ABSTRACT
In this retrospective study, we evaluated long-term survival and late effects in 137 patients affected by thalassemia major (TM) who received an allogeneic hematopoietic cell transplantation (HCT). Median age at HCT was 10.1 years. After a median follow-up of 30 years, 114 (83.2%) patients are living and 108 (78.8%) are cured. The cumulative incidence of nonrelapse mortality and thalassemia recurrence was 9.5% at 1 year and 10.2% at 39 years respectively. The 39-years cumulative incidence of overall survival and disease-free survival were 81.4% and 74.5%. One hundred twenty-three patients who survived more than 2 years after HCT were evaluated for late effects concerning hematological disorders, iron burden, growth, obesity, diabetes mellitus, thyroid and gonadal function, eye, heart, liver, lung, kidney, gastrointestinal, neurologic and psychiatric system, osteoarticular system, secondary solid cancer (SSC), performance status, and Covid-19 infection. Fertility was preserved in 21 males whose partners delivered 34 neonates and 25 females who delivered 26 neonates. Fifteen cases of SSC were diagnosed for a 39-year cumulative incidence of 16.4%. HCT represents a definitive cure for the majority of TM patients at the price, however, of a non-negligible early and late mortality which in the long run affects survival and disease-free survival.
Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Neoplasms, Second Primary , beta-Thalassemia , Male , Female , Infant, Newborn , Humans , Child , beta-Thalassemia/therapy , Retrospective Studies , Hematopoietic Stem Cell Transplantation/adverse effects , Disease-Free Survival , Neoplasms, Second Primary/etiology , Disease Progression , Transplantation Conditioning/adverse effectsSubject(s)
Bone Marrow Transplantation , COVID-19/epidemiology , SARS-CoV-2 , Transplant Recipients/statistics & numerical data , Adolescent , COVID-19/immunology , Child , Female , Hematologic Diseases/complications , Hematologic Diseases/therapy , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Leukemia/complications , Leukemia/therapy , Lymphoma/complications , Lymphoma/therapy , Male , Pancytopenia/etiology , Peripheral Blood Stem Cell Transplantation , Prospective Studies , SARS-CoV-2/pathogenicity , Severity of Illness Index , Transplantation Conditioning/adverse effects , Transplantation, Homologous , United KingdomSubject(s)
COVID-19/complications , Hematopoietic Stem Cell Transplantation/adverse effects , SARS-CoV-2 , Adolescent , Adult , Aged , Allografts , COVID-19/diagnostic imaging , COVID-19/mortality , Child , Child, Preschool , Cohort Studies , France/epidemiology , Humans , Immunosuppressive Agents/adverse effects , Kaplan-Meier Estimate , Middle Aged , Retrospective Studies , Risk Factors , Thrombocytopenia/etiology , Transplantation Conditioning/adverse effects , Young AdultABSTRACT
The novel coronavirus disease 2019 has grown to be a global public health emergency. The rapid spread of the infection has raised many questions in the oncohematological scientific community regarding the appropriateness of high-dose chemotherapy with autologous stem cell transplantation (ASCT). We here report two cases of patients who received ASCT at our Institute during the epidemic in Italy, affected with Hodgkin lymphoma and germ cell tumor, respectively. The two patients underwent a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on hospital admittance and during the period of bone marrow aplasia. They were attended to exclusively by dedicated health care staff who followed specifically implemented protocols for bedside nursing and care. They completed the procedure without unexpected side effect. Our experience demonstrates how ASCT can be performed safely if procedures are reorganized ad hoc to reduce the risk of SARS-CoV-2 infection.