The effect of cryopreservation on engraftment kinetics in fully matched allogeneic stem cell transplantation: Real-life data and literature review.

INTRODUCTION: The standard approach for allogeneic stem cell transplantation (allo-SCT) is to administer donor cells on the same day as a fresh product to a patient who has been given a preparative regimen. The difficulty in collecting and transporting donor cells, especially during the COVID-19 pandemic, has made it essential to collect and cryopreserve the grafts before the recipient begins the transplant preparation regimen. However, the short- and long-term impacts of cryopreservation on transplant outcomes remain controversial. MATERIALS AND METHODS: This retrospective study included 93 patients who underwent allo-SCT between January 2012 and August 2022 at the Stem Cell Transplant Unit of Bursa Uludag University Faculty of Medicine using frozen and fresh products of peripheral blood stem cells from a fully matched sibling donor. The effect of cryopreservation of donor grafts on engraftment kinetics was investigated. RESULTS: Frozen and fresh products were used in 37 and 56 patients, respectively. The majority of patients had acute myeloid leukemia and acute lymphoblastic leukemia. The median age at transplantation was 41 years. Neutrophil engraftment time was similar between the two groups (median: 14 vs. 16 days, p = 0.393). Platelet engraftment time was longer in the frozen product group (median: 12 vs. 15 days, p < 0.001). There was no statistically significant difference between freezing time and viability. The acute graft-versus-host disease (GVHD) rate was 37.8 % in the frozen product group and 28.6 % in the fresh product group (p = 0.349). There was no significant difference between the two groups in terms of primary and secondary graft failure, chronic GVHD, 30-day chimerism, relapse, overall survival, progression-free survival, and nonrelapse mortality. CONCLUSION: Having donor cells ready before transplantation significantly prevents donor-induced adverse events and provides confidence and practicality to both the clinician and the recipient. Allo-SCT with frozen products is a successful method that can be safely applied, especially when disruptions in donor-derived cell collection or transportation are foreseen.

Systemic inflammatory indices for predicting prognosis of myelofibrosis.

The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 109/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.

Potential modifications of the PLASMIC scoring system for predicting thrombotic thrombocytopenic purpura: Sometimes, less is more.

INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening occlusive disease of the microcirculation characterized by systemic platelet plugs, organ ischemia, deep thrombocytopenia, and fragmentation of erythrocytes. One of the widely used scoring system to determine the clinical probability of TTP is the PLASMIC scoring system. This study aimed to evaluate the contribution of PLASMIC score modifications to sensitivity and specificity in patients with microangiopathic hemolytic anemia (MAHA) undergoing plasma exchange with a prediagnosis of TTP at our center. MATERIALS AND METHODS: The data of patients who were hospitalized with a previous diagnosis of MAHA and TTP and underwent plasma exchange at Bursa Uludag University, Faculty of Medicine, Department of Hematology between January 2000 and January 2022 were retrospectively analyzed. RESULTS: Overall, 33 patients (including 15 and 18 with and without TTP, respectively) were included in this study. Receiver operating characteristic (ROC) analysis revealed that the area under the curve (AUC) for the original PLASMIC score was 0.985 (95% confidence interval [95% CI]: 0.955-1.000), and AUC for the PLASMIC score without mean corpuscular volume (MCV) was 0.967 (95% CI: 0.910-1.000), which is close to the original AUC. With the removal of MCV from the scoring system, the sensitivity decreased from 100% to 93%, whereas the specificity increased from 33% to 78%. CONCLUSIONS: Based on the results of this validation study, removing MCV from the PLASMIC score led to the categorization of eight non-TTP cases in the low-risk category, and this could avoid unnecessary plasma exchange. However, in our study increasing the specificity was at the expense of the sensitivity by missing one patient with this new scoring system without MCV. Further multicenter studies with large sample sizes are required owing to the fact that different parameters may be effective in TTP prediction among different populations.

Two Cases of Kidney Transplant Recipients With Multiple Relapsing Pure Red Cell Aplasia Due to Parvovirus B19 Infection.

Although anemia is common after kidney transplant, pure erythroid aplasia due to parvovirus B19 infection is rare. Therefore, there are delays in diagnosis in transplant patients. Here, we aimed to raise awareness that pure red blood cell aplasia due to parvovirus B19 should be considered in the differential diagnosis of posttransplant anemia. Our report analyzes 2 kidney transplant recipients under immunosuppressive therapy who were diagnosed with pure red blood cell aplasia due to parvovirus B19 infection. Both patients were examined for anemia as a cause for transfusion dependence. Normochromic, normocytic anemia, and reticulocyte levels were low. Leukocyte and platelet counts and biochemical parameters were within reference ranges. Therefore, pure red blood cell aplasia associated with parvovirus B19 was included in the differential diagnosis. Bone marrow showed erythroid hypoplasia and megaloblastic changes with giant erythroblasts containing dark-stained inclusion structures. Results from the other series (neutrophils, lymphocytes, platelets) were within reference ranges. Parvovirus B19 immunoglobulin M and G levels were negative in both patients, yet serum parvovirus B19 DNA polymerase chain reaction test results were positive. Therefore, diagnosis was parvovirus B19-associated pure red blood cell aplasia. Anemia resolved completely by 4 weeks after reduction of immunosuppression and intravenous immunoglobulin. Both patients relapsed in month 5 of treatment. One patient relapsed 3 times during follow-up, with complete response to intravenous immunoglobulin for all 3 events. The second patient showed partial response to intravenous immunoglobulin after relapse. We suggest that pure red blood cell aplasia associated with parvovirus B19 should be considered in transplant patients who present with anemia and reticulocytopenia. Negative serology does not exclude the diagnosis, and it is important to perform a parvovirus B19 DNA polymerase chain reaction test. Intravenous immunoglobulin therapy is effective to cure anemia within weeks. Follow-up of patients is important because relapse may occur after treatment.

The Role of White Blood Cell Count in Perianal Pathologies: A Retrospective Analysis of Hematologic Malignancies.

Background and Objective: Infections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period. Methods: Patients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study. Results: A total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology.In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.

Evaluation of Using Empiric Glycopeptides in Accordance with the IDSA Guidelines in Hematologic Malignancy Patients with Febrile Neutropenia.

Background: This study aimed to evaluate the effects of the appropriate use of empiric glycopeptide therapy in hematologic malignancy patients with febrile neutropenia (FN). Materials and Methods: Patients with FN who were hospitalized in our clinic and started empiric glycopeptide therapy were retrospectively analyzed. Empiric glycopeptide treatment initial indications were determined according to 7 specific criteria in the IDSA guidelines. In addition, the duration of glycopeptide use according to initial indications, causative pathogens in culture positivity, frequency of VRE infection, and the mortality rate was identified. Results: 87 patients were included. Of these, 102 episodes of FN were analyzed. Appropriate use of glycopeptides was observed in 98% of patients. The most common initial indication for glycopeptide was skin or soft-tissue infection, with 52% (n = 53). The mean duration of glycopeptide use was 11 (2-22) days. The time of glycopeptide use was longer in patients with catheter-related infections than in those with severe mucositis and hemodynamic instability (p = 0,041/p = 0,016). The duration of glycopeptide use was shorter in patients with consolidation therapy than in those without consolidation therapy. The mortality rate in culture-positive patients was significantly higher than in culture-negative patients (p = 0.041). At 72 h, glycopeptide therapy was discontinued in 8 of 79 FN episodes within culture-negative patients. Conclusion: This study showed that the mortality rate was higher in culture-positive patients. Additionally, glycopeptides should be discontinued early with no evidence of gram-positive infection.

The comparison of the relationship between sociocultural-economic features and sexual dysfunction frequency in sexually active premenopausal female patients on renal replacement therapy.

INTRODUCTION: Many studies determine different risk factors for sexual dysfunction (SD) in women, but little is known about the influence of socioeconomic and cultural factors, medical and psychological features on female SD frequency in patients under renal replacement therapy (RRT). AIM: This study aimed to compare the relationship between medical, psychological, sociocultural-economic factors, and SD frequency in patients on RRT with the diagnosis of end-stage renal disease. METHOD: The 115 RRT patients (hemodialysis [HD] 39, peritoneal dialysis [PD] 43, kidney transplant [KT] 33) and 103 healthy premenopausal female volunteers (control) without any known health problems were included in the study. MAIN OUTCOME MEASURES: The questionnaire forms containing sociodemographic data, the hospital anxiety depression scale, and Arizona Sexual Experiences Scale were completely filled by subjects who were included in the study. RESULTS: There was no significant difference about mean age, dialysis duration, and body mass index between the groups. While there were significant differences among participants training period and employment conditions, socioeconomic status scores were similar. Significant differences were found in marriage type, marital duration, husband's age, training period and working time per week, spending time with each other, weekly sexual intercourse frequency, the number of children, mothers' and fathers' education. RRT groups were more depressed than control, but no significant differences were observed among the RRT groups. PD and HD groups were more anxious than the KT and control groups. It was identified that SD rates were higher in KT and dialysis patients compared with the control. SD rates were significantly high in the HD group. Multivariate analysis showed that marital duration and being an HD patient are independent SD risk factors for RRT population. CONCLUSIONS: Successful KT may improve SD. Differences in sociocultural, economic, medical, and psychological factors among individuals with SD should be taken into consideration in their treatment management.