM per region. Results: From 2006 to 2015, the number of autologous HSCT performed worldwide for MM increased by 107% (Figure 1). Activity increased in each region from 2006 to 2015 from 56% in USA and Canada to 335% in Latin America. Utilization of autologous HSCT was highest amongst the Northern America and European WB regions, with an increase from 13% to 24% in Northern America, and an increase from 15% to 22% in Europe. The activity increased considerably in the Latin American countries (335,46% increase) and the utilization reached >10%. In contrast, the utilization of autologous HSCT was much lower in the Africa/Mediterranean and Asian/Pacific region, with autologous HSCT utilization only changing marginally from 1.8% in 2006 to 4% in 2015 despite increase in activity. The number of first allogeneic HSCT performed globally for MM declined after a peak in 2012 by -3% since 2006 mostly in North America. Allogeneic HSCT remains highest amongst the European WB region (increase 8%). The increase in activity was accompanied by an increase in team numbers from 1327 in 2006 to 1581 in 2015 but also by an increase of activity in the teams. Discussion: Autologous HSCT utilization has increased worldwide in high-income SDI WB region countries for MM yet has not increased proportionally amongst low-middle income WB regions. There is a disparity in autologous HSCT utilization amongst high-income regions, exceeding 20% in North America and Europe, while remaining poorly utilized in Africa and the East Mediterranean. Latin America has increased their utilization and is for the first time above 10%. However, we are limited with respect to use of incidence data in LMIC countries from the GBD, likely due to under reporting. Conflicting clinical trial data likely contributed to the decline in some regions for first allogeneic HSCT in MM. More work is needed to improve access to transplantation services for MM patients, especially in low to middle income countries. Conclusion: Although autologous HSCT numbers and rates have increased globally, there are marked disparities in usage amongst high versus low to middle income countries. More work is needed to improve access to HSCT for MM globally. Figure 1 Disclosures Cowan: Celgene: Consultancy, Research Funding; Cellectar: Consultancy; Juno: Research Funding; Sanofi: Consultancy; Abbvie: Research Funding; Janssen: Consultancy, Research Funding. Atsuta:Janssen Paharmaceutical K.K.: Honoraria; Kyowa Kirin Co., Ltd: Honoraria; Chugai Pharmaceutical Co., Ltd.: Honoraria; Mochida Pharmaceutical Co. Ltd: Honoraria. Worel:Sanofi Genzyme, Malinckrodt Therakos: Research Funding; Jazz, Sanofi, Celgene, Novartis, Malinckrodt Therakos: Honoraria; Sanofi Genzyme, Malinckrodt Therakos: Speakers Bureau. Libby:Alnylam: Consultancy; Abbvie: Consultancy; Pharmacyclics and Janssen: Consultancy; Akcea: Consultancy. Pasquini:Novartis: Research Funding; Kite Pharmaceuticals: Research Funding; BMS: Research Funding; Medigene: Consultancy; Amgen: Consultancy; Pfizer: Consultancy. Galeano:Szabo SA: Other: (Equity interest). Szer:Amgen: Honoraria, Other: Travel, Research Funding; Alexion: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding; Takeda: Honoraria, Other: Travel, Research Funding; Prevail Therapeutics: Honoraria, Other: Travel, Research Funding; Novartis: Honoraria, Other: Travel, Research Funding; MSD: Honoraria, Other: Travel, Research Funding; Celgene: Honoraria, Other: Travel, Research Funding. Kroeger:Neovii: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Riemser: Research Funding; JAZZ: Honoraria; Sanofi-Aventis: Honoraria; Novartis: Honoraria, Research Funding; Medac: Honoraria; DKMS: Research Funding. Weisdorf:Fate Therapeutics: Consultancy; Incyte: Research Funding; Pharmacyclics: Consultancy. Niederwieser:Cellectis: Consultancy; Daichii: Speakers Bureau.

HSCT is the only curative option for many malignant and non-malignant diseases. The WBMT was founded as an umbrella organization of societies involved in cellular therapies with the mission of promoting excellence in HSCT. As a non-governmental organization in official relation with the World Health Organization (WHO), the WBMT assisted in the founding of regional societies (Latin America Blood and Marrow Transplantation Group and African Blood and Marrow Transplantation Group), performs global activity surveys, conducts workshops and provides expert support for programs in evolving countries. In this retrospective evaluation we analyzed worldwide activity trends in HSCT up to the year 2016 and evaluated possibilities of improving availability of HSCT by the use of telemedicine. Methods: HSCT activity was collected annually from member societies, national registries and individual centers including donor type (allogeneic/autologous), stem cell source (bone marrow/peripheral blood stem cells/cord blood) and indications for transplant. Transplant rates (TR) were calculated as HSCT/10 million inhabitants without adjustment for patients transplanted in a country other than that of primary residence. Country team density (TD) was defined as teams/10 million inhabitants. Workshops were organized in a number of locations where there was little or no HSCT activity or where improvement in one or more aspect of local or regional HSCT activity was requested, including Vietnam, Brazil, China, South Africa and Morocco. Other countries were paired with established centers using WBMT affiliated partners. In two countries, a pilot program was established involving a 6 month physician training in a JACIE/FACT accredited center followed by daily telemedicine-guided supervision of clinical activities. Results: From 1957-2016 a total of 1,298,897 HSCT (57.1% autologous) procedures were collected. By the end of 2016, HSCT activity was reported from 87 of the 195 WHO member states. A total of 89,070 HSCT from 1662 centers was reported in 2016. Assuming a frequency of 84,000/year, 1.5 million HSCT will be reached in 2019, only 7 years after the 1 million report in 2012 (Figure 1). The global activity/year increased continuously from 10,000/year in 1991 to 82,718 first HSCT/year in 2016 with a global increase of >7% (7.0% in autologous and 7.8% in allogeneic HSCT). As in previous years, slightly more autologous (53.5%) than allogeneic and more related (53,6%) than unrelated HSCT were reported. The further increase in related HSCT was caused mainly by an increase of non-identical family donors (39.5% of related HSCT). Increase in activities according to regions is given in Figure 2. TR and TD varied according to region and are highest in Nord America with 511.2 TR, followed by Europe with 390.9 TR, Latin America with 63.9 TR, APBMT with 46.2 TR and Africa/EMRO with 32.8 TR. In contrast, TD was highest in Europe (7.5 TD) followed by Nord America (6.0 TD), APBMT (1.9 TD), Latin America (1.9 TD) and Africa/EMRO (0.4 TD). Commonest indications were lymphoproliferative diseases for autologous and leukemia for allogeneic HSCT and continue to rise (Figure 3 autologous and Figure 4 allogeneic HSCT). Graft source were predominantly peripheral blood in autologous (99.7%) and 65% in unrelated HSCT, while umbilical cord blood as a stem cell source (13.8% of all unrelated) declined. More than 150 HSCT were performed in one country and one center without activities using daily telemedicine-guided supervision. In conclusion, the global distribution and activities are increasing continuously by more than 7,0% per year with numbers currently running at app. 90,000/year. Of note is the increase of haploidentical HSCT activity, while the use of umbilical cord blood HSCT continues to decrease. TR data show significant gaps between regions. Supervisory telemedicine is a powerful tool to overcome lack of experience and establish JACIE/FACT compatible new programs with collateral benefits for conventional hematology, blood banking, microbiology and virology. Abbreviations: EUR, Europe; AMR/PHA, America; SEAR/WPR, South-East Asia/Western Pacific; AFR/EMRO, African/Eastern Mediterranean. Disclosures Niederwieser: Daichii: Speakers Bureau; Cellectis: Consultancy. Atsuta:Kyowa Kirin Co., Ltd: Honoraria; Chugai Pharmaceutical Co., Ltd.: Honoraria; Mochida Pharmaceutical Co. Ltd: Honoraria; Janssen Paharmaceutical K.K.: Honoraria. Worel:Sanofi Genzyme, Malinckrodt Therakos: Research Funding; Jazz, Sanofi, Celgene, Novartis, Malinckrodt Therakos: Honoraria; Sanofi Genzyme, Malinckrodt Therakos: Speakers Bureau. Galeano:Szabo SA: Other: (Equity interest). Novitzky:Astellas, Roche: Consultancy. Szer:Prevail Therapeutics: Honoraria, Other: Travel, Research Funding; Novartis: Honoraria, Other: Travel, Research Funding; MSD: Honoraria, Other: Travel, Research Funding; Celgene: Honoraria, Other: Travel, Research Funding; Amgen: Honoraria, Other: Travel, Research Funding; Alexion: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding; Takeda: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding. Kröger:Celgene: Honoraria, Research Funding; DKMS: Research Funding; JAZZ: Honoraria; Medac: Honoraria; Neovii: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Riemser: Research Funding; Sanofi-Aventis: Research Funding. Weisdorf:Incyte: Research Funding; Pharmacyclics: Consultancy; Fate Therapeutics: Consultancy. Pasquini:Amgen: Consultancy; BMS: Research Funding; Medigene: Consultancy; Pfizer: Other: Advisory Board; Novartis: Research Funding; Kit Pharma: Research Funding.

Introduction: Cardiovascular disease is the first cause of death worldwide; in Uruguay it corresponds to 30%. Classical risk factors are: age, smoking, male gender, diabetes, hypertension, hyperuricemia and dyslipidemia. In the last decades, the increasing use of chemotherapy and radiotherapy in oncology have augmented cardiovascular side effects. The improvement in response and overall survival of hematologic patients allow a longer time to develop cardiovascular complications. Cardiotoxicity has been studied extensively in the setting of breast cancer and anthracyclines use.However, within Hematopoietic Stem Cell Transplantation (HSCT) this is still being in research. The estimated incidence is 5-10 % but the data is little and unsystematic. The primary objective of this trial is to assess subclinical myocardial damage using biomarkers and echocardiography and identify patients at high risk of developing cardiotoxicity after HSCT. Methods: This is a prospective, single center trial that started on April 2017. Population: adult patients admitted in the British Hospital Transplant Unit, Montevideo Uruguay to receive either an autologous or allogeneic HSCT. Inclusion criteria: 18 years old or older, Eastern Cooperative Oncology Group performance status 0-1. Patients who signed informed consent. Exclusion criteria: baseline left ventricular ejection fraction (LVEF) Results: Between May 2017 and April 2019 we have perform 96 HSCT, of those, all 96 consented to enter into the study. Male gender 57 (60%). Median age 56 years old (18-74). Diseases: Multiple myeloma: 42, Non Hodgkin Lymphoma 27, Hodgkin Lymphoma 12, Acute Myeloid Leukemia 11, Solid tumors 2, Aplasia 1, Renal Amyloidosis 1. Type of transplant: Autologous were 85 and Related Allogenic 11 patients. 82 patients (85,5%) have been studied with the 4 biomarkers determinations and the 2 echocardiograms proposed by the study. Causes for which patients were not studied: 3 because they died before the time points, and 11 because violation of protocol. Forty nine (51%) patients had one biomarker elevated at Day 30, so they would have to be studied at Day 100. Of them 49% performed the echocardiogram studies at D100 and 45% the biomarkers. Biomarkers: The evolution of the biomarkers during transplant is shown in figure 1. Pro-BNP is the biomarker that has more significant changes: 71% of transplanted patients has pro-BNP elevated at day 14; at day 30 53% persists with this biomarker elevated. At day 100, Troponin T and I 0% elevated, CPK 4% and pro-BNP 75% elevated. Echocardiogram: no one patient reached the definition of cardiotoxicity in terms of a decrease in LVEF of more than 10% to a value of less than 53%. However, 12 patients (12,5%) had a reduction of the Global Longitudinal Strain (GLS) of more than 15%. Currently, the deformation index strain is an echocardiographic way to detect early cardiac involvement. The decline in rates of deformation precedes the decline in LVEF and persists during subsequent cancer treatment. A relative reduction of 15% or more of GLS has the greatest specificity in predicting subclinical left ventricular dysfunction. In 74 patients we were able to measure the strain at the admission and 81 at day 30. At day 100 there were no significant reduction of LVEF and 3 patients had a relative reduction of GLS more than 15%. Conclusions: This is a prospective and systematic analysis of biomarker and echocardiographic changes during HSCT. We found changes in biomarkers and echocardiographic measures during HSCT: pro-BNP is the biomarker that raises during transplant, and it is persistently elevated at day 30 in 53%. GLS has a significant reduction in 12,5% of patients. We hypothesized that this changes can be predictive of clinical cardiotoxicity in the future, therefore, we are planning to enroll 100 more patients to confirm this results and after that, correlate this changes with comorbidities, conditioning regimens and study the development of clinical cardiotoxicity after 1-year post HSCT. Disclosures Galeano: Szabo SA: Other: (Equity interest).

In recent years there has been great increase in the relationship between the Latin American Societies of Hematology and the American Society of Hematology. This led to the meeting Highlights of the American Society of Hematology (ASH) in Latin America (HOA-LA), first held in Sao Paulo and Rio de Janeiro, Brazil with its third meeting taking place in 2011 in Punta del Este in Uruguay. With this exchange, it soon proved necessary to know the reality of hematology in Latin America and the context of development in different countries, so that the links between the different scientific societies of the area would become stronger. With this in mind, information was collected using a standardized questionnaire provided to the participants of the 2011 HOA-LA accompanied by guidelines on how to complete the questionnaire. The information provided was discussed during a specific section of the 2011 HOA-LA on April 30 coordinated by Drs. Raul Gabus, Carmino Antonio de Souza and Scott Howard. The session was attended by representatives of Argentina, Brazil, Bolivia, Chile, Colombia, Mexico, Paraguay, Peru, Uruguay and Venezuela as well as those from the United States of America, Canada, Spain and Italy. The aim of the meeting was to prepare a document to evaluate the current status of hematology in Latin America in order to improve interactions between Latin American Societies of Hematology. An additional objective was to encourage the organization of cooperative projects on support and training for the diagnosis and treatment of patients with blood diseases in Latin America. Member societies of the OAH-LA were asked to designate a spokesperson for this activity before 15 December 2010. Questionnaires were distributed to these spokespeople to obtain a representative sample of partners and hematology services of each country. The questionnaires were then sent to the coordinators in January 2011. In February 2011, each representative wrote a brief summary of data on the general situation in their country that reflected the opinion of the respective Society of Hematology. Data were collected and analyzed by the coordinators of the LA-HOA in Uruguay in March 2011 with the reports being divulged to the participating scientific societies. In April 2011 the results were presented and the final text of the document was discussed. The estimated population of the countries involved (Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Paraguay, Peru, Uruguay and Venezuela) is approximately 475 million people in an area of 19,046,336 km2. There are currently 4,306 hematologists for this population which is a rate of 0.9/100,000 hematologists/inhabitants with a heterogeneous distribution between the countries and between regions within each country. A total of 76.7% hematologists are connected to hematology institutions in their countries (range: 45-100%). In the case of Colombia, the Hematology Society is linked to oncology and in five countries (Bolivia, Brazil, Chile, Paraguay and Venezuela) to transfusion medicine. In seven countries (Argentina, Bolivia, Brazil, Colombia, Paraguay, Uruguay and Venezuela), there are formal medical fellowships programs in hematology. Three countries (Brazil, Colombia and Uruguay) reported that it is the National Health System that regulates funds and supportive care. In the other countries the health care system is divided between the public health insurance, prepayments, loans and others. The participation of the public sector in different countries varies between 25 and 73%. Exclusive private healthcare covers 10 and 20% of care. There are few national records and those that exist are limited to specific diseases. The registries are mainly of isolated Hematology Centers with partial data and with little intervention of Hematology Societies (Figure 1). Figure 1 Registry With regards to healthcare in hematology, although most people can easily have access to referral centers, however there are geographic areas far from these centers, such as the Brazilian Amazon and Bolivian Altiplano (Figure 2). Figure 2 Healthcare in hematology accessibility The availability of cytogenetics, flow cytometry, molecular biology, immunohistochemistry, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) was found to be heterogeneous across countries and even within the same country. Some complex techniques such as computed tomography or immunophenotyping by flow cytometry (IHC) are generally accessible to the public. Some countries do not have cytogenetics, molecular biology, MRI or PET-CT availability. Moreover, even in countries that rely on these resources, access to them is not universal for all inhabitants (Figure 3). The reports also mention a need to develop IHC to assist diagnosis of hematologic diseases. Figure 3 Healthcare in hematology diagnosis About the availability of blood components and other resources in transfusion medicine, packed red blood cell and platelet concentrates are availability to the entire population and usually at no cost to the patient. The availability of platelets by apheresis and irradiated blood products is generally limited; normally they are only available to patients in Hematopoietic Stem Cell Transplantation (HSCT) units (Figure 4). It was found that in most countries, patients have access to basic hematology-oncology treatment, but only a part of the population has access to high-cost treatment. Monoclonal antibodies, new drugs and access to HSCT are considered high-cost (Figure 5). There are countries where HSCT is not performed or the program is poorly developed. Figure 4 Healthcare in hematology support Figure 5 Access to treatment and medications The financing of regular treatment is guaranteed by the state, by health insurance or medical organization to which the patient is affiliated. However, there are situations that hematological patients lack coverage (Figure 5). There is no guarantee of coverage of high-cost treatments and medications to all populations. In some countries it is the responsibility of the state, parastatal organizations, other health insurance institutions or medical organizations to which the patient is affiliated. Occasionally, this coverage is funded by a foundation or through a support program of the pharmaceutical industry (Figure 5). Regarding the study protocol and / or treatment, some hematology centers with guidelines or consensus on certain conditions, however almost none of them are national protocols. Most treatment programs follow international protocols with little or no adaptation to the country or region (Figure 6). Figure 6 Hemato-oncological protocol treatment This survey showed that the number of hematologists is inadequate and they are unevenly distributed (Figure 7). Figure 7 Human resources Most societies stated that the number of doctors who are currently in hematology specialist courses is insufficient to meet the needs of the population (Figure 7).

Introduction: Autologous stem cell transplant (ASCT) plays a central role in the treatment of diverse diseases. Infection is one of the major causes of morbidity and costs of the procedure, representing the 2ndcause of death (24%) after primary disease (69%). Thus, preventing infections is a major goal.1There are no publications concerning infections in ASCT in our country. Patients and Methods: Retrospective single center study. Objectives: to compare the incidence of febrile neutropenia (FN) and characteristics of infections between 2 different antibacterial approaches. From January 2006 - December 2017, 279 ASCT have been done in our center. We included 266 patients with complete data: 249 received 1 ASCT and 17 received two. Anti-bacterial prophylaxis from 2006-2013 (Group 1) was ciprofloxacin from day 0 to neutrophil recovery. From 2013 to present (Group 2), levofloxacin was used. First febrile episode empirical treatment was Ceftazidime-Amikacin in Group 1 and Meropenem in Group 2. Results: Median age was 56 years (18-72). MM and NHL (79,7%), 40% in complete remission, were the prevailing diseases. Median CD34+ cells transplanted was 4,87 x 106/kg (0,88-37). Median duration of neutropenia was 11 days (9-32). (Table 1) Group 1: 28% had no FN episodes. Catheter-related and gastrointestinal were the most prevalent sites of infection. Positive cultures were 17,4%, 66,6% Gram+. 91% received Ceftazidime+Amikacine. A 2ndantibiotic was added in 52 patients (60%). Six patients required intensive care unit (ICU) admission (4.9%), due to pneumonia (3), sepsis (2) and viral encephalitis (1). Median days at discharge after ASCT was 17 (10-56); 20,6 for those who had FN episodes and 16,5 for those who did not (p= 0,004). Group 2: 13,8 % had no FN episodes. Pneumonia and catheter-related infections were the most prevalent sites of infection. Positive cultures: 20 %; 69% Gram +. 70 patients received an additional agent (56%).Six patients required ICU admission (4,1%), 1 due to pneumonia, 1 sepsis, 1 alitiasic cholecystitis, 1 catheter-related infection and pneumonia, 1 bradyarrhythmia and 1 atrial fibrillation. Median days at discharge after ASCT was +16 (12-62), 19,8 for those who experienced FN and 17 for those who did not (p=0,184). Incidence of FN was 72% in Group 1 and 86,2% in Group 2 (p=0,004). Culture-negativity was 82,6% in Group 1 and 80% in Group 2. In blood + cultures, Gram + agents represented 66.6% in Group 1 and 69% in Group 2 (p=0.68). Discussion: FN is common in ASCT (63-94%)2,3, implying longer hospitalization, more diagnostic procedures and increase in morbidity and mortality. Significant differences in FN incidence between groups, in favor of Ciprofloxacin prophylaxis (72% vs 86,2% (p=0,004) were found. The incidence of positive cultures was similar in both groups. Gram+ agents were the most common isolation. Prophylaxis with quinolones leaded to a low Gram negative bacteria isolation, as reported by others.4Most infectious episodes were associated with fever of unknown origin: 53 % in Group 1 and 56.8 % in Group 2, with differences in sites of infection's frequency: catheter-related infection prevailed in Group 1 and pneumonia in Group 2. (Table 2) We hypothesized that a better Gram+ coverage with Levofloxacin might have help to reduce the incidence of clinical catheter infections. A 2nd antibiotic was needed in 60% from Group 1 and 56% in Group 2 (p=0,47). Median to neutrophil recovery was shorter in Group 1 (+8 vs +10), (p=0,0001). ICU admission was mostly due to sepsis, similar in both groups (p=0,74). During hospitalization, 2 patients died of sepsis in Group 1 and 0 in Group 2. Mortality rate was 1,87 %, similar to international reports.5 Patients in Group 2 were older, with more advanced diseases and hypogammaglobulinemia, which may contribute to difference in favor of Ciprofloxacin group in terms of FN and days to hematopoiesis recovery. (Table 3) Levofloxacin prophylaxis was not associated with an increase in resistant bacteria nor Clostridium difficile infection. Conclusions: The incidence of FN in ASCT was high. Levofloxacin prophylaxis was associated with more FN episodes and later discharge. Epidemiology and severity of infections and 2nd antibiotic requirement were comparable in both groups. Patients admitted for ASCT in the last 7 years had additional risk features that may contribute to explain the differences found. Mortality rate was low in both groups. Disclosures No relevant conflicts of interest to declare.

Correction to: Bone Marrow Transplantation (2017) 52, 671–677; doi:10.1038/bmt.2016.361; published online 23 January 2017 Since the online publication of this article, the authors realised there were errors in the legends for Figures 1 and 2. The original legend for Figure 1 was: ‘Reasons for auto (left) (N=2057) and allotransplants (right) (N=1206).

More than a million HCT have been performed worldwide to date, but transplant rates and indications vary widely across regions. The Latin American Bone Marrow Transplantation Group (LABMT) was created under the auspices of the Worldwide Network for Blood and Marrow Transplantation (WBMT) in 2011 to assist in diffusing the practice, to integrate centers from multiple countries and to improve access to transplantation in the region. To evaluate the actual HCT activity, trends and contemporary practices in Latin America (LA), the LABMT surveyed centers for the annual activity from 2009 to 2012. Methods: The WBMT Global Activity Survey was used as a template and sent to all Hematology and HCT Societies in the region. This survey includes information of annual HCT numbers by center, indications, stem cell source and donor type. Results: A total of 11,116 HCT were performed between 2009 and 2012 with an increase in annual numbers from 2,517 in 2009 to 3,072 in 2012 (22%). The majority of the HCT were autologous (62%) with a 32% increase in activity over the period analyzed. In contrast, the increase in allogeneic HCT (6%) was relatively small. The majority of allogeneic HCT used related donors (n=3210), mostly HLA-identical peripheral blood (n=1812), bone marrow (n=1128) and non-identical related peripheral blood (n=156). Unrelated donor HCT (n=982) were performed mostly using cord blood (n=427), followed by bone marrow (n=332) and peripheral blood (n=223). In 2012, 91 teams from 12 countries reported 3,072 patients. Transplant rates (TR; HCT/10 million population) were 21 for allogeneic (ranging from 6 in Venezuela to 85 in Uruguay) and 60 for autologous HCT (ranging from 8 in Mexico to 215 in Uruguay). Unrelated donor TR was 5, ranging from 0 (Costa Rica, Panama, Peru, Paraguay and Venezuela) to 18 (Chile). Transplant center team density (team/10 million inhabitants) was 1.8 in 2012, with the highest in Uruguay (15), followed by Panama (8), Costa Rica (4), and Argentina (4). In comparison to other regions, transplant center density in LA was identical to the Asian Pacific region and lower than in Europe (7) or US/Canada (6). TR in LA compared to Asia/Pacific were higher for autologous (39 vs. 14) and lower for allogeneic (21 vs. 24, respectively, Table 1). Most transplant indications for autologous HCT (65% of all HCT) were plasma cell disorders (48%) and lymphomas (41%). Most allogeneic transplants (35% of all HCT) were performed for acute leukemias (58%, equally myeloid and lymphoid leukemias) and 18% for non-malignant disorders. Conclusion: While transplant indications are comparable to HCT performed in Europe and North America, transplant rates, transplant center and transplant team densities in LA are markedly lower. More autologous than allogeneic HCT are performed and autologous HCT increased considerably between 2009 and 2012. Unrelated donor TR is lower than in other regions. Initiatives are currently being taken to increase transplant activity, especially using alternative donor transplants within the region. Table 1. Transplant Rates and Team Density Worldwide Transplant rates (HCT/10 million population) Team density Region POP TOTAL AUTO ALLO FAMILY SIBLING UNRELATED LA 511.7 60.0 39.2 20.9 16.0 14.3 4.9 1.8 SEAR/WPR 3078.0 38.6 14.2 24.4 12.5 8.2 11.9 1.8 EUROPE 846.4 379.3 222.5 156.8 68.2 57.0 88.6 7.6 USA/Canada 348.0 482.5 264.9 217.5 91.2 75.8 126.3 6.2 EMR/AFR 690.9 29.8 12.7 17.2 15.7 15.0 1.4 0.4 HCT, hematopoietic cell transplantation; POP, population; AUTO, autologous; ALLO, allogeneic; SEAR/WPR, South East Asia/Western Pacific Region; LA, Latin America; EMR/AFR; Eastern Mediterranean/African Region Disclosures No relevant conflicts of interest to declare.