Oncology Patients Who Develop Transfusion-Associated Circulatory Overload: An Observational Study.

BACKGROUND: Transfusion-associated circulatory overload (TACO) is a largely preventable transfusion complication that results in significant morbidity and mortality. Cancers, related treatments, and comorbidities are among the factors that can predispose patients to TACO, but currently there are limited data on this topic in the literature. METHODS: We collected data retrospectively from the electronic health records of 93 adult patients with cancer who met Centers for Disease Control and Prevention (CDC) criteria for TACO from July 1, 2019, through October 31, 2020. The parameters we studied included demographics, comorbidities, treatment modalities, transfusion practices, and outcomes. We summarized data by means and ranges for continuous variables, and proportions for categorical variables. RESULTS: During the study period, the incidence of TACO among oncology patients was 0.84 per 1000 transfusions (95% CI, 0.68-1.02), representing 6.6% of all reactions. This percentage is high, compared with 1%-6% among other populations. Unique characteristics such as hematology malignancy (75.3%), receipt of cardiotoxic chemotherapy (87.1%), pneumonia (57.0%), preexisting oxygen use (59.1%), dyspnea (62.4%), hypertension (55.9%), renal insufficiency (46.2%), daily use of corticosteroids (43.0%), daily use of diuretics (40.9%), daily use of beta-blockers (36.6%), and elevated NT-proBNP (33.3%) were frequently observed in these group of oncology patients. CONCLUSIONS: Our study indicates that oncology patients have unique factors that may lead to diagnosis of TACO. Developing appropriate guidelines that apply to oncology patients, in addition to those set forth by the CDC, should be considered. Implementation by ordering healthcare providers of a tools that can predict TACO can help in early recognition and mitigation of TACO.

Intermediate dose of imatinib in combination with chemotherapy followed by allogeneic stem cell transplantation improves early outcome in paediatric Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL): results of the Spanish Cooperative Group SHOP studies ALL-94, ALL-99 and ALL-2005.

Philadelphia-chromosome acute lymphoblastic leukaemia (Ph+ ALL) is a subgroup of ALL with very high risk of treatment failure. We report here the results of the Sociedad Española de Hematología y Oncología Pediátricas (SEHOP/SHOP) in paediatric Ph+ ALL treated with intermediate-dose imatinib concurrent with intensive chemotherapy. The toxicities and outcome of these patients were compared with historical controls not receiving imatinib. Patients with Ph+ ALL aged 1-18years were enrolled in three consecutive ALL/SHOP trials (SHOP-94/SHOP-99/SHOP-2005). In the SHOP-2005 trial, imatinib (260mg/m(2) per day) was given on day-15 of induction. Allogeneic haematopoietic stem-cell transplantation (HSCT) from a matched related or unrelated donor was scheduled in first complete remission (CR1). Forty-three patients were evaluable (22 boys, median age 6·8years, range, 1·2-15). Sixteen received imatinib whereas 27 received similar chemotherapy without imatinib. Seventeen of 27 and 15 of 16 patients in the non-imatinib and imatinib cohort, respectively, underwent HSCT in CR1. With a median follow-up of 109 and 39months for the non-imatinib and imatinib cohorts, the 3-year event-free survival (EFS) was 29·6% and 78·7%, respectively (P=0·01). These results show that, compared to historical controls, intermediate dose of imatinib given concomitantly with chemotherapy and followed by allogeneic HSCT markedly improved early EFS in paediatric Ph+ ALL.

Recomendaciones en el tratamiento nutricional para pacientes oncológicos ante Covid - 19 / Recommendations in the nutritional treatment for cancer patients before Covid ­ 19

Los pacientes con cáncer tienen alto riesgo de infección y muerte por Covid-19 tras exposición a dicho virus. En estos pacientes confluyen la edad avanzada, inmunodepresión, desnutrición, anemia, exposición a varios prestatarios de cuidados de salud durante el tratamiento citorreductor, estadía en hospitales y unidades cerradas, y los tiempos dilatados de los esquemas terapéuticos como factores de riesgo para desarrollar una infección por dicho virus. Esta revisión presenta recomendaciones sobre acciones requeridas para la identificación, evaluación del impacto sobre el estado de salud y la respuesta terapéutica, e intervención de la desnutrición presente en el paciente con cáncer. Las intervenciones alimentarias y nutricionales se adecúan a la etapa del tratamiento citorreductor, y las terapias empleadas, se orientan a la restauración de una inmunocompetencia requerida para prevención de la infección y la continuidad de los tratamientos antineoplásicos. Se prevén acciones nutricionales en aquellos pacientes con cáncer en caso de la ocurrencia de la Covid-19 a fin de preservar la vida del enfermo y prevenir complicaciones mayores. El presente manuscrito enfatiza las medidas de protección personal, familiar y ambiental contra la Covid-19 que son aplicables con iguales propósitos en el paciente con cáncer. El objetivo de esta revisión narrativa es proporcionar recomendaciones nutricionales claras para el paciente con cáncer en situaciones de alta vulnerabilidad inmunológica y nutricional, para lograr una disminución del riesgo de contagio viral con sus consecuentes complicaciones, asegurando así la continuidad de las acciones citorreductoras en el enfermo con cáncer.

Cancer patients are at high risk of infection and death from Covid-19 after exposure to this virus. In these patients, advanced age, immunosuppression, malnutrition, anemia, exposure to several health care providers during cytoreductive treatment, length of stay in hospitals and closed units, and lengthy therapeutic regimens converge as risk factors to developed an infection by Covid-19. This review presents recommendations on actions required for the identification, evaluation of the impact on the health status and therapeutic response, and intervention of malnutrition present in cancer patients. The food and nutritional interventions are adapted to the cytoreductive treatment stage, and the therapies used aim to restore the immunocompetence required for the prevention of infection and the continuity of antineoplastic treatments. Nutritional actions are foreseen in cancer patients with Covid-19 in order to preserve the life of the patient and prevent major complications. This manuscript emphasizes the personal, family, and environmental protection measures against Covid-19 that are applicable to the same purposes in cancer patients. This narrative review aims to provide clear nutritional recommendations for the cancer patient in high immunological and nutritional vulnerability to achieve a reduction in the risk of viral infection with its consequent complications, thus ensuring the continuity of cytoreductive actions in cancer patients.