Fabio Di Piazza

Infections increase the risk of central venous catheter-related thrombosis in adult acute myeloid leukemia

INTRODUCTION Central venous catheters (CVC) related thrombosis (CRT) represents a well known complication in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy but the efficacy of antithrombotic prophylaxis still remains controversial. PATIENTS AND METHODS We analyzed 71 consecutive AML patients whose CVC was inserted before each chemotherapy cycle for an overall number of 106 CVC placements. In 47/106 insertions, a prophylaxis with 100 IU/kg/day low molecular weight heparin (LMWH) was administered for 7 days after CVC insertion and additional 7 after CVC removal. This unconventional dose of LMWH, although higher than usual, appeared adequate for a short-course approach. LMWH was delivered regardless of the platelet (PLT) count once provided that it should have been maintained above 20 x 10(9)/L by transfusions. RESULTS Of 106 insertions, we observed 19 (18%) episodes of CRT, 58 (54%) of sepsis and 50 (47%) infections of CVC-exit site with no difference between LMWH and no-LMWH group. Occurrence of CRT was significantly associated with CVC-exit site infections (14/19, p=0.01) and sepsis (16/19, p=0.005) with no difference between LMWH and no-LMWH group. In multivariate analysis, both CVC-exit site infections and sepsis were confirmed to be independent risk factors for CRT development. CONCLUSION Our retrospective study, although based on a small sample size, suggests that the occurrence of CVC-exit site infections and neutropenic sepsis following chemotherapy significantly increases the risk of CRT in AML, independently from the use of LMWH prophylaxis.

Hematopoietic, Mesenchymal, and Immune Cells Are More Enhanced in Bone Marrow than in Peripheral Blood from Granulocyte Colony-Stimulating Factor Primed Healthy Donors

The use of granulocyte colony-stimulating factor (G-CSF) primed bone marrow (G-BM) has been recently considered as an alternative to mobilized hematopoietic stem cells from peripheral blood (G-PB), especially in the haploidentical transplant setting. The purpose of this study was to compare the effect of in vivo G-CSF priming on BM and PB hematopoietic, mesenchymal (MSC), and immune cells. Forty healthy donors undergoing BM harvest for haploidentical transplant were given subcutaneous recombinant human G-CSF for 7 days. BM and PB samples were harvested on days -7 and 0. The hematopoietic stem/progenitor cells increased significantly after G-CSF priming in both BM and PB with a selective rise of BM CD34(+)CD38(-) cell subset. A striking enhancement of the mesenchymal progenitors was detected in G-BM. CD3(+), CD4(+), CD8(+), and CD19(+) cell fractions; the naive CD4(+) and CD8(+) subpopulations; and natural killer and regulatory T cells increased in G-BM, whereas only slight changes were detected in PB. Myeloid dendritic cells (DC1) were significantly up-regulated in both G-BM and G-PB, whereas DC2 increased only in G-BM. In conclusion, our results show substantial differences in the biologic effects exerted by G-CSF at BM and PB levels on hematopoietic cells and immune cell fractions. Furthermore, the impressive rise of MSC progenitors in G-BM might also be relevant to provide MSCs for several clinical use.

Patient‐reported outcomes and quality of life assessment: New targets for new targeted therapy?

We read with great interest the article by Wood et al, which demonstrated that patient-reported physical component impairment reported before hematopoietic cell transplantation (HCT) independently predicted poor overall survival after allogeneic HCT. Prompted by their article, we would like to provide some interesting observations. First, the physical component scale of the Medical Outcomes Study Short Form-36 Health Survey (SF-36) questionnaire enumerates 4 components: physical functioning, role functioning, bodily pain, and general health. The patient-perceived component impairment could be related to coexisting illness (hematological disease burden, therapy-related complications, or comorbid illness), as stated by the authors. It also could be considered as a causal factor for complications, with a subsequent effect on morbidity and overall survival. In our opinion, among the 4 components, physical functioning retains a major role in the prognosticate patient trajectory during all the phases of disease and treatment, from initial treatment to transplant, and from diagnosis to advanced-phase disease. Second, the article by Wood et al strengthens our opinion in favor of both the baseline and prospective use of quality of life assessment with the aim of producing a “dashboard” with indicators and alarms that may both ameliorate the capacity of prognosticate HCT risk prior to the procedure and help to monitor the development of complications after HCT. However, several points should be discussed concerning this issue, such as which symptoms should be evaluated (predefined symptoms, patienttailored symptoms) and how often (daily, weekly, monthly), but suggestions could be drafted. Finally, patient-reported outcomes assessment could be interlaced with prearranged patient-reported outcomesdriven procedures of supportive care, such as prehabilitation/rehabilitation or pain control. It is our firm opinion that those targeted interventions should be initiated promptly to prevent and treat physical component impairment, not only at the time of transplantation but immediately after disease diagnosis and during induction therapy. Effects on both the patients’ quality of life and caregivers’ workload are strongly expected, whereas a positive impact on morbidity and mortality could only be hypothesized and addressed with dedicated clinical trials.

The Rome Transplant Network model compared to the Italian Bone Marrow Donor Registry activity for unrelated donor search process and transplant efficiency for hematologic malignancy

From 2011 to 2014, a total of 71% of the 3834 patients with hematologic malignancies successfully identified a matched unrelated donor (MUD) through the Italian Bone Marrow Donor Registry (IBMDR), corresponding to a transplant efficiency of 62%.