Endocrine Sequelae in 157 Pediatric Survivors of Hematopoietic Stem Cell Transplantation (HSCT).

Context: Successful rates of hematopoietic stem cell transplantation (HSCT) face paralleled escalation of late endocrine and metabolic effects. Objective: This work aimed to characterize these sequelae distinguishing between the underlying pathologies and treatments received. Methods: A retrospective descriptive study was conducted in 157 children post-HSCT (hematopoietic pathology [N = 106], solid tumors [N = 40], and rare entities [N = 11]) followed at a single endocrine department between 2009 and 2019. Regression analysis was used to ascertain association. Results: Of all patients, 58.7% presented with at least one endocrine abnormality. Endocrinopathies post HSCT were most frequently developed in lymphoblastic leukemia (60.5% of them), whereas myeloid leukemias had the fewest. A total of 64% of patients presented with primary hypogonadism, 52% short stature, and 20% obesity. Endocrinopathy was associated with older age at HSCT (9.78 years [6.25-12.25] vs 6.78 years [4.06-9.75]) (P < .005), pubertal Tanner stage V (P < .001), chronic graft-vs-host disease (GVHD) (P = .022), and direct gonadal therapy (P = .026). The incidence of endocrinopathies was higher in girls (15% more common; P < .02) and in patients who received radiotherapy (18% higher), steroids (17.4% increase), allogenic HSCT (7% higher), thymoglobulin, or cyclophosphamide. Those on busulfan presented with a 27.5% higher rate of primary hypogonadism (P = .003). Conclusion: More than half of children surviving HSCT will develop endocrinopathies. Strikingly, obesity has risen to the third most frequent endocrine disruption, mainly due to steroids, and partly adhering to the general population tendency. Lymphoblastic leukemia was the condition with a higher rate of endocrine abnormalities. Female sex, older age at HSCT, pubertal stage, allogenic transplant, radiotherapy, alkylating drugs, and GVHD pose risk factors for endocrine disturbances.

Infiltración cutánea como manifestación de leucemia congénita: presentación de 2 casos / Skin infiltration as a presenting sign of congenital leukaemia: Presentation of two cases

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Ruxolitinib in refractory acute and chronic graft-versus-host disease: a multicenter survey study.

Graft-versus-host disease is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. First-line treatment is based on the use of high doses of corticosteroids. Unfortunately, second-line treatment for both acute and chronic graft-versus-host disease, remains a challenge. Ruxolitinib has been shown as an effective and safe treatment option for these patients. Seventy-nine patients received ruxolitinib and were evaluated in this retrospective and multicenter study. Twenty-three patients received ruxolitinib for refractory acute graft-versus-host disease after a median of 3 (range 1-5) previous lines of therapy. Overall response rate was 69.5% (16/23) which was obtained after a median of 2 weeks of treatment, and 21.7% (5/23) reached complete remission. Fifty-six patients were evaluated for refractory chronic graft-versus-host disease. The median number of previous lines of therapy was 3 (range 1-10). Overall response rate was 57.1% (32/56) with 3.5% (2/56) obtaining complete remission after a median of 4 weeks. Tapering of corticosteroids was possible in both acute (17/23, 73%) and chronic graft-versus-host disease (32/56, 57.1%) groups. Overall survival was 47% (CI: 23-67%) at 6 months for patients with aGVHD (62 vs 28% in responders vs non-responders) and 81% (CI: 63-89%) at 1 year for patients with cGVHD (83 vs 76% in responders vs non-responders). Ruxolitinib in the real life setting is an effective and safe treatment option for GVHD, with an ORR of 69.5% and 57.1% for refractory acute and chronic graft-versus-host disease, respectively, in heavily pretreated patients.

Empatía y mindfulness como factores mentalizadores intervinientes en las relaciones entre el apego y la sensibilidad interpersonal en mujeres / Empathy and mindfulness as mentalizing factors intervening in the relationships between attachment and interpersonal sensitivity in women

INTRODUCCIÓN Y OBJETIVOS: El objetivo de esta investigación es evaluar el papel de las variables mentalizadoras (empatía y mindfulness) en la relación entre el estilo de apego adulto y la sensibilidad interpersonal en mujeres. MATERIAL Y MÉTODOS: La muestra consta de 364 mujeres, con una media de edad de 36.54 años (DT = 3.69). Las variables de estilo de apego, empatía, mindfulness y sensibilidad interpersonal se han evaluado utilizando instrumentos autoadministrados de adecuada validez y fiabilidad. RESULTADOS: Los resultados indican una mayor sensibilidad interpersonal en las mujeres con estilos de apego inseguros, en comparación con las mujeres que refieren estilos de apego más seguros. Por otro lado, existe mayor empatía y mindfulness en las mujeres con estilos de apego seguros. Además, la empatía y el mindfulness explican de forma significativa un porcentaje de la varianza en la sensibilidad interpersonal. CONCLUSIONES: Se comentan las implicaciones de estas diferencias significativas en el desarrollo de programas tanto de prevención como de intervención en mujeres

INTRODUCTION AND OBJECTIVES: The goal of this study is to evaluate the role of mentalizing variables (empathy and mindfulness) in the relationship between adult attachment style and interpersonal sensitivity in women. MATERIAL AND METHODS: The sample consists of 364 women, with an average age of 36.54 years (SD = 3.69). Attachment style, empathy, mindfulness and interpersonal sensitivity variables have been evaluated using self-report instruments with adequate validity and reliability. RESULTS: The results show greater interpersonal sensitivity in women with insecure attachment styles, compared to women who report more secure attachment styles. On the other hand, there is greater empathy and mindfulness in women with secure attachment styles. In addition, empathy and mindfulness significatively explain a percentage of the variance in interpersonal sensitivity. CONCLUSIONS: The implications of these differences in the development of both prevention and intervention programs for women are discussed

Vaccine Rubella: A Rare Cause of Post-transplant Hematopoietic Death, but a Major Public Health Problem.

We report the first case, to our knowledge, of a child who presented with severe zonal hepatic necrosis after allogeneic hematopoietic stem cell transplantation secondary to infection with the rubella virus RA27/3 vaccine strain.