Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation

ABSTRACT Introduction: Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. Objective: To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. Materials and methods: A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. Results: A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). Conclusion: The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.

Real-world practice of acute leukemia intrathecal chemotherapy administration: A Mexican nationwide survey

ABSTRACT Introduction: Intrathecal chemotherapy is a mainstay component of acute lymphoblastic leukemia treatment. In Mexico, there is a considerable practice variability in aspects, such as the manner of preparation and the administration technique. Objective: Our objective was to describe the different techniques used for the application of ITC and review the existing recommendations in the literature. Method: A cross-sectional, nationwide survey study was conducted by an electronic questionnaire sent to hematologists and oncologists in Mexico. We collected demographic data, personal experience, intrathecal chemotherapy techniques, drug preparation and postprocedural conduct. Results: We received 173 responses. Twenty percent had an anesthesiologist administering sedation and pain management. The platelet count considered safe was 50 × 109/L in 48% of the participants. In 77% (n = 133) of the cases, the conventional needle with stylet used was, 49% did not receive any added diluent in the intrathecal chemotherapy and only 42% were recommended to rest in a horizontal position for more than 30 min. Conclusion: We identified a considerable variation in the administration of intrathecal chemotherapy across the hematologists in Mexico. We discuss the implications and opportunities in reducing the variation in our setting, highlighting the unmet need to establish guidelines that should be evaluated by the Mexican professional society to produce a position paper regarding practice standardization.

Dengue durante el embarazo, menor incidencia de trombocitopenia que en la población general / Dengue during pregnancy, less incidence of thrombocytopenia than in general population

RESUMEN Objetivo El dengue es una enfermedad viral generalmente autolimitada, que en México se considera un problema de salud pública. Puede acompañarse de alteraciones de laboratorio como neutropenia, linfopenia y trombocitopenia. El objetivo del estudio fue evaluar la incidencia de alteraciones hematológicas en pacientes con dengue. Métodos Se incluyeron retrospectivamente 64 pacientes, 14 embarazadas, con diagnóstico de dengue en los Hospitales Universitario de Monterrey y Civil Nuevo de Guadalajara, de enero de 2014 a diciembre de 2017. Resultados El dato clínico más común en el grupo general fue cefalea y dolor retroocular en 53 pacientes (83%), seguido de la fiebre, que se presentó en 12 pacientes embarazadas (86%). La mediana de cuenta plaquetaria en el grupo general fue de 51.4x103/pl, además, se encontró trombocitopenia en el 88% de los pacientes, mientras que en las pacientes embarazadas fue de 141.1 x103/pl, con trombocitopenia en 57% de ellas (p=0.002). La recuperación plaquetaria ocurrió en 7 días en el grupo general y 4.5 días en las pacientes embarazadas. Conclusiones Contrario a lo reportado en la literatura, las pacientes embarazadas presentaron una menor incidencia de trombocitopenia y una mayor cuenta plaquetaria, al momento del diagnóstico sin impacto en mortalidad materna ni en el curso del embarazo.(AU)

ABSTRACT Objective Dengue is a generally self-limited viral disease, considered a public health problem in Mexico. It can be accompanied by laboratory alterations such as neutropenia, lymphopenia and thrombocytopenia. The objective of the study was to evaluate the incidence of hematological alterations in patients with dengue. Methods We retrospectively included 64 patients, including 14 pregnant women, with a diagnosis of dengue at the Hospital Universitario de Monterrey and Civil Nuevo de Guadalajara from January 2014 to December 2017. Results The most common clinical symptom in the general group was headache and retro-ocular pain in 53 patients (83%), while in pregnant patients it was fever in 12 patients (86%). The median platelet count in the general group was 51.4x103/ μ!, with thrombocytopenia in 88% of patients, while in pregnant patients it was 141.1 x103/ with thrombocytopenia in 57% of patients (p=0.002). Platelet recovery was achieved in 7 days in the general group and 4.5 days in pregnant patients. Conclusions Contrary to that reported in the literature, pregnant patients had a lower incidence of thrombocytopenia and a higher platelet count at time of diagnosis without impact on maternal mortality or in the course of pregnancy.(AU)

Use of complementary and alternative medicine by patients with hematological diseases: experience at a university hospital in northeast Mexico

BACKGROUND: Complementary and alternative medicine includes a diverse group of medical and healthcare systems, practices and products not considered part of conventional medicine. Although there is information on unconventional practices in oncological diseases, specific data regarding the use of complementary and alternative medicine by hematology patients is scarce. OBJECTIVE: The aim of this study is to document the prevalence of this modality of unconventional therapy in patients with malignant and benign hematological diseases, particularly children with acute lymphoblastic leukemia. METHODS: An observational study of adult patients and guardians of children with malignant or benign hematological diseases was carried out by applying a structured questionnaire detailing the use and results of the most prevalent complementary and alternative medicine practices. RESULTS: One hundred and twenty patients were included; 104 had malignant and 16 had benign hematological diseases. The use of complementary and alternative medicine was greater in benign diseases but the difference was not statistically significant (64.7% versus 41.7%; p-value = 0.08). Patients and guardians with high school or college educations used these alternative practices more than patients with less schooling (60.7% versus 54.7%; p-value = 0.032). The use of folk remedies was most prevalent followed by herbal preparations and spiritual healing. Sixty-four percent of patients that used these unconventional practices reported improvement in their symptoms and increased capacity to perform daily activities. CONCLUSION: No significant difference was documented between patients with malignant or benign hematological diseases using these alternative practices. The majority of complementary and alternative medicine users reported improvement of the disease or chemotherapy-related symptoms.