Outcomes of Jehovah's Witnesses with hematological malignancies treated without transfusions - single center experience.

Malignancies of the hematopoietic system frequently are associated with severe cytopenias requiring transfusions of blood components. Refusal of blood components by Jehovah's Witnesses (JW) produces challenges to treatment. In this report we describe the outcome of hematological malignancies of JW patients treated without transfusions. Altogether, eight JW, diagnosed 1994-2015, 6 (75%) females, the median age at diagnosis 40 years (range, 20-78), were included into the analysis. The diagnoses were: acute lymphoblastic leukemia (2, 25%), acute myeloid leukemia (2, 25%), non-Hodgkin's lymphomas (4, 50%). One patient died without treatment while the remaining 7 patients received treatment, including imatinib in 1 patient with BCR-ABL1+ acute lymphoblastic leukemia. Five (62.5%) patients received erythropoiesis stimulating agents. Median hemoglobin concentration at diagnosis was 8.7 g/dL (range, 6.3-13.1), and it decreased to 3.2 g/dL (range, 2.6-9.3) during first-line treatment. Median platelet count at diagnosis was 52 × 109/L (range, 15-392). All patients became thrombocytopenic upon treatment reaching median platelet count 8 × 109/L (range, 2-85). Five patients developed respiratory failure. Anemia contributed substantially to the death of 3 out of 6 patients (50%). One patient (17%) developed central nervous system bleeding in the course of thrombocytopenia. Objective response rate was 43%, with 29% complete remissions after first-line treatment. Despite the median overall survival of 15.3 months (95% CI, 0.2-52.2), all but one acute leukemia patients succumbed shortly after the diagnosis. To conclude, the outcome of JW treated because of hematological malignancies without blood transfusions is very dismal, nevertheless, selected patients can obtain complete remissions. Anemia contributes significantly to the death of JW.

Sinusitis in patients undergoing allogeneic bone marrow transplantation – a review / Sinusite em pacientes submetidos a transplante alogênico de medula óssea – uma revisão

Abstract Introduction Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. Objective The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. Methods An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Results Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31–955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Conclusion Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation.

Resumo Introdução A sinusite é uma doença comum na população em geral, porém pouco se sabe sobre a sua ocorrência em pacientes gravemente imunocomprometidos submetidos a transplante alogênico de células-tronco hematopoiéticas. Objetivo O objetivo do estudo foi analisar a literatura sobre sinusite em pacientes submetidos a transplante alogênico de medula óssea. Método Uma busca na base de dados eletrônica foi realizada com o objetivo de identificar todos os artigos originais que investigaram sinusite em receptores de transplante alogênico de células-tronco hematopoiéticas. A busca foi limitada a publicações em língua inglesa. Resultados Foram identificados 25 estudos, publicados entre 1985 e 2015, sendo que nenhum deles era um ensaio clínico randomizado. Eles incluíram 31-955 pacientes, discutindo diferentes questões, ou seja, valor da avaliação sinonasal pré-transplante e seu impacto na morbidade e mortalidade pós-transplante, tratamento, análise de fatores de risco. Conclusão Os resultados dos estudos analisados produziram resultados inconsistentes. No entanto, algumas recomendações para boas práticas poderiam ser feitas. Em primeiro lugar, parece aconselhável avaliar todos os pacientes submetidos a transplante alogênico de hematopoiéticas com tomografia computadorizada (TC) antes do procedimento. Em segundo lugar, os pacientes com sintomas de sinusite devem ser tratados antes de um Transplante de Células-Tronco Hematopoiéticas (TCTH), de preferência com abordagem clínica conservadora. Em terceiro lugar, os pacientes que se submeteram a TCTH devem ser cuidadosamente monitorizados para sinusite, especialmente no período inicial após o transplante.

Sinusitis in patients undergoing allogeneic bone marrow transplantation - a review.

INTRODUCTION: Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. OBJECTIVE: The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. METHODS: An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. RESULTS: Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. CONCLUSION: Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation.

An isolated outbreak of influenza A H1N1 in a haematological department during post-pandemic period.

INTRODUCTION AND OBJECTIVE: Influenza A H1N1 virus strain was associated with the pandemic outbreak of febrile respiratory infections worldwide in 2009, however in August 2010, the WHO announced that the world had entered the postpandemic period. It offered specific recommendations for this period, including the identification of clusters of severe respiratory disorders and deaths. Here we report the fulminant course of influenza AH1N1 infection in the postpandemic period in a group of patients in a single hematology department. We make an attempt to identify potential risk factors and the mode of spreading, and to provide recommendations for best practice. MATERIAL AND METHODS: We conducted a retrospective analysis of a cluster of patients diagnosed with or suspected of influenza A H1N1 infection in the period from December 2010 to March 2011. RESULTS: Fourteen patients with hematological disorders unexpectedly developed acute respiratory failure ARDS (Acute Respiratory Distress Syndrome). Of them, nine tested positive for influenza A H1N1 in a screening test and eight in confirmatory polymerase chain reaction. The infection was fatal in nine patients, despite artificial ventilation in eight and oseltamivir administration in 11. Ten were in reverse isolation according to CDC. No similar cases occurred in the whole hospital concurrently, or in the hematology wards at any other time. CONCLUSIONS: The occurrence of A H1N1 epidemics in a hematological ward in the post-pandemic period highlights the importance of awareness of this complication, prompt testing and antiviral treatment. Furthermore, it confirms the importance of vaccinating patients and personnel against influenza as a prophylactic measure.

Intrapericardial and intrapleural administration of rituximab to a patient with marginal zone lymphoma.

The addition of rituximab to standard chemotherapy has improved the results of the treatment of B cell non-Hodgkin's lymphomas. Under specific circumstances, it can be administered locally, as an alternative to systemic administration. We administered rituximab intrapericardially in an attempt to control pericardial effusion. We report the case of an 85-year-old woman, diagnosed with marginal zone lymphoma, who developed heart failure due to lymphomatous infiltration of the pericardium. We discuss in detail the possibility of intrapericardial treatment of such patients. The patient received rituximab intrapericardially at a dose of 100 mg in addition to systemic rituximab, cyclophosphamide, vincristine and prednisone immunochemotherapy. The treatment proved to be safe and effective. The patient has remained in good health for more than 3 years at the time of writing. Intrapericardial administration of rituximab may be a valuable therapeutic option for patients with lymphoma that involves the pericardium and heart.

Factors determining the risk of severe (WHO grades 3 and 4) hemorrhage in hematologic patients.

Hemorrhage is a frequent cause of death in hematologic patients. Factors influencing its occurrence are still not precisely defined. Hence, the objectives of this report were to define these factors in a group of patients suffering from severe (WHO grades 3 and 4) hemorrhage, hospitalized in the Department of Hematology, Oncology and Internal Medicine, The Medical University of Warsaw, Poland.