Outpatient haploidentical hematopoietic stem cell transplant using post-transplant cyclophosphamide and incidence of hemorrhagic cystitis

Abstract Introduction Hemorrhagic cystitis (HC) is a common complication of haploidentical hematopoietic stem cell transplantation (haplo-HSCT), characterized by irritative symptoms of the urinary tract and a higher morbidity and mortality rate. The worldwide incidence is reported between 10% and 70%. The use of alkylating agents and BK viral infection are the most frequent etiologies. The aim of this study was to report the HC incidence in an outpatient haplo-HCST program with a reduced intensity-conditioning (RIC) regimen, cataloguing risk factors, complications and final outcomes. Methods The medical database of patients who received a haplo-HSCT between January 2012 and November 2017 was retrospectively analyzed. Demographic variables, general characteristics and HC incidence were included. Results One hundred and eleven patients were included, 30 (27%) of whom developed HC, most of them (70%) being grade II, with a 30-day (7-149) median time of post-transplant HC onset. The BK virus was detected in 71% of the urine samples analyzed. All HC patients responded to treatment, except two (6.6%), who died due to HC complications. Conclusions There was no difference in the HC incidence or severity, compared to that reported when performing haplo-HSCT in hospitalized patients, although the donor-recipient sex mismatch did relate to a higher HC incidence.

Utilidad del índice de choque como valor predictivo para el requerimiento de trasfusión en hemorragia obstétrica / Utility of the shock index in obstetric hemorrhage as a predictive value for the transfusion requirement

Resumen Objetivo: Determinar el punto de corte del índice de choque obstétrico asociado con trasfusión masiva en mujeres con hemorragia obstétrica. Materiales y métodos: Estudio retrospectivo, transversal y analítico efectuado con base en la revisión de los expedientes clínicos de pacientes que ingresaron a la unidad de cuidados intensivos. Cálculo del índice de choque obstétrico al momento del diagnóstico de hemorragia obstétrica. Análisis de los signos vitales, gasometría, tipo de componentes sanguíneos trasfundidos y cantidad de líquidos administrados. Resultados: Se incluyeron 105 pacientes con hemorragia obstétrica; en 65 (61%) el resultado del índice de choque fue ≥ 0.9, de éstas 38 (58%) requirieron trasfusión masiva. El índice de choque obstétrico ≥ 0.9 se asoció, significativamente, con trasfusión masiva (p < 0.001). La pérdida sanguínea fue de 3000 mL (RIC 2000 mL) en pacientes con índice de choque obstétrico ≥ 0.9 vs 2500 mL (RIC 1000 mL) en pacientes con índice de choque obstétrico < 0.9 (p = 0.04). Las mujeres con índice de choque obstétrico ≥ 0.9 mostraron mayor requerimiento de trasfusión de concentrados globulares (p = 0.03) y plaquetarios (p = 0.01). Conclusiones: Un índice de choque obstétrico ≥ 0.9 se asoció con altos requerimientos de trasfusión sanguínea y mayor incidencia de eventos adversos graves, por lo que se recomienda este valor como el punto de corte para predicción de la necesidad de trasfusión masiva.

Abstract Objective: To determine the cut-off point of obstetric shock index associated with massive transfusion in women with obstetric hemorrhage. Materials and methods: We designed a cross-sectional study in women who were admitted to the intensive care unit. The obstetric shock index was calculated at the time of the diagnosis of obstetric hemorrhage. We analyzed vital signs, arterial blood gas, loss of blood, fluid replacement and transfused blood products. Results: One hundred and five women with obstetric bleeding were included, in 65 (61%) the obstetric shock index was ≥ 0.9, of whom 38 (58%) needed massive transfusion. Obstetric shock index ≥ 0.9 was significantly associated with massive transfusion (p < 0.001). The blood loss was of 3000 mL (RIC 2000 mL) in the patients with obstetric shock index ≥ 0.9 compared to 2500 mL (RIC 1000 mL) in patients with obstetric shock index < 0.9 (p = 0.04). Women with obstetric shock index ≥ 0.9 showed more significant requirement of transfusion of package red blood (p = 0.03) and platelets (p = 0.01). Conclusions: An obstetric shock index ≥0.9 was associated with high transfusión requirements and a higher incidence of serious adverse events, this value is recommended as the cut-off point for predicting the need for massive transfusion.

High frequency of primary refractory disease and low progression-free survival rate of Hodgkin's lymphoma: a decade of experience in a Latin American center

Abstract Background: Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. Method: A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. Main results: One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value = 0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value = 0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value = 0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value = 0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. Conclusion: Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.