Annals of Hematology

Haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HSCT) has emerged as a novel strategy to treat patients suffering from severe aplastic anemia (SAA) who lack matched donors due to the availability and easy access to sources of donors. Anti-human leukocyte antigen donor-specific antibodies (DSAs) have been found to influence the outcome of Haplo-HSCT. Between March 2016 and March 2020, 7 SAA patients with DSAs underwent Haplo-HSCT in our center. We employed a modified protocol of post-transplantation cyclophosphamide and plasma exchange aiming to decrease the levels of DSAs. All 7 patients successfully achieved hematopoietic reconstruction. The median follow-up is 31 (range, 8 to 45) months. They survived and were transfusion-independent in the absence of clonality. No occurrence of primary or secondary graft failure has been noted among any of the patients. There was no severe acute and chronic GVHD occurred. This protocol is effective for Haplo-HSCT in SAA patients with DSAs, which provides an option for the SAA patients without other alternative donor.

This study aimed to investigate the association between vitamin D deficiency and anemia in a hospitalized geriatric population. An observational study, at the acute care geriatric unit of Brest Hospital, France, was conducted among 226 patients aged ≥70 years consecutively hospitalized between January 22, 2010 and August 9, 2010. Vitamin D and hemoglobin levels were measured. Vitamin D deficiency was defined as a 25(OH)D level <50 nmol/L and anemia as defined by the World Health Organization. After adjustment for albuminemia, anemia was not significantly associated with vitamin D deficiency (odds ratio (OR) = 1.37; 95 % confidence interval (CI) = 0.72–2.6). But anemia was significantly associated with hypoalbuminemia (OR = 2.08; 95 % CI = 1.11–3.91). Denutrition reflected by hypoalbuminemia could be a possible confounding factor in the previously described association between anemia and vitamin D deficiency.

Many patients with chronic myeloid leukemia (CML) retain a certain degree of normal hematopoiesis at disease presentation. This fact, suspected on the basis of cytogenetic findings, has been confirmed by long-term bone marrow cultures (LTBMC) and the combined use of phenotypic and molecular studies. Based on the lack of HLA-DR expression, it has been possible to recognize a benign subpopulation within the stem-cell compartment in CML. Different in vitro techniques have been developed for the selection of these benign progenitors, including LTBMC, marrow incubation with cytolytic drugs or interferon, positive selection based on their phenotypic characteristics, and exposure to synthetic antisense oligodeoxynucleotides. In vivo selection with interferon or intensive chemotherapy is also possible. The primary goal of the selection of benign hematopoietic progenitors is their use for autotransplantation. To date, a few hundred CML patients have been submitted to the latter procedure using bone marrow or peripheral blood. The fact that the majority of them show evidence of persistent disease emphasizes the necessity for better selection methods of the benign progenitors, for intensifying the conditioning regimen to reduce the tumor burden as much as possible, and for the use of adjuvant therapy post-transplantation. Future trends include the refinement of positive selection methods, negative selection by taking advantage of the different stromal adhesiveness of the benign and malignant progenitors, or the use of autologous natural killer cells, antisense oligodeoxynucleotides, or specific antibodies to the bcr/abl junction region, and retroviral marking to determine the origin of relapse in autologous transplantation.

 Conventional cytogenetics is considered the gold standard for evaluating CML during interferon (IFN) treatment. Drawbacks to this approach are the small number of metaphases available during IFN therapy and the impossibility of scoring interphase cells. We applied, besides cytogenetics, double-color FISH (dc-FISH) detection of BCR-ABL gene fusion to monitor 20 CML patients on IFN. dc-FISH easily detected 200 cells per specimen, while with cytogenetic examination a mean of 16.1 mitoses per sample were scored. Though the correlation of dc-FISH and cytogenetic data was good (r=0.77, p<0.001), the discrepancy between the two methods as regards the proportion of leukemic cells in the marrow was often important. dc-FISH detected a relevant proportion of BCR-ABL+ cells in three patients classified as complete cytogenetic responders and showed that, after 9–12 months of IFN treatment, a significant reduction of BCR-ABL+ cells was present in all the 20 patients tested. This might suggest that all CML patients are potentially responsive to IFN. Though more data are required, we think that dc-FISH is more informative than cytogenetic analysis for CML monitoring. Notably because of the simplicity of the procedure, this method could be easily standardized among different laboratories, thus permitting cross-comparison in therapeutic trials.

We retrospectively evaluated 107 fiberoptic bronchoscopies with and without transbronchial lung biopsy (TBLB) in 98 consecutive patients with haematologic malignancies and pulmonary infiltrates. Bronchoalveolar lavage (BAL) was performed in 45 and BAL plus TBLB in 62 procedures. There was no procedure-related severe haemorrhage, pneumothorax or death. Infectious aetiology was identified in 26 of 107 (24%), toxic pneumonitis in 17 of 107 (16%) and neoplastic infiltration in 9 of 107 (8.5%) episodes. Combined BAL and TBLB was significantly superior to BAL alone with respect to the diagnosis of neoplastic infiltrates (p=0.008) and toxic pneumonitis (p<0.001) and should therefore be included in the diagnostic work-up of this patient cohort.