JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY

Commentary article on AI and EI

Hans-Jochem Kolb — 2024-07-24

HEMATOPOIETIC CELL TRANSPLANTATION (HCT) FOR ALL: A report from the 2024 Congress of the Brazilian Bone Marrow Transplantation and Cellular Therapy Society (SBTMO)

Fernando Barroso Duarte — 2024-09-25

This article analyzes current data, and the main challenges faced in Hematopoietic cell Transplantation (HCT) in Brazil, as presented at the SBTMO 2024 meeting, with the aim of guiding future actions. Topics discussed included the waiting list for HCT transplants, access to beds for adults and pediatric patients, and the need for a more efficient distribution of resources across the country. Among the identified needs were the creation of a program to expand access to transplants through the Brazilian Unified Health System (SUS), the importance of health registries for data-driven decisions, and the development of the "Mais Saúde Amazônia" project to expand transplant centers in the Amazon region. Additionally, the provision of financial incentives for transplant centers, the implementation of mentorship programs to increase access to HCT, and the formation of a cooperative network between SBTMO (Brazilian Society of Bone Marrow Transplantation and Cellular Therapy), ABHH (Brazilian Association of Hematology, Hemotherapy, and Cellular Therapy), ANVISA (Brazilian Health Regulatory Agency), ABRALE (Brazilian Association of Lymphoma and Leukemia), and INCA (Brazilian National Cancer Institute) to improve the integration of HCT services were discussed

The Evaluation of adherence, safety and effectiveness of an antibiotic de-escalation strategy in patients with febrile neutropenia during autologous hematopoietic stem cell transplantation.

Guillermo Andrés Herrera Rueda — 2024-11-06

Introduction: There are ongoing concerns about optimal antibiotic regimens for febrile neutropenia during autologous hematopoietic stem cell transplantation (ASCT). Objectives: We assessed adherence, safety, and clinical outcomes of an antibiotic de-escalation protocol at a hematopoietic stem cell transplant reference center. Methods: We conducted a retrospective analysis of clinical data from 100 patients who developed febrile neutropenia during autologous stem cell transplantation between January 2020 and June 2021. In addition to presenting descriptive variables, we compared clinical outcomes, including treatment duration, hospitalization length, ICU admission, and mortality, among intervention groups. Results: Approximately 61% of the patients underwent the antibiotic de-escalation strategy, with an adherence rate of approximately 80% and only 20 protocol deviations. Comparing intervention groups, statistically significant differences favored the de-escalation and early termination group, which had shorter hospital stays (16 vs. 18 days, p 0.01) and fewer days of antibiotic treatment (5 vs. 8 days, p 0.006). There were no differences in safety outcomes. Conclusions: The antibiotic de-escalation strategy demonstrated significant adherence and proved to be safe and effective, with the added benefit of shorter hospital stays and reduced antibiotic exposure.

10-Year Real-World Data on Acute Myeloid Leukemia:

Camilla Campos — 2024-11-06

Introduction: Despite advances in Acute Myeloid Leukemia (AML) diagnosis and treatment, the outcomes in low- and middle-income countries (LMIC) are far apart from those in high-income countries (HIC). Objective: To describe the clinical features and outcomes of AML patients in Brazil's public health system, we conducted a retrospective analysis of all cases of non-promyelocytic AML diagnosed within 10 years (2007- 2017) in northeastern Brazil, Bahia. Methodology: We analyzed the real-life outcomes of 62 patients diagnosed with non-promyelocytic AML between 2007 and 2017 at a university hospital in Northeast Brazil. We classified patients using the European LeukemiaNet 2022 guideline into favorable (n=8), intermediate (n=18), and adverse risk (n=7) groups. Twenty-nine were not otherwise classified because no cytogenetic and/or molecular tests were available at diagnosis. Results: Allogeneic bone marrow transplant (alloBMT) was performed in 16 patients (37%). Median overall survival (mOS) was seven months. Among patients receiving alloBMT, mOS was 49 months, while for the chemotherapy group, it was six months (P = 0.003). For 10-year real-life data, we found complete remission of 53%, 5-year OS of 27%, and a mortality rate during induction therapy of 27%, inferior to HIC. Conclusion: Inferior outcomes found in LMIC result from a multifactorial scenario and an unmet need in the worldwide panorama of AML.

INFORMAL CAREGIVERS FOR BONE MARROW TRANSPLANTS – A QUALITATIVE STUDY ON OCCUPATIONAL LIFE

LETÍCIA FERNANDES DE ANDRADE — 2024-11-06

OBJECTIVE: To understand the experience of informal caregivers' burden related to the task of caring for people undergoing hematopoietic stem cell transplantation. METHOD: Qualitative study based on interviews with six informal caregivers of onco-hematological patients who underwent hematopoietic stem cell transplantation and were admitted to the Bone Marrow Transplant Unit of a public, tertiary hospital, located in the interior of the State of São Paulo. Participants were selected through active search and recommendation from the unit's team. After ethical approval (CAAE: 64066622.9.0000.5393, on 05/29/2023), sociodemographic characterization data were collected and the interviews were audio-recorded and fully transcribed. The MAXQDA software was used for data analysis. Participant profile data were analyzed using simple descriptive statistics and qualitative data underwent thematic analysis according to Braun & Clarke. RESULTS: Two thematic units address the impacts of overload on the informal caregiver's occupational life and coping strategies for managing overload. CONCLUSION: The informal caregiver plays an important role, but this creates an overload that impacts the treatment of the sick person. Therefore, caring for caregivers and welcoming them as subjects of care can mitigate the impacts faced by caregivers during and after the transplant process.

Pre-transplant Screening for MMP-9 in Allogeneic HSCT Candidates

McKenna Morrow — 2024-11-06

Purpose: InflammaDry® (Quidel Eye Health, San Diego, California), an FDA-approved point-of-care commercial test, measures matrix metalloproteinase-9 (MMP-9) levels in the tear film. MMP-9 is an inflammatory biomarker that is elevated in response to ocular surface stress, particularly observed in ocular graft-versus-host disease (oGVHD). The purpose of this study is to assess the prevalence of MMP-9 positivity and a score >4 on the OSDI-6 questionnaire in patients before allogeneic hematopoietic stem cell transplant (HSCT).

Methods: A prospective, observational, cross-sectional single center pilot study was conducted among 23 patients (46 eyes) undergoing planned allogenic HSCT. InflammaDry® results, OSDI-6 questionnaire results, and development of oGVHD were collected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and chi-square test were calculated.

Results: InflammaDry® demonstrated high sensitivity (1.0) but low specificity (0.1429) for oGVHD development. The PPV was 0.25, while the NPV was 1.0. No statistical significance was found between InflammaDry® result and development of oGVHD (p-value> 0.05).

Conclusion: InflammaDry® is not an effective tool for detecting the onset or predicting the risk of developing oGVHD. A significant percentage of patients exhibited ocular inflammation before allogeneic HSCT, suggesting that initiating prophylactic treatment could be valuable in reducing oGVHD development.

PATIENT BLOOD MANAGEMENT (PBM) STRATEGIES IN BONE MARROW TRANSPLANTATION UNIT - IMPACT ON PRIMARY OUTCOMES

Ana Vitória Magalhães Chaves — 2024-11-06

Objective: Hematopoietic Stem Cell Transplant (HCT) recipients are among the largest consumers of allogeneic red blood cells and platelets. The impact of Patient Blood Management (PBM) strategies on these recipients is poorly understood. Therefore, we evaluated the PBM strategies and their impact on patients undergoing autologous and allogeneic HCT. Methodology: We conducted a retrospective analysis of 333 patients who underwent HCT at the Bone Marrow Transplant Center of the Walter Cantídio University Hospital (HUWC) from 2018 to 2022. Clinical data were collected from medical records. Statistical analysis was performed using Jamovi software version 2.03, with a statistical significance level of p = 0.05. Results: The mean age of the patients was 45 years, with 51% being male. Of the transplants performed, 63% were autologous. The most common diagnosis was plasma cell neoplasia (36.3%). Restrictive strategies were adopted, and the transfusion parameters during HSCT hospitalization were as follows: Hemoglobin <7g/dL, platelets <50,000/µL in case of bleeding or lumbar puncture, <20,000/µL in the presence of fever or central venous access puncture, and <10,000/µL prophylactically. The transfusion requests consisted of 1 unit of red blood cells and 1 unit of platelet "buffy coat" per administration. During hospitalization, 94.3% of the patients received platelet transfusions, and 50.3% received red blood cells. Patients undergoing allogeneic HCT required more transfusions, experienced more transfusion reactions (24.6%), and had a higher number of deaths during hospitalization (p<0.0001) compared to those undergoing autologous HCT. The most frequent transfusion reactions were allergic (8.7%) and febrile non-hemolytic (15%). The number of red blood cell and platelet transfusions showed a strong (p<0.5) and significant (p<0.01) correlation with the collected volume and engraftment time. There was no correlation between the number of transfusions and age or patient survival after hospital discharge. The number of transfusions during this period did not have a significant impact on survival. However, higher mortality was observed among patients who received more transfusions and those who underwent allogeneic HCT. Conclusion: The implementation of PBM for HCT recipients was associated with a significant reduction in allogeneic red blood cell and platelet transfusions and a reduction in transfusion-related costs, without any negative impact on clinical outcomes.

EMERGING ACTIVITY OF CELLULAR IMMUNOTHERAPY FOR TREATMENT OF CANCER IN BRAZIL

Cinthya Corrêa da Silva — 2024-07-24

Chimeric antigen receptor T-cells (CAR T cells) are genetically modified cellular immunotherapies approved for standard of care treatment of patients with lymphoma and leukemia worldwide. Here we report the initial activity in Brazilian centers through the collaboration between the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) and Center for International Blood and Marrow Transplant Research (CIBMTR). A total of 38 patients who received CAR T cells between 2020 and 2023. The median age was 47 years (range 4-77). Indications include Non-Hodgkin Lymphoma (NHL; 26 cases; 68%), Acute Lymphoblastic Leukemia (ALL; 9 cases; 24%), and Multiple Myeloma (MM; 3 cases; 8%). 84% (75% - 24 NHL cases and 25% - 8 ALL cases) were commercial. This report demonstrates the initial implementation of CAR T cells in Brazil among centers that report to the SBTMO/CIBMTR. This infrastructure will assist in further capturing the activity, assessing the outcomes, and complying with regulatory requirements.