Mass Spectrometry-Based Assessment of M-protein in Peripheral Blood During Maintenance Therapy in Multiple Myeloma.

Mass spectrometry (MS) can detect multiple myeloma-derived monoclonal proteins in peripheral blood (PB) with high sensitivity, potentially serving as a PB assay for measurable residual disease (MRD). This study evaluated the significance of PB MS MRD negativity during post-transplant therapy in patients with newly diagnosed multiple myeloma. Serum samples from 138 patients treated in the phase 3 ATLAS trial of post-transplant maintenance with either carfilzomib, lenalidomide, dexamethasone or lenalidomide alone were analyzed using EXENT MS methodology. We established feasibility of measuring MRD by MS in PB in the post-transplant setting, despite unavailability of pre-treatment calibration samples. There was high agreement between MRD by MS in PB and paired BM MRD results at the 10-5 threshold, assessed by either next generation sequencing (NGS) or multiparameter flow cytometry (MFC) (70% and 67%, respectively). Agreement between PB MS and both BM MRD methods was lowest early after transplant and increased with time. MS negativity was associated with improved progression-free survival (PFS), which in landmark analysis reached statistical significance after 18 cycles post-transplant. Combined PB/BM MRD negativity by MFC or NGS was associated with superior PFS compared to MRD negativity by only one modality. Sustained MS negativity carried similar prognostic performance to sustained BM MRD negativity at the 10-5 threshold. Overall, post-transplant MS assessment was feasible and provided additional prognostic information to BM MRD negativity. Further studies are needed to confirm the role and optimal timing of MS in disease evaluation algorithms. The ATLAS trial is registered at www.clinicaltrials.gov as #NCT02659293.

Parameter Identification of the Fractional-Order Mathematical Model for Convective Mass Transfer in a Porous Medium.

Fractional calculus is an essential tool in studying new phenomena in hydromechanics and heat and mass transfer, particularly anomalous hydromechanical advection-dispersion considering the fractal nature of the porous medium. They are valuable in solving the urgent problem of convective mass transfer in a porous medium (e.g., membranes, filters, nozzles, convective coolers, vibrational prillers, and so on). Its solution allows for improving chemical engineering and technology workflows, refining process models for obtaining porous granular materials, realizing the convective cooling of granular and grain materials, and ensuring the corresponding apparatuses' environmental safety. The article aims to develop a reliable convective mass transfer model for a porous medium and proposes a practical approach for its parameter identification. As a result, a general scientific and methodological approach to parameter identification of the fractional convective mass transfer model in a porous medium was proposed based on available experimental data. It mainly used Riemann-Liouville fractional time and coordinate derivatives. The comprehensive application of the Laplace obtained the corresponding general solution transform with respect to time and a coordinate, the Mittag-Leffler function, and specialized functions. Different partial solutions in various application case studies proved this solution. Moreover, the algorithm for practically implementing the developed approach was proposed to evaluate parameters for the considered model by evaluation data. It was reduced to the two-parameter model and justified by the available experimental data.

Polyclonal immunoglobulin recovery in patients with newly diagnosed myeloma receiving maintenance therapy after autologous haematopoietic stem cell transplantation with either carfilzomib, lenalidomide and dexamethasone or lenalidomide alone: Subanalysis of the randomized phase 3 ATLAS trial.

Previous studies suggest that postautologous stem cell transplant (ASCT) recovery of polyclonal immunoglobulin from immunoparesis in patients with multiple myeloma is a positive prognostic marker. We performed a longitudinal analysis of polyclonal immunoglobulin concentrations and unique B-cell sequences in patients enrolled in the phase 3 ATLAS trial that randomized 180 subjects to either carfilzomib, lenalidomide, dexamethasone (KRd) or lenalidomide (R) maintenance. In the KRd arm, standard-risk patients with minimal residual disease negativity after six cycles de-escalated to R alone after cycle 8. One year from the initiation of maintenance at least partial recovery of polyclonal immunoglobulin was observed in more patients on the R arm (58/66, p < 0.001) and in those who de-escalated from KRd to R (27/38, p < 0.001) compared to the KRd arm (9/36). In patients who switched from KRd to R, the concentrations of uninvolved immunoglobulin and the number of B-cell unique sequences increased over time, approaching values observed in the R arm. There were no differences in progression-free survival between the patients with at least partial immunoglobulin recovery and the remaining population. Our analysis indicates that patients receiving continuous therapy after ASCT experience prolonged immunoparesis, limiting prognostic significance of polyclonal immunoglobulin recovery in this setting.

Microscopic Droplet Size Analysis (MDSA) of "Five Thieves' Oil" (Olejek Pieciu Zlodziei) Essential Oil after the Nebulization Process.

Nowadays, due to a higher resistance to drugs, antibiotics, and antiviral medicaments, new ways of fighting pathogens are intensively studied. The alternatives for synthesized compositions are natural products, most of which have been known in natural medicine for a long time. One of the best-known and intensively investigated groups are essential oils (EOs) and their compositions. However, it is worth noting that the method of application can play a second crucial part in the effectiveness of the antimicrobial activity. EOs possess various natural compounds which exhibit antimicrobial activity. One of the compositions which is based on the five main ingredients of eucalyptus, cinnamon, clove, rosemary, and lemon is named "five thieves' oil" (Polish name: olejek pieciu zlodziei) (5TO) and is used in natural medicine. In this study, we focused on the droplet size distribution of 5TO during the nebulization process, evaluated by the microscopic droplet size analysis (MDSA) method. Furthermore, viscosity studies, as well as UV-Vis of the 5TO suspensions in medical solvents such as physiological salt and hyaluronic acid, were presented, along with measurements of refractive index, turbidity, pH, contact angle, and surface tension. Additional studies on the biological activity of 5TO solutions were made on the P. aeruginosa strain NFT3. This study opens a way for the possible use of 5TO solutions or emulsion systems for active antimicrobial applications, i.e., for surface spraying.

Carfilzomib, lenalidomide, and dexamethasone or lenalidomide alone as maintenance therapy after autologous stem-cell transplantation in patients with multiple myeloma (ATLAS): interim analysis of a randomised, open-label, phase 3 trial.

BACKGROUND: Lenalidomide is a cornerstone of maintenance therapy in patients with newly diagnosed multiple myeloma after autologous stem-cell transplantation. We aimed to compare the efficacy and safety of maintenance therapy with carfilzomib, lenalidomide, and dexamethasone versus lenalidomide alone in this patient population. METHODS: This study is an interim analysis of ATLAS, which is an investigator-initiated, multicentre, open-label, randomised, phase 3 trial in 12 academic and clinical centres in the USA and Poland. Participants were aged 18 years or older with newly diagnosed multiple myeloma, completed any type of induction and had stable disease or better, autologous stem-cell transplantation within 100 days, initiated induction 12 months before enrolment, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (1:1) using permuted blocks of sizes 4 and 6 and a web-based system to receive up to 36 cycles of carfilzomib, lenalidomide, and dexamethasone (28-day cycles of carfilzomib 20 mg/m2 administered intravenously in cycle one on days 1 and 2 then 36 mg/m2 on days 1, 2, 8, 9, 15, and 16 in cycles one to four and 36 mg/m2 on days 1, 2, 15, and 16 from cycle five up to 36 [per protocol]; lenalidomide 25 mg administered orally on days 1-21; and dexamethasone 20 mg administered orally on days 1, 8, 15, and 22) or lenalidomide alone (10 mg administered orally for the first three cycles and then at the best tolerated dose [≤15 mg for 28 days in 28-day cycles]) until disease progression or unacceptable toxicity as maintenance therapy. After 36 cycles, patients in both treatment groups received lenalidomide maintenance. Randomisation was stratified by response to previous treatment, cytogenetic risk factors, and country. Investigators and patients were not masked to treatment allocation. Patients in the carfilzomib, lenalidomide, and dexamethasone group with no detectable minimal residual disease after cycle six (as per International Myeloma Working Group criteria) and standard-risk cytogenetics were switched to lenalidomide maintenance as of cycle nine. The primary endpoint was progression-free survival in the intention-to-treat population (defined as all randomly assigned patients). Safety was analysed in all randomly assigned patients who received at least one dose of study treatment. This unplanned interim analysis was triggered by the occurrence of 59 (61%) of the expected 96 events for the primary analysis and the results are considered preliminary. This trial is registered with ClinicalTrials.gov, NCT02659293 (active, not recruiting) and EudraCT, 2015-002380-42. FINDINGS: Between June 10, 2016, and Oct 21, 2020, 180 patients were randomly assigned to receive either carfilzomib, lenalidomide, and dexamethasone (n=93) or lenalidomide alone (n=87; intention-to-treat population). The median age of patients was 59·0 years (IQR 49·0-63·0); 84 (47%) patients were female and 96 (53%) were male. With a median follow-up of 33·8 months (IQR 20·9-42·9), median progression-free survival was 59·1 months (95% CI 54·8-not estimable) in the carfilzomib, lenalidomide, and dexamethasone group versus 41·4 months (33·2-65·4) in the lenalidomide group (hazard ratio 0·51 [95% CI 0·31-0·86]; p=0·012). The most common grade 3 and 4 adverse events were neutropenia (44 [48%] in the carfilzomib, lenalidomide, and dexamethasone group vs 52 [60%] in the lenalidomide group), thrombocytopenia (12 [13%] vs six [7%]), and lower respiratory tract infections (seven [8%] vs one [1%]). Serious adverse events were reported in 28 (30%) patients in the carfilzomib, lenalidomide, and dexamethasone group and 19 (22%) in the lenalidomide group. One treatment-related adverse event led to death (respiratory failure due to severe pneumonia) in the carfilzomib, lenalidomide, and dexamethasone group. INTERPRETATION: This interim analysis provides support for considering carfilzomib, lenalidomide, and dexamethasone therapy in patients with newly diagnosed multiple myeloma who completed any induction regimen followed by autologous stem-cell transplantation, which requires confirmation after longer follow-up of this ongoing phase 3 trial. FUNDING: Amgen and Celgene (Bristol Myers Squibb).

Monitoring of Measuring Devices Using a Programmable Logic Controller and a Dedicated Desktop Application.

An appropriate control and measurement system is one of the elements that allows for the safe and effective operation of a technological installation. Such a system may have a diverse structure that corresponds to the expectations and needs of its user. The devices of various manufacturers, including PLC (programmable logic controllers), can be used as a source of measurement data. This enables flexible measurement-control installations, which are adapted to the technological installations, to be built. This paper presents a system, which was created by the authors, for monitoring the temperature, pressure and flow rate of fluids. It uses the operational and IT properties of the PLC and is adapted to an existing installation on the test stand for multiphase spraying processes. In addition, as a part of the research, an application written in Python language, which allows collected data to be displayed, stored and exported, was implemented.

Analysis of Statistically Predicted Rate Constants for Pyrolysis of High-Density Plastic Using R Software.

The surge in plastic waste production has forced researchers to work on practically feasible recovery processes. Pyrolysis is a promising and intriguing option for the recycling of plastic waste. Developing a model that simulates the pyrolysis of high-density polyethylene (HDPE) as the most common polymer is important in determining the impact of operational parameters on system behavior. The type and amount of primary products of pyrolysis, such as oil, gas, and waxes, can be predicted statistically using a multiple linear regression model (MLRM) in R software. To the best of our knowledge, the statistical estimation of kinetic rate constants for pyrolysis of high-density plastic through MLRM analysis using R software has never been reported in the literature. In this study, the temperature-dependent rate constants were fixed experimentally at 420 °C. The rate constants with differences of 0.02, 0.03, and 0.04 from empirically set values were analyzed for pyrolysis of HDPE using MLRM in R software. The added variable plots, scatter plots, and 3D plots demonstrated a good correlation between the dependent and predictor variables. The possible changes in the final products were also analyzed by applying a second-order differential equation solver (SODES) in MATLAB version R2020a. The outcomes of experimentally fixed-rate constants revealed an oil yield of 73% to 74%. The oil yield increased to 78% with a difference of 0.03 from the experimentally fixed rate constants, but light wax, heavy wax, and carbon black decreased. The increased oil and gas yield with reduced byproducts verifies the high significance of the conducted statistical analysis. The statistically predicted kinetic rate constants can be used to enhance the oil yield at an industrial scale.

A review of flocculants as an efficient method for increasing the efficiency of municipal sludge dewatering: Mechanisms, performances, influencing factors and perspectives.

Mechanical sludge dewatering is one of the stages of the municipal wastewater treatment process, which allows the amount of generated sludge and the cost of its transport and management to be reduced. Achieving a high degree of dewatering is possible thanks to the use of flocculation technology. The article presents issues related to the theory of flocculation, sewage sludge, and its dewatering. The main mechanisms of flocculation, the kinetics of the process, the division of flocculants, and flocculation in dual systems are discussed. The influence of particular parameters on the efficiency of flocculation and the dewatering of sewage sludge was analyed. The assessed parameters are: pH, the presence of salt, the mixing process, the structure and ionicity of chains, and the dose. The results of experimental studies on the dewatering of various types of sludge were compared. The literature review included in the paper helps to better understand the process of flocculation and sludge dewatering, and presents the progress to date and the possible directions for further development in this field.

Spray curtains as devices for surface spraying during the SARS-CoV-2 pandemic.

Counteracting the spread of the SARS-CoV-2 virus is a current and important problem. A crucial issue in this area is the disinfection of various surfaces, as well as the air itself. For this purpose, devices such as foggers, which have different designs, are used. The appropriate size of droplets and their distribution determines the effectiveness of disinfectants. The paper presents droplet size distributions and characteristic mean droplet diameters, which are obtained with the use of a conical pressure-swirl atomizer. For the purpose of the analysis, the laser diffraction method was used. The influence of gas pressure and the distance from the atomizer's orifice on the spray angle and the distance between the nozzles on the spray curtain was also demonstrated.

Flow Rate Control by Means of Flow Meter and PLC Controller.

This paper presents a design of a flow meter based on a programmable logic controller (PLC). The new construction of a flow meter controlled by PLC increases the possibilities for the control and automation of fluid flow. Additionally, the didactic potential of the use of simple automation in the form of a programmable logic controller was considered. A device enabling the measurement of fluid flow rate based on a PLC controller was designed, constructed, and tested. The choice of device was the Gems Sensors FT-210 series turbine flow sensor, which is characterized by low purchase and maintenance costs. The properties and the chemical resistance of polyamide-12, the material the sensor is made of, make it possible to test the flow of various types of fluids. As part of the work, an algorithm and a program controlling the device was developed based on the APB Soft software, enabling the accurate reading of the number of impulses sent by the turbine flow sensor. The results of the designed flow meter were compared with the results obtained for the Krohne VA-40 high accuracy rotameter.

Evaluation of the Possibility of Using 1.4462 and 1.4501 Steel as a Construction Material for Apparatus Operating at an Increased Temperature and with Corrosive Factors.

The objective of this study was to determine the requirements for steels used as construction materials for chemical apparatus operating at an elevated temperature and to correlate them with the properties of the tested steels. The experimental part examined the influence of the annealing process on the structure and properties of X2CrNiMoN22-5-3 (1.4462) and X2CrNiMoCuWN25-7-4 (1.4501) steel. Heat treatment was carried out on the tested samples at a temperature of 600 °C and 800 °C. Changes were observed after the indicated time intervals of 250 and 500 h. In order to determine the differences between the initial state and after individual annealing stages, metallographic specimens were performed, the structure was analyzed using an optical microscope and the micro-hardness was measured using the Vickers method. Potentiostatic tests of the samples were carried out to assess the influence of thermal process parameters on the electrochemical properties of the passive layer. An increase in the hardness of the samples was observed with increasing temperature and annealing time, the disappearance of magnetic properties for both samples after annealing at the temperature of 800 °C, as well as a significant deterioration in corrosion resistance in the case of treatment at a higher temperature.

The diagnostic and prognostic significance of flow cytometric bone marrow assessment in myelodysplastic syndromes according to the European LeukemiaNet recommendations in single-centre real-life experience.

INTRODUCTION: This analysis attempts to determine the diagnostic and prognostic value of bone marrow (BM) evaluation by multiparameter flow cytometry in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS: The study group consisted of patients who underwent diagnostic process in the years 2008-2017 due to cytopenia and finally were diagnosed with MDS (n = 71). The comparative group included patients with cytopenia diagnosed in the same period, whose definitive diagnosis was other than MDS (n = 39). Flow cytometric evaluation of BM was performed following the recommendations of the European LeukemiaNet (ELN) in all patients. RESULTS: The median number of immunophenotypic abnormalities found on granulocytes in the MDS group was significantly higher compared to the comparative group [2 (range 0-5) vs 0 (range 0-2); P < .0001]. Similarly, the median Ogata score was significantly higher in the MDS group [2 (range 0-4) vs 1 (range 0-3); P < .0001]. Since the disturbances of the CD11b/HLA-DR and CD11b/CD13 on granulocytes were significantly more common in MDS patients, the Ogata score was extended by these abnormalities, what resulted in its higher diagnostic sensitivity (82%) while preserving high specificity (87%). The positive correlation was found between risk score determined by the Revised International Prognostic Scoring System and the number of the BM immunophenotypic abnormalities (P = .017). CONCLUSIONS: Our results indicate that the diagnostic usefulness of the Ogata score may be increased by including the abnormal expression of CD11b/HLA-DR and CD11b/CD13 on granulocytes. Moreover, our findings suggest the prognostic significance of the number of BM cytometric abnormalities in MDS.

Evaluation of thromboelastometry parameters as predictive markers for sinusoidal obstruction syndrome in patients undergoing allogeneic stem cell transplantation for acute leukaemia.

Hepatic sinusoidal obstruction syndrome (previously named veno-occlusive disease, SOS/VOD) is a serious complication of allogeneic stem cell transplantation (HSCT). Early identification of patients at risk of SOS/VOD may possibly improve the outcome and reduce mortality. Rotation thromboelastometry (ROTEM) is global assay allowing for the precise assessment of both bleeding and thrombotic conditions, however, its usefulness in patients undergoing HSCT for acute leukaemia has not been studied. We evaluated the thromboelastometry parameters in patients undergoing allogeneic HSCT for acute leukaemia to identify candidate biomarkers of SOS/VOD occurrence. ROTEM assays (INTEM, EXTEM, FIBTEM, APTEM) were performed on day -10, on the day of stem cell infusion (day 0) and on days +12 and +28 post-HSCT. The diagnosis of SOS/VOD was based on the Baltimore criteria. Seven patients (26%) developed SOS/VOD. On day +12, the patients with SOS/VOD had statistically significant longer INTEM-CT (clotting time, 199 ± 33.41vs166 ± 23.65s, p = 0.0033), EXTEM-CT (69.5 ± 6.39vs.52 ± 3.42s, p = 0.0139) and FIBTEM-CT (69.5 ± 22.75vs. 50.8 ± 14.31s, p = 0.0124) compared to SOS/VOD (-). ROC curve on day +12 indicated a cut-off value of 179s in INTEM-CT (AUC = 0.91), 69s in EXTEM-CT (AUC = 0.90) and 102s in FIBTEM-CT (AUC = 0.82) for the prediction of SOS/VOD. This is the first study evaluating the usefulness of ROTEM assays in the early detection of haemostasis abnormalities predictive of SOS/VOD development in patients undergoing HSCT for acute leukemia. Patients with SOS/VOD had a significant delay in the initiation of thrombin formation in the analysed ROTEM assays. The utility of ROTEM assays in the optimal management of patients undergoing HSCT should be clarified in further prospective studies.

The analysis of pneumatic atomization of Newtonian and non-Newtonian fluids for different medical nebulizers.

OBJECTIVE: The article contains results of the experimental studies on atomization process of inhaled drugs and aqueous solutions of glycerol with aqueous solutions of glycerol polyacrylamide (Rokrysol WF1) in pneumatic nebulizers. In experiments, the different concentration of aqueous solutions of glycerol polyacrylamide have been tested. In addition, the effect of nebulizer design on atomization process has been determined. The one of the main elements of medical pneumatic nebulizer is nebulizer cup. SIGNIFICANCE: The experiment with this scope is new and is very important from the point of view of aerosol therapy. METHODS: The results have been obtained by the use of the digital microphotography technique. In order to determine a physicochemical properties of tested liquids, a rheological measurements and measurements of the surface tension were carried out. RESULTS: The differences between characteristics of aerosol for the liquids have been observed. The analysis of the droplets size distributions shows that the different diameters of droplets for Newtonian and non-Newtonian fluids have been formed during atomization in pneumatic nebulizers equipped with different nebulizer cups. The effect of the mouthpiece location on the droplets diameters has been shown. CONCLUSIONS: Precise design of nebulizer and nebulizer cups, and also physicochemical properties of atomized liquids are of high importance in order to the effectiveness of drug delivery to patient's respiratory tracts.

The modified swirl sedimentation tanks for water purification.

This paper discusses design, evaluation, and application for the use of swirl/vortex technologies as liquid purification system. A study was performed using modified swirl sedimentation tanks. The vortex separators (OW, OWK, OWR and OWKR) have been studied under laboratory conditions at liquid flow rate from 2.8⋅10-5 to 5.1⋅10-4 [m3/s]. The pressure drop and the efficiency of purification of liquid stream were analyzed. The suspended particles of different diameters were successfully removed from liquid with the application of swirl chambers of proposed constructions. It was found that damming of liquid in the tank increases alongside liquid stream at the inlet and depends on the tank construction. The efficiency of the sedimentation tanks increases alongside the diameters of solid particles and decrease in the liquid flow rate. The best construction proved to be the OWR sedimentation tank due to smallest liquid damming, even at high flow rates, and the highest efficiency of the purification liquid stream for solid particles of the smallest diameter. The proposed solution is an alternative to the classical constructions of sedimentation tanks.

The prognostic significance of surface dipeptidylpeptidase IV (CD26) expression in B-cell chronic lymphocytic leukemia.

A number of factors related to B-cell chronic lymphocytic leukemia (B-CLL) patients' prognosis have been identified. However, still some factors better reflecting disease activity in individual cases are explored. The study aimed to evaluate prognostic significance of dipeptidylpeptidase IV/CD26 expression on B-CLL cells and its relationship with other well established prognostic factors. The study included 94 patients with newly diagnosed B-CLL and involved analysis of clinical, laboratory, flow-cytometry and cytogenetic data. Detailed analysis showed that CD26 expression on B-CLL cells correlates with Rai's clinical stage of the disease at diagnosis (p=0.034), ß2-microglobulin concentration (p=0.012), lactic acid dehydrogenase activity (p=0.045) and absolute lymphocytes' count (p=0.027) in the blood. The multivariate analysis revealed that time to treatment (TTT) was significantly influenced by Rai clinical stage, LDH activity in blood and CD26 expression on B-CLL cell's. Moreover, in the multivariate analysis restricted to the group of patients with documented cytogenetic risk (n=36) CD26 expression, Rai clinical stage and cytogenetic profile remained their independent impact on TTT. The results of our study indicate that the CD26 expression should be incorporated in B-CLL patients risk assessment along with well known prognostic factors, since it seems to have a relationship with the tumor mass and influences TTT.

Second malignancies after autologous haematopoietic stem cell transplantation following modified BEAM conditioning regimen in patients with Hodgkin lymphoma - characteristics and risk factor analysis.

AIM OF THE STUDY: The aim of the study was to determine the incidence of second malignancies among patients with Hodgkin lymphoma (HL) treated with autologous haematopoietic stem cell transplantation (ASCT) following a modified BEAM (BCNU, etoposide, cytarabine, melphalan, dexamethasone) regimen between 1992 and 2012 at our department. We also intended to define the risk factors for the occurrence of second neoplasm after ASCT. MATERIAL AND METHODS: The long-term outcomes after transplant were evaluated in 170 patients, median age 31 years (range 17-61), who received a median of two pre-transplant chemotherapy lines (range 1-5). RESULTS: MOPP (mechlorethamine, vincristine, procarbazine, prednisone) or MOPP-type regimens were given to 12% of patients prior to ASCT. The median follow-up of the survivors was 73 (12-242) months. The 7-year overall survival and progression-free survival were 75% and 64%, respectively. Second malignancies occurred in 7 of the 170 patients, including 5 haematological malignancies, and 2 solid tumors. They developed at a median of 8 years (range 0.4-13.5) from ASCT. The 10-year and 15-year cumulative incidence of developing a second malignancy were 7% and 13%, respectively. In multivariate analysis, age ≥ 40 years at transplant (HR = 8.8; p = 0.008) and pre-transplant MOPP-type chemotherapy (HR = 5.6; p = 0.030) were the only factors significant for developing a second malignancy. CONCLUSIONS: Our results indicate that age of patient and the type of pre-transplant chemotherapy contribute to the risk of the development of a second neoplasm after ASCT in patients with HL. We believe that better characterization of second malignancies and associated risk factors may be useful for clinicians who care for these patients.

Prognostic factors and long-term outcome of autologous haematopoietic stem cell transplantation following a uniform-modified BEAM-conditioning regimen for patients with refractory or relapsed Hodgkin lymphoma: a single-center experience.

Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.