Marie Y. Detrait

Prospective study of erythropoietin use on quality of life and cost effectiveness in acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation patients

Despite frequent anemia and multiple transfusions in patients undergoing chemotherapy and allogeneic hematopoietic stem cell transplantation (allo‐HSCT) for acute myeloid leukemia , recommendations for use of erythropoiesis‐stimulating agents (ESAs) in these populations are still missing. The primary objective was the effect of ESA administration on patients quality of life (QoL). Secondary objectives were hemoglobin (Hb) recovery, red blood cell (RBC) transfusions, overall survival, and event‐free survival.

Diphyllobothriasis, a rare cause of profuse diarrhea following autologous transplantation

Diphyllobothriasis is a zoonosis acquired by humans after the ingestion of plerocercoid larvae present in raw and undercooked fish. In North America, Diphyllobothrium latum (D. latum) infection is limited mostly to areas with cold water lakes. Various species of freshwater or anadromous (living in both fresh and saltwater) fishes may be infected by D. latum plerocercoid larvae, including perch, trout, salmon, char and pike. We report herein the first case of D. latum infection in an immunocompromised patient who presented with profuse diarrhea. The patient was a 60-year-old man who lived in the north-east area of the Province of Quebec, Canada, and who had never traveled outside the country. This patient with anaplastic T-cell lymphoma had achieved minimal residual disease with ESHAP (etoposide, methylprednisolone, cytosine arabinoside and cis-platinum) chemotherapy. He was admitted to our institution in December 2005 to undergo auto-SCT. His disease initially presented with widespread abdominal lymph nodes and multiple hepatic nodular lesions, which progressed after eight cycles of CHOP (CY, doxorubicin, VCR and prednisone). His medical history was significant for mild, chronic diarrhea (2–3 loose stools/day) of 1-year duration; complete investigation by a gastroenterologist, including upper and lower endoscopies, was negative. After conditioning with BEAC (bis-chloronitrosourea, etoposide, cytosine arabinoside and CY), the patient received his autologous stem cell graft on 29 December 2005. On day þ 3, though neutropenic, he developed fever, diffuse abdominal pain and profuse diarrhea, which reached a maximum of 5025ml/day (Figure 1). A computed tomography scan of the abdomen revealed right colitis as well as a thickening of the cecum and distal parts of the small bowel. Coprological cultures were negative for pathogenic bacteria or viruses; quantitative PCR in blood leukocytes for CMV was also negative. The patient recovered from aplasia on day þ 18 with decreased diarrhea. However, the improvement was of short duration, with recurrence of both diarrhea and fever on day þ 28 despite the resolution of aplasia (Figure 1). Multiple repeat stool cultures were unable to identify any specific pathogen. A careful physical examination showed a new right cervical lymph node. Repeat computed tomography scans of the chest and abdomen were suggestive of lymphoma relapse with recurrence of several lymph nodes in previously involved areas. Biopsy of the right cervical lymph node confirmed relapse of anaplastic T-cell lymphoma. A microbiology consultation was obtained on day þ 42; three stool specimens were sent for parasitic examination. A diagnosis of D. latum infection was made after identification of numerous characteristic parasite eggs (Figure 2). The patient received a single dose of praziquantel (10mg/kg) on day þ 43 with initial improvement in stool output. Two stool specimens became negative for parasite eggs after the first treatment. However, on day þ 49, profuse diarrhea recurred and eggs in two separate stool specimens were again identified. A second dose of

Extracorporeal photopheresis for GVHD prophylaxis after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation: a prospective multicenter phase 2 study

Abstract We performed a prospective multicenter phase 2 study to evaluate the safety and efficacy of prophylactic Extracorporeal Photopheresis (ECP) in adult patients with hematological malignancies early after RIC allo-HSCT on day 21 twice per week during the first two weeks and then once per week for the next four weeks for a total of eight ECP courses. A total of 20 patients were included; 10 were males, median age was 60 years. All patients engrafted, 17 (85%) received the total eight ECP courses. There were no adverse effects related to ECP. Seven patients developed acute graft-versus-host disease (GVHD), with 15% grade ≥ II cumulative incidence at day 100. The cumulative incidence of chronic GVHD at 2 years was 22%. The 2 years probability of overall survival (OS) and progression-free survival (PFS) were 84 and 74%, respectively. This study shows encouraging results with low acute and chronic GVHD incidence and no interference with graft-versus-leukemia (GVL) effect.

Better outcome with haploidentical over HLA-matched related donors in patients with Hodgkin’s lymphoma undergoing allogeneic haematopoietic cell transplantation—a study by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy

The question of the best donor type between haploidentical (HAPLO) and matched-related donors (MRD) for patients with advanced HL receiving an allogeneic hematopoietic cell transplantation (allo-HCT) is still debated. Given the lack of data comparing these two types of donor in the setting of non-myeloablative (NMA) or reduced-intensity (RIC) allo-HCT, we performed a multicentre retrospective study using graft-vs.-host disease-free relapse-free survival (GRFS) as our primary endpoint. We analysed the data of 151 consecutive HL patients who underwent NMA or RIC allo-HCT from a HAPLO (N  =  61) or MRD (N  =  90) between January 2011 and January 2016. GRFS was defined as the probability of being alive without evidence of relapse, grade 3–4 acute GVHD or chronic GVHD. In multivariable analysis, MRD donors were independently associated with lower GRFS compared to HAPLO donors (HR  =  2.95, P   < 0.001). Disease status at transplant other than CR was also associated with lower GRFS in multivariable analysis (HR  =  1.74, P  =  0.01). In addition, the administration of ATG was independently linked to higher GRFS (HR  =  0.52, P  =  0.009). In summary, we observed significantly higher GRFS in HL patients receiving an allo-HCT using the HAPLO PT-Cy platform compared to MRD.

Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation

Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation

Clofarabine versus fludarabine‐based reduced‐intensity conditioning regimen prior to allogeneic transplantation in adults with AML/MDS

We have retrospectively compared survivals between acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) patients who received either a clofarabine/busulfan (CloB2A2) or a fludarabine/busulfan (FB2A2) RIC regimen for allogeneic stem cell transplantation. Between 2009 and 2014, 355 allotransplanted cases were identified from the SFGM‐TC registry as having received either the FB2A2 (n = 316, 56% males, median age: 59.2 years, AML 78.5%, first complete remission [CR1] 72%, median follow‐up: 20 months) or the CloB2A2 (n = 39, 62% males, median age: 60.8 years, AML 62%, CR1 69%, median follow‐up: 22.4 months) RIC regimen. In multivariate analysis, FB2A2 was associated with significant lower overall survival (OS, HR: 2.14; 95%CI: 1.05–4.35, P = 0.04) and higher relapse incidence (RI, HR: 2.17; 95%CI: 1.02–4.61, P = 0.04) and a trend for lower leukemia‐free survival (LFS, HR: 1.75; 95%CI: 0.94–3.26, P = 0.08). These results were confirmed using a propensity score‐matching strategy. However, when considering AML and MDS patients separately, the benefit of the CLOB2A2 regimen was restricted to AML patients (2‐year OS FB2A2: 38% [14.5–61.6] vs. CloB2A2: 79.2% [62.9–95.4], P = 0.01; 2‐year LFS FB2A2: 38% [16–59.9] vs. CloB2A2: 70.8% [52.6–89], P = 0.03). The better survivals were due to the lower risk of relapse in this CloB2A2 AML subgroup (2‐year RI FB2A2: 41.2% [19–62.4] vs. CloB2A2: 16.7% [5–34.2], P = 0.05). This retrospective comparison suggests that the CloB2A2 RIC regimen can likely provide longer survival than that awarded by a FB2A2 RIC regimen and may become a new standard of care RIC regimen for allotransplanted AML patients. A prospective phase 3 randomized study is warranted.