Efficiency of intravenous iron carboxymaltose in patients with iron-deficiency anemia due to heavy menstrual bleeding: a single-center experience.

OBJECTIVE: Heavy menstrual bleeding (HMB) is the most common cause of iron deficiency anemia (IDA) in premenopausal women. Clinical studies have shown that iron carboxymaltose (ICM) is an appropriate, effective, and well-tolerated treatment option for clinical situations associated with iron deficiency (ID). PATIENTS AND METHODS: This study took 78 out of 400 consecutive patients diagnosed with IDA due to HMB and intolerant or insufficient response of oral iron. All patients were administered the total calculated dose of ICM separately, based on the body weight and current hemoglobin (Hb) level. All the anemia parameters of the patients were compared before and after treatment. RESULTS: All anemia parameters, including median Hb, ferritin, and transferrin saturation, significantly increased four weeks after treatment. Pre- and post-treatment mean Hb levels were 8.9 (± 1.7) g/dL and 12.3 (± 1.2) g/dL, respectively. The mean ferritin level of the patients before treatment was 3.93 (± 2.7) ng/mL. After treatment, the mean ferritin level was 244 (± 185) ng/mL. The mean transferrin saturation levels before and after treatment were 5.7% (± 5.0) and 43.1% (± 20.9), respectively. Although no serious side effects were observed in all patients, headache was detected in 2 patients (2.6%), urticaria in 3 patients (3.8%), and flushing in 2 patients (2.6%). CONCLUSIONS: ICM is an effective and safe treatment option for patients with IDA due to HMB, in which oral iron therapy is insufficient or intolerant. In fact, without waiting for the failure or intolerance of oral iron therapy, moving ICM to the frontline could be cost-effective and more convenient to patients with HMB and health care providers.

Nivolumab as a bridge to allogeneic hematopoietic stem cell transplantation is associated with improved survival.

OBJECTIVE: The aim of the present study was to compare the effects of nivolumab bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT) on progression-free survival (PFS) and overall survival (OS) and toxicity profile. PATIENTS AND METHODS: The study population consisted of relapsed/refractory cases of HL, who were treated with nivolumab for disease control and subsequently underwent allo-SCT at our institution. The control group consisted of HL patients who relapsed or refractory after multiple lines of therapy and underwent allo-SCT without nivolumab before transplantation as bridging therapy. RESULTS: The incidence of acute and chronic graft vs. host disease (GVHD) was similar in both groups. The 100-day mortality occurred in 1 patient (10%) in the nivolumab group and 4 patients (16.7%) in the control group (p = 0.54). During 30-month follow-up, PFS was achieved in 60% of patients in the nivolumab group and 45.8% in the control group (p = 0.69). OS during 30-month follow-up was 80% in the nivolumab group and 41.7% in the control group, OS was superior in patients in the nivolumab group than in the control group (p = 0.04). CONCLUSIONS: Allo-SCT after bridging therapy with nivolumab provides a survival advantage over patients who underwent allo-SCT without the bridging. Therapy with nivolumab in combination with post-transplant cyclophosphamide does not appear to increase GVHD.

Pregnancy outcomes in female cancer survivors after hematopoietic stem cell transplantation.

OBJECTIVE: This study was conducted to retrospectively investigate the pregnancy outcomes of patients who underwent stem cell transplantation (SCT). We also aimed at determining the reasons for avoiding pregnancy despite prolonged remission. PATIENTS AND METHODS: The study population consisted of patients who became pregnant after autologous or allogeneic SCT at Dr. Abdurrahman Yurtarslan Oncology Hospital between 2009 and 2020 for hematologic diseases. Data from 83 patients who had undergone allogeneic or autologous SCT were available for analysis. A total of 18 pregnancies occurred in 14 of these patients. To compare pregnancy outcomes, pregnant patients who received care at Etlik Zübeyde Hanim Maternity Hospital were selected as the control group. RESULTS: No pregnancy occurred in 69 of the patients whose data were analyzed. Of these 69 patients, 48 (69.6%) did not want to become pregnant. The most common reason for not wanting a pregnancy was due to the fact that the patient was not married [21 patients (30.4%)]. The pregnancy rate was higher in the HL group than in other hematologic malignancies [8 patients (57.1%)]. Twelve (85.7%) of the patients who became pregnant did so after autologous SCT and 2 (14.3%) after allogeneic SCT. The cumulative incidence of obstetric complications was higher in pregnancies after SCT than in the control group, and the prevalence of low birth weight was observed more frequently. CONCLUSIONS: Patients who became pregnant after SCT have a higher rate of pregnancy complications. However, these patients achieve similar live birth rates as the healthy population. Many patients have concerns about pregnancy and should be counseled appropriately.

Is classical Hodgkin lymphoma a different disease in the elderly? A single-center retrospective cohort study.

OBJECTIVE: Although the clinical features and treatment results of Hodgkin lymphoma (HL) in young adults are well known, it is thought that the disease may have different characteristics in elderly patients with HL, which constitutes almost 25% of the group. In this study, our aim is to evaluate the clinicopathological features, treatment outcomes, and survival of elderly classical Hodgkin lymphoma (CHL) patients. PATIENTS AND METHODS: Patients aged 60 and over who were treated with a diagnosis of CHL were included in our retrospective cohort study. Patients under the age of 60, those with a diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) were excluded from the study. RESULTS: The median age of 51 patients in the study was 66 (60-76). Forty (78.4%) patients had at least one comorbid disease. The most common histological subtype was mixed cellular HL (n = 23, 45%) and 23 (45%) patients had B-symptoms. Thirty-two (62.8%) patients were in the advanced stage. The most preferred regimen in first-line treatment was doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) combination chemotherapy (n: 45; 88.2%). Forty-three (84.3%) patients were able to complete the initially planned treatment. Complete response was achieved in 34 (66.7%) patients. During the median follow-up period of 45.2 months, 23 (42.6%) patients had died. The 5-year OS was 57.4%. CONCLUSIONS: In conclusion, it was observed that the distribution of histological subtypes was different in elderly patients with CHL, B-symptoms were more common in elderly patients, and OS decreased with increasing age.

Is Cytomegalovirus Surveillance Necessary for Patients With Low Reactivation Risk in an Autologous Hematopoietic Cell Transplantation Setting?

BACKGROUND: In an autologous hematopoietic cell transplantation (AHCT) setting, routine cytomegalovirus (CMV) surveillance is not indicated except in high-risk situations. On the other hand, some studies reported increased CMV reactivation in AHCT setting as a result of incorporation of novel agents into treatment algorithms, such as bortezomib and rituximab. We retrospectively analyzed CMV reactivation and infection rates in patients with no high-risk features, who were treated with AHCT. METHODS: During January 2010 to November 2015, all consecutive, CMV-seropositive patients were included. The viral copy numbers were measured twice a week from the start of the conditioning regimen until engraftment, once a week for the remaining time period until day 30 after AHCT and once weekly only for patients who had been diagnosed with CMV reactivation before and who developed primary/secondary engraftment failure during 31 to 60 days after AHCT. RESULTS: One hundred one (61.6%) men and 63 (38.4%) women were included in the study. The median age of study cohort was 51 years (range, 16-71 years). The indications for AHCT were Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma in 44 (26.8%), 41 (25%), and 79 (48.2%) patients, respectively. CMV reactivation occurred in 60 (37%) patients, and 13 patients (8%) received pre-emptive ganciclovir treatment. CONCLUSIONS: On the basis of our results, it might be stated that CMV surveillance may be recommended during 40 days after AHCT in countries with a high CMV prevalence, even in patients without high-risk features regarding reactivation. Additionally, the risky conditions necessitating CMV screening after AHCT must be re-defined in the era of novel agents.