ABSTRACT
Background: Patients with hematological disease are 15 times more likely to develop sepsis than the general population. The patient with hematological disease and, mainly, those undergoing hematopoietic stem cell transplantation (HSCT), develop a severe secondary humoral immunodeficiency, with low serum levels of IgM, which may take more than a year to be restored. Materials and Methods: This is a retrospective, controlled and observational study that analyzed 51 patients with underlying hematological disease, who were diagnosed with sepsis or septic shock during the study period, to evaluate whether IgM-rich Ig replacement decreases the 30-day mortality. Results: Of the 51 patients, 35 patients received IgM-rich immunoglobulin (group A) and 16 (31%) received conventional therapy. Eleven (69%) patients in the control group were alive after 30 days compared to 11 (34%) patients in the intervention group, p= 0.013. Conclusion: There are no apparent benefits in the use of IgM-rich immunoglobulin in septic patients with hematological disease.
ABSTRACT
Acute Lymphoblastic Leukemia is a very aggressive malignant disorder of lymphoid cells in adults, with recurrence (30 to 60% of the cases) after the initial treatment. Until this moment, there is no gold standard therapy for the treatment of adult patients with acute relapsed/refractory lymphoblastic leukemia. In this case report, we describe two cases of relapsed leukemia: one of lymphocytic leukemia B and one of trilineage leukemia, which presented a satisfactory response to treatment with Bortezomib associated with Vincristine, Dexamethasone, and Bendamustine.
ABSTRACT
Hematopoietic stem cell transplantation (HSCT) has been used to treat many malignant and nonmalignant hematologic conditions; however, the use of HSCT in patients who refuse blood transfusions has rarely been described in the literature, and no data have been published concerning haploidentical HSCT without the use of blood products. The aim of this study is to describe the experience of a Brazilian group in performing 21 HSCTs without the use of blood components in the first 100 days after transplantation, which is the period corresponding to the greatest risk of toxicity for this procedure. We developed 21 HSCTs without transfusion support in 19 patients admitted to 2 Brazilian transplantation centers. The patients were subjected to stem cell mobilization and different conditioning regimens. No mortality related to the procedure occurred among the transplant recipients. The global survival rate after 100 days, which is the period related to the immediate toxicity of HSCT, was 94.7%, and the median duration of follow-up was 980 days, with an overall survival rate of 68.4%. Thus, refusal of blood transfusion is not an absolute contraindication for HSCT. This therapy is feasible in specific situations when the patient clearly expresses a desire to avoid blood transfusions and when favorable clinical conditions are achievable with strict, specialized medical monitoring.
