COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study.

OBJECTIVE: To study the effectiveness of COVID-19 convalescent plasma (CCP) therapy for patients with moderate and severe COVID-19 disease. METHODS: This non-randomized prospective cohort study was conducted from May 21 to June 30, 2020, at four major tertiary hospitals in Kuwait. CCP was administered to 135 patients. The control group comprised 233 patients who received standard treatment. All patients (N = 368, median age 54 [range 15-82]) had laboratory-confirmed SARS-CoV-2 infection and either moderate or severe COVID-19 disease. RESULTS: CCP treatment was associated with a higher rate of clinical improvement in patients with moderate or severe disease. Among those with moderate COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 8 days in the control group (p = 0·006). For severe COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 15.5 days in the control group (p = 0·003). In the adjusted analysis, patients with moderate disease treated with CCP had a significantly lower 30-day mortality rate. Compared to the control group, oxygen saturation improved within 3 days of CCP transfusion, and lymphocyte counts improved from day 7 in patients with moderate COVID-19 disease and day 11 in patients with severe disease. C-reactive protein levels declined throughout the first 14 days after CCP transfusion. None of the CCP patients developed a serious transfusion reaction. CONCLUSIONS: The data show that administration of CCP is a safe treatment option for patients with COVID-19 disease with a favorable outcome in the rate of, and time to, clinical improvement.

Extranodal lymphoma: a comparative study.

BACKGROUND: The incidence of extranodal non-Hodgkin's lymphoma (NHL) is increasing worldwide. The epidemiology of NHL in the Middle East is largely unknown. PATIENTS AND METHODS: We evaluated all cases of NHL diagnosed at our institutions between 1998 and 2003 according to the site of presentation and their classification into primary nodal and primary extranodal NHL using strict criteria. Extranodal cases and early stage primary nodal cases were compared in terms of clinical characteristics and treatment outcomes. RESULTS AND DISCUSSION: There were 422 NHL cases diagnosed between January 1998 and December 2003, among which 97 cases (23%) were primary nodal, 132 (31%) were early nodal, and 193 (46%) were disseminated primary nodal. In general, there was a male preponderance of primary nodal cases (63% versus 44%; p=0.007). There was a higher prevalence of primary nodal cases in Arabs than in Asians: Kuwaiti Arabs, 50%; other Arabs, 46%; and Asians, 11%. There was a different distribution of histologic subtypes between primary nodal and extranodal NHL (p=0.001). The most common histologic subtype among extranodal cases was diffuse large B cell lymphoma, which accounted for 71% (69) of cases. The most common anatomic site involved was the gastrointestinal tract, which accounted for 45% of all cases. The difference in event-free survival between nodal and extranodal low-grade NHL was not statistically significant (p=0.17). Primary nodal high-grade lymphomas show an overall survival than the primary extranodal disease (p=0.003). CONCLUSION: We conclude that extranodal NHL is common among patients of Arabic descent. Diffuse large B cell lymphoma is the most common histologic subtype and often involves the gastrointestinal tract. Patients with aggressive primary extranodal NHL have lower overall survival than patients with early primary nodal disease.

Factors associated with successful mobilization of progenitor hematopoietic stem cells among patients with lymphoid malignancies.

PURPOSE: This study's main aim was to assess the effect of 2 mobilization regimens (granulocyte colony-stimulating factor [G-CSF] and chemotherapy vs. G-CSF alone) on the yield of CD34(+) cells in the apheresis components of patients with lymphoid malignancy. We also sought to identify possible predictors of CD34(+) cell yield in the apheresis components. PATIENTS AND METHODS: CD34(+) cells were mobilized and harvested from 89 patients with non-Hodgkin lymphoma (n = 62) or Hodgkin disease (n = 27). Forty-one patients (46.1%) were mobilized with G-CSF, and 48 (53.9%) were mobilized with chemotherapy and G-CSF. Univariate and multivariate analyses were used to examine potential predictors of the CD34(+) cell yield (collection of > 2.7 x 10(6) cells/kg), such as the number of peripheral CD34(+) cells, age, sex, diagnosis, disease stage, weight, bone marrow status at baseline, mononuclear cells, white blood cells, and platelet counts. RESULTS: The median patient age was 41 years (range, 12-66 years), and the median patient weight was 72 kg (range, 44-123 kg). Mobilization of peripheral blood progenitor cells (PBPCs) was superior when using chemotherapy and G-CSF versus G-CSF alone (3.6 x 10(6) cells/kg vs. 2.2 x 10(6) cells/kg; P = .001). CD34(+) cell counts and platelet counts in the peripheral blood significantly correlated with CD34(+) yield (P < .01 and P = .009, respectively). The yield was also significantly affected by weight, diagnosis, mobilization regimen, and baseline bone marrow status (P = .021, P = .05, P = .002, and P = .043, respectively). CONCLUSION: Many factors influence harvesting of PBPCs, including diagnosis, bone marrow status at baseline, patient weight, and the type of mobilization regimen. The number of CD34(+) cells in the peripheral blood can be used to predict the timing of apheresis and optimize yield.

Factors influencing engraftment in autologous peripheral stem cell transplantation. The experience of a local Kuwaiti transplantation center.

OBJECTIVE: To assess factors affecting engraftment among patients with lymphoproliferative disorders treated with high dose-chemotherapy and autologous peripheral blood stem cell transplantation. METHODS: Fifty-four patients with lymphoproliferative disorders were treated from March 2000 to April 2006, at the Hamid Al-Essa Multiorgan Transplant Center, Kuwait. There were 37 males and 17 females, with a median age of 43 years (range 12-60). The cohort included 13 Hodgkin's lymphoma, 31 non-Hodgkin's lymphoma, and 10 multiple myeloma cases. RESULTS: The median number of infused CD34+ cells was 1.7x10(6) per kg (0.38-15). The medians for absolute neutrophil count (ANC) and platelet (PLT) engraftment were 12 days (10-15) and 11 days (6-33). The CD34+ cell dose and timing of granulocyte-colony stimulating growth factor administration had no significant influence on ANC engraftment (p=0.3 and p=0.05). CONCLUSION: The results imply that the CD34+ cell dose is the most important predictor of hematopoietic engraftment, namely PLT engraftment. The other factors studied had no clear influence on engraftment kinetics in this cohort.

The use of gallium-67 scintigraphy to monitor tumor response rates and predict long-term clinical outcome in patients with lymphoma.

The aim of this study was to determine whether gallium (Ga)-67 scintigraphy can monitor the treatment response rates and predict the long-term clinical outcome in patients with lymphoma. Gallium-67 scintigraphy was performed upon admission (baseline Ga) in 33 consecutive, newly diagnosed patients. Twenty-eight patients (Hodgkin's disease, n = 18; non-Hodgkin's lymphoma, n = 13) with Ga avid tumors were included in the study. All the patients were treated with induction chemotherapy. Gallium-67 scintigraphy was performed in all patients after the first cycle of chemotherapy (post-cycle 1 Ga) and repeated after the fourth cycle (post-cycle 4 Ga) or after completion of treatment (end-of-chemotherapy Ga). Nineteen patients had a fast response (68%, negative in post-cycle 1 and end-of-chemotherapy Ga), 4 intermediate response (14%, partial positive post-cycle 1 Ga that progressed to negative post-cycle 4 Ga), 3 slow response (11%, partial positive in both post-cycle 1 and post-cycle 4 Ga) and 2 no response (7%, positive in both post-cycle 1 and end-of-chemotherapy Ga). In patients who had either fast or intermediate response, 22 (96%) were free of disease at a median follow-up period of 30 months (range, 11-45 months). All 5 patients (100%) who had slow or no response had progressive disease or residual disease. In conclusion, the findings indicate that Ga could effectively be used to monitor the treatment response rates and predict the long-term clinical outcome in patients with lymphoma and should be used in treatment modifications aimed at reducing toxicity of effective therapy in patients with fast response and replacing treatments early in patients with slow or no response.

Primary gastrointestinal non-Hodgkin's lymphoma: treatment outcome.

Primary gastrointestinal lymphoma is the most common extranodal presentation of non-Hodgkin's lymphoma. In this retrospective study, all cases of primary gastrointestinal lymphoma registered at Kuwait Cancer Control Center between January 1992 and December 2001 were reviewed. Patients were diagnosed through an endoscopic biopsy or exploratory laparotomy. Staging procedures included computed axial tomography scan, bone marrow biopsy, barium and follow-through study, as well as routine chemistry (including lactate dehydrogenase) and hemography. There were 46 patients (30 men and 16 women); ages ranged from 16 to 82 years (median age, 43.6 years). The most common site of involvement was the stomach (70%), and the most common histology was large B cell. At least 50% of cases underwent primary radical surgery, and the majority of patients received subsequent chemotherapy and/or local radiation therapy. Chemotherapy consisted of the CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) regimen for large B-cell histology and CVP (cyclophosphamide/vincristine/prednisone) or oral alkylating agents for low-grade histology. Of this cohort, only 12 cases (26%) have had local or distant relapse. Disease-free survival rates for low-grade and high-grade non-Hodgkin's lymphoma were 64% and 81%, respectively. Primary gastrointestinal lymphoma is a potentially curable malignancy.