bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2293 PEGFILGRASTIM VERSUS FILGRASTIM IN THE MANAGEMENT OF THERAPY‐RELATED NEUTROPENIA IN RELAPSED AND REFRACTORY MULTIPLE MYELOMA IN TREATMENT WITH POMALIDOMIDE‐DEXAMETHASONE
Authors: Cerchione C. , Martinelli G. , Nappi D. , Pareto A. E. , Pane F. , Catalano L. 
Published: June 2019

Background:Pegfilgrastim is a pegylated long‐acting recombinant form of G‐CSF that extends the half‐life and allows for once‐per‐cycle dosing, requiring less frequent dosing than nonpegylated G‐CSF.Aims:The objective of this study was to compare the efficacy and safety of pegfilgrastim in patients affected by heavily pretreated MM, treated with pomalidomide‐dexamethasone, in order to determine whether a single subcutaneous injection of pegfilgrastim is as effective as daily injections of standard filgrastim, in terms of haematological toxicity, febrile neutropenic episodes, antibiotic usage and hospedalization duration.Methods:We enrolled 33 patients (19 male and 14 female) median age at diagnosis 69 years (r. 52‐84), and median age at start of treatment 76 years (r.56‐90) treated with several lines of treatments (median 7, r. 2‐11), every refractory to all the drugs previously received, received Pomalidomide‐Dexamethasone (Pomalidomide 4 mg for 21 days, Dexamethasone 40 mg days 1,8,15,22, pegfilgrastim day +8) every 28 days, until progression.Results:Since first course, received in domestic setting, with a very good compliance, patients performed blood counts once weekly and received, from day +8 to day +19 (“day + 1” when the protocol starts), prophylactic oral chinolonic antibiotics and anti‐fungal drugs. During neutropenia after first cycle, Filgrastim (5 μgr/kg/day for 3 days) was given if neutrophils count was <1500 × 10^9 cells/L. Median number of filgrastim administrations was 4.8 (r. 3‐6); nadir neutropenia was registered after a median of 10.7 days (r. 7‐14); median of nadir neutrophil count was 1.17 × 10^9 cells/L (range 0.3 – 1.5 × 10^9 cells/L), with maximum duration of 14 days. From the second course, all patients switched to prophylaxis with pegfilgrastim (6 mg), injected subcutaneously with a single administration on day +3 independently from the neutrophil count at that time. During pegfilgrastim, neutropenia was never longer than 8 days, with a consequent reduction of neutropenia‐related infections. Median nadir neutrophil count, evaluated for every patients for at least three courses of therapy (r. 3‐6) registered at day +11, was 1.39 (range 0.9‐2.2 × 10^9 cells/L). Only 4 patients needed a supplement of 3 administrations of filgrastim. Pegfilgrastim was well tolerated in all patients: main side effects in our patients were mild fever and bone pain (21.2%).Summary/Conclusion:In conclusions, in patients affected by heavily pretreated MM treated with pomalidomide‐dexamethasone, pegfilgrastim seems to reduce the incidence of severe neutropenia and infections and may increase the possibility to maintain the scheduled time of treatment.
PB2296 SURVEILLANCE BREAST SCREENING PROGRAMS FOR PATIENTS WHO UNDERWENT CHEST RADIATION THERAPY (LYMPHOMA SURVIVORS)
Authors: Moschetta M. , Telegrafo M. , Troiano N. , Perrone T. , Bambace S. , Piombino M. , Specchia G. , Gaudio F. 
Published: June 2019

Background:Women who underwent chest radiation therapy (CRT) during pediatric/young‐adult age have an increased breast cancer (BC) risk. The cumulative BC incidence in women who underwent CRT is 13‐20%, higher than the incidence observed in the young female general population. BC is diagnosed on average about 15 years after CRT at about 40 years of age, compared with about 61 years in the non‐exposed female general population.Aims:From January 2018 to December 2018, a group of consecutive 46 patients (45 females, 1 male), aged between 23 and 62 (mean 44), who underwent CRT at least in the previous 8 years, underwent breast clinical, ultrasound (US) and mammographic examinations.Methods:Breast density at US was evaluated according to the BIRADS lexicon (homogeneous‐fat; homogeneous‐fibroglandular; heterogeneous) and compared with a control group of healthy patients (n = 46) with similar demographic features. Any statistical significant difference was searched by t‐student test for unpaired samples. The incidence of breast cancer in the examined series was assessed.Results:Among the examined series, 10/46 (22%) patients with homogeneous, 20/46 (43%) with fibroglandular and 16/46 (35%) with heterogeneous density were found. In the control group, 8/46 (17%) patients with homogeneous, 21/46 (46%) with fibroglandular and 17/46 (37%) with heterogeneous density were found. No significant difference occurred among the two groups of patients (p > 0.05). 4/46 (3 females, 1 male) patients were affected by breast cancer (invasive ductal carcinoma, n = 3; ductal carcinoma in situ, n = 1) with a 9% incidence.Summary/Conclusion:A surveillance breast imaging protocol should be strongly recommended to patients with a previous CRT. Breast cancer incidence seems to be higher compared with general population. No significant effect on US breast density seems to exist in CRT patients. Future research should be directed at examining the underlying cancer biology and etiology of treatment induced cancers, as well as inherent and treatment‐induced genetic susceptibility of HL survivors.
PB2303 SPECTRAL‐DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN ASYMPTOMATIC CHILDHOOD SICKLE CELL PATIENTS
Authors: Yilmaz K. , Öncül H. , Uzel H. , Öncel K. , Soker M. , Soker S. , Yilmaz E. D. 
Published: June 2019

Background:Sickle cell disease results in localized ischemia and sometimes infarction of local tissues in the area of vascular sickling of erythrocytes.This process can result in a variety of ocular abnormalities; all structures can be affected, ranging from orbital tissues to the retina. Macular thinning has been described in patients with sickle cell disease.Aims:The aim of this study was to investigate the effect of asymptomatic childhood sickle cell anemia on choroidal, macular and retinal nerve fiber layer thickness (RNFL) by spectral‐domain optical coherence tomography(SD‐OCT).Methods:Twenty sickle cell patients (40 eyes) without ocular diseases and 30 healthy control patients (60 eyes) underwent SD‐OCT. We used SD‐OCT to take all measurements of ocular thickness, as well as measured intraocular pressure, axial length, and central corneal thickness. We later analyzed correlations of hemoglobin S levels and number of crises with ocular parameters.Results:A statistically significant difference emerged between patients with sickle cell anemia and the healthy controls in terms of mean values of subfoveal and temporal choroidal thickness (p = 0.004 and p = 0.042, respectively). There was no statistically significant difference between the two groups in central and paracentral macular thickness. In addition, there was no statistically significant difference between the two groups in the thickness of the retinal nerve fiber layer.There was no statistically significant difference correlation analyses between the hemoglobin S level and the study parameters. Correlation analysis of the number of crisis and working parameters revealed a negative correlation with subfoveal choroidal thickness and superonasal quadrant RNFL thickness (p = 0.036 and p = 0.002, respectively)Summary/Conclusion:Manual segmentation of SD‐OCT images revealed quantitative and qualitative changes in asymptomatic sickle cell patients.Further studies are required in a larger number of patients to detect a possible association between the retinal thinning seen on SD‐OCT images and peripheral retina ischemia.
PB2307 SICKLE CELL DISEASE PATIENTS HAVE NORMAL NEUTROPHIL OXIDATIVE BURST RESPONSE
Authors: El‐Samahi M. , Makkeyah S. , Hamza M. , Abouelnour A. 
Published: June 2019

Background:Bacterial infections are a frequent cause of acute morbidity and sometimes mortality in sickle cell disease (SCD). Splenic dysfunction alone does not explain the susceptibility to specific organisms e.g., Staphylococcus aureus and Klebsiella as shown in some studies; suggesting that the splenic dysfunction is not the only explanation and that neutrophil dysfunction may be present. Neutrophils destroy microbes by producing a burst of reactive oxygen species (ROS) (respiratory burst) in response to bacterial components, as well as to phorbol‐myristate‐acetate (PMA). Some studies have shown that the state of chronic hemolysis in SCD impairs the ability to develop neutrophils to mount a bactericidal oxidative burst, and hence increasing susceptibility to bacterial infections.Aims:to assess the neutrophil oxidative burst in SCD patients and explore the relation to markers of hemolysis.Methods:Twenty‐seven hydroxyurea naïve children and adolescents with SCD (mean age 11.1 ± 3.9 years) were enrolled from Pediatric Hematology Clinic at Ain Shams University Children's Hospital. They were compared to 26 age‐ and sex‐matched healthy controls. Patients were studied stressing on transfusion history, chelation therapy, serum ferritin, hematological profile, markers of hemolysis and serum haptoglobin. Neutrophil oxidative burst assay was performed using DHR based flow cytometry.Results:Eleven (40%) out of the 27 patients had HBSS while 16 (60%) patients were sickle thalassemias. Six patients (22.2%) were splenectomized. Severe vaso‐occlusive crisis and acute chest syndrome were found in 22.2% and 18.5% of patients, respectively. Four (14.8%) patients had evidence of stroke. Bone fractures and avascular necrosis were found in 5.5% and 11.1 % of patients, respectively. Most of the studied patients were on chelation therapy, either as monotherapy or combined chelation (37% each). White blood cell count and reticulocytic count were significantly higher in SCD patients as compared to healthy controls (P = 0.03 and <0.01 respectively). All subjects, whether SCD or controls showed a normal neutrophil oxidative burst response to PMA‐stimulation. Unstimulated and PMA stimulated rhodamine fluorescence were comparable in SCD patients and controls, indicating normal basal production of reactive oxygen species, and normal oxidative burst in SCD patients (P = 0.09). We did not demonstrate any correlation between markers of hemolysis including reticulocytic count, indirect bilirubin, LDH, serum haptoglobin and DHR response in the SCD group.Summary/Conclusion:Neutrophils in SCD patients can mount a normal oxidative burst in response to PMA stimulation. This data excludes the role of impaired neutrophil oxidative burst as a risk for bacterial infections in SCD.
PB2309 INCIDENCE OF ALLOIMMUNIZATION IN SICKLE CELL DISEASE: EXPERIENCE OF A CENTER IN LISBON
Authors: Dutra R. , Araújo E. , Dias M. , Marco J. 
Published: June 2019

Background:Nowadays, red blood cell (RBC) transfusion is an indispensable option for the treatment and prevention of chronic complications of sickle cell disease (SCD). In SCD patients it has been reported at a rate of 18–76% of alloimmunization after transfusion. It has also been suggested, that transfusion is related to the formation of RBC autoantibodies, especially in patients with hemoglobinopathies. Interestingly, some authors correlate higher susceptibility to allo and autoimmunization in patients without the spleen. That could be one of the explanations why SCD patients have a higher incidence of RBC immunization.Aims:To determinate the rate of alloimmunization among the transfused SCD patients residing in Lisbon. The other objectives were to clarify among the same study population the incidence of positive direct antiglobulin (DAT) test and spleen absence and correlate both with alloimmunization.Methods:The subjects for the study were selected from the adult patients (≥18 years of age) of a tertiary hospital in Lisbon, between 01‐01‐2017 and 20‐02‐2018, that were transfused at least one time and monitored for the presence of irregular antibodies. A total of 61 patients met the inclusion criteria. Most of the routine immunohematological tests, i.e. blood group typing, indirect antiglobulin test (IAT) and DAT, were done using a microtube gel technique. Moreover, clinical assessment of the spleen status (absence or presence) were obtained from imagiological data.Results:In our study, we obtained a rate of alloimmunization of 21,3% (N = 13). 40% of the transfused SCD (N = 22) have in DAT positive and 50% of those/these have alloantibodies. We found in our population a significant association between positive DAT with alloimmunization (p < 0.001). In 58 patients we succeed in obtaining their spleen status and among those without a spleen (N = 36) 25% became alloimmunized.Summary/Conclusion:In our study, the risk of alloimmunization was higher in patients who received more than 20 red blood cell units. Our alloimmunization rate is in agreement with the literature as well as the significant association of DAT with alloimmunization. Interestingly, 50% of those patients with DAT positive also have alloantibodies, supporting the idea that those patients develop autoantibodies due to transfusion therapy. This fact advocates some plausibility in screening for autoantibodies at regular intervals prior to each transfusion. There was no significant correlation between the presence or absence of a spleen and alloimmunization (p = 0.7475). In conclusion, this study is one of the few to approach the rate of alloimmunization in SCD patients. Therefore, it is necessary to have further studies in Portugal in order to study and to understand our heterogeneous SCD population.
PB2320 PHASE II STUDY OF IMATINIB MESYLATE PLUS MYCOPHENOLATE MOFETIL FOR PEDIATRIC STEROID‐REFRACTORY SCLEROTIC/FIBROTIC TYPE CHRONIC GRAFT‐VERSUS‐HOST DISEASE
Authors: Kang H. J. , Choi J. Y. , Kim H. , Baek H. J. , Kook H. , Lee J. M. , An H. Y. , Hong K. T. , Shin H. Y. 
Published: June 2019

Background:Chronic graft‐versus‐host disease (cGVHD) is the most common late complication following allogeneic stem cell transplantation. Sclerotic/fibrotic cGVHD is one of the severe type, and often refractory to standard and secondary therapy.Aims:In this study, we evaluated the efficacy and safety of imatinib mesylate and mycophenolate mofetil (MMF).Methods:In non‐randomized, open‐label, single‐arm, multi‐center, prospective phase II study, we enrolled patients with steroid‐refractory sclerotic/fibrotic type cGVHD. Participants were treated with MMF at a dose of 15‐20 mg/kg (maximum 1 g) bid and imatinib mesylate at the initial dose of 260 mg/m2/day (maximum 400 mg) in combination with previous cGVHD treatment. The primary endpoints was overall (complete and partial) response rate at 1 year. Secondary endpoints included safety, quality of life, discontinuation of steroid and overall survival (OS) rate.Results:A total of 13 patients were enrolled between October 2013 and July 2017. The median age was 10.4 years (range 5.0‐20.1 years). Five of the 13 patients had previously experienced acute GVHD. The diagnoses were acute lymphoblastic leukemia in 5, acute myeloid leukemia in 3, chronic granulomatous disease in 3, neuroblastoma in 1 and hemophagocytic lymphohistiocytosis in 1 patient. Nine of the 13 patients achieved partial response (PR), 2 showed stable diseases (SD), and 1 died of pulmonary infection and progression of chronic lung GVHD. The remaining 1 patient died of primary disease progression. The overall response rate was 69.2 %. Nine of the 13 patients were able to reduce or discontinue steroids. Among 13 patients, 6 patients showed improvements in Lee cGVHD symptom scale score to assess quality of life. Common adverse events included grade 1‐2 liver enzyme, creatinine elevations and fever. The 2‐ and 5‐year OS rate was 76.9% and 67.3%, respectively.Summary/Conclusion:Although limited by a small sample size, Gleevec plus MMF for cGVHD showed promising results with acceptable toxicity.
PB2329 THE IMPACT OF VITAMIN D LEVELS ON PERIPHERAL STEM CELL MOBILIZATION IN ALLOGENEIC HEMATOPOIETIC STEM CELL DONORS
Authors: Hocaoğlu E. , Yegin Z. A. , Can F. , Özkurt Z. N. , Yağcı M. 
Published: June 2019

Background:Vitamin D is a steroid hormone which has an essential role in many physiological conditions including bone metabolism, immune regulation and hematopoiesis. Vitamin D was indicated to have a favourable impact on hematopoietic stem cell (HSC) production in in‐vitro studies. Additionally, animal experiments designated a potential for vitamin D receptor in HSC mobilization. Despite these advances, the possible role of vitamin D in peripheral HSC mobilization remains to be defined.Aims:The aim of this study was to evaluate the impact of pre‐mobilization serum vitamin D levels on peripheral HSC mobilization in allogeneic donors.Methods:We investigated the impact of pre‐mobilization serum vitamin D levels of 112 allogeneic donors [median age: 39(18‐69) years; male/female: 62/50] on peripheral HSC mobilization. All donors had received granulocyte colony stimulating factor (G‐CSF) at a dose of 10 mcg/kg/day for 4 days. First HSC apheresis was performed on the fourth day of G‐CSF. Serum 25‐hydroxy vitamin D levels were measured with immunoassay method before G‐CSF administration.Results:Median vitamin D level was found to be 15.8(3‐63.2) μg/L in the study population. On the first apheresis day, median peripheral and product CD34(+) cell counts were 36.5(7‐206) × 106/kg and 5.3(0.5‐22.8) × 106/kg respectively. Median vitamin D levels were significantly lower in donors with low peripheral CD34(+) cell count which was defined as <20 × 106/kg, compared to donors with CD34 level≥20 × 106/kg [13.5(7‐27.4) μg/L vs 17(3‐63.2) μg/L; p = 0.035] (Figure 1). When we divide the study group into two subgroups based on median vitamin D levels, peripheral CD34(+) cell counts were found to be significantly lower in low‐vitamin D group compared to high‐vitamin D group [35(7‐135) × 106 vs 41.4(10‐206) × 106; p = 0.038]. Any significant association was not observed between vitamin D levels and product CD34(+) cell counts. In logistic regression analysis, serum vitamin D level was considered to be correlated with peripheral CD34(+) cell count [p = 0.042; SE: 0.034; 95% Cl Exp(B): 1.003‐1.145].Summary/Conclusion:Mobilization failure still remains to be a critical issue for HSC transplantation. In this study, the significant association between vitamin D levels and peripheral CD34(+) cell counts, lacking a similar correlation with product CD34(+) cell counts, requires further evaluation with larger study populations and more standardized procedures including product processing and collection. In these circumstances, the possible role of vitamin D in HSC mobilization deserves further consideration as vitamin D replacement before mobilization would be an easy, safe and cost‐effective approach to improve mobilization success.image
PB2352 PROPHYLACTIC PROSTAGLANDIN E1 PREVENT SINUSOIDAL OBSTRUCTION SYNDROME/VENO‐OCCLUSIVE DISEASE OF THE LIVER AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
Authors: Lim S.‐N. , Ko S. , Park S. , Sohn B. 
Published: June 2019

Background:Prostglandin E1 (PGE1) was used to prevent sinusoidal obstruction/veno‐occlusive disease (SOS/VOD) of the liver after allogeneic hematopoietic stem cell transplantation (HSCT) for hematologic malignancies.Aims:We evaluated retrospectively that prophylactic using of prostaglandin E1 prevent SOS/VOD of the liver in patients received allogeneic hematopoietic stem cell transplantation.Methods:It was given in continuous intravenous infusion from day ‐8 to day 14 after allogeneic HSCT at a dose of 0.3 micrograms/kg/hour. The patients were studied according to the risk factors for SOS/VOD: diagnosis, intensification of the conditioning and previous liver abnormalities. The diagnosis of SOS/VOD was made on revised diagnosis and severity criteria for SOS/VOD in new classification from the European society for blood and marrow transplantation. Seventy‐eight patients underwent allogeneic HSCT between September 2010 and November 2017 and 71 were treated by PEG1 and seven did not receive it.Results:The median age of included patients was 45‐year‐old (range, 18‐64 year‐old) and the male was 36 patients (46%). The actual incidence of SOS/VOD was 1.3% (one patient) in the PGE1 group and 14.3% (one patient) in the non PGE1 group (P < 0.001). SOS/VOD developed in two of 78 patients (2.6%) with diagnosis day 7 and day 11 after hematopoietic stem cell infusion. of two patients, one had moderate SOS/VOD and one had severe SOS/VOD as new EBMT criteria for severity grading. Two patients who were diagnosed in SOS/VOD were in acute leukemia. Survival at day +100 forSummary/Conclusion:The prophylactic PGE1 treatment may decrease the incidence of SOS/VOD in patients by allogeneic hematopoietic stem cell transplantation.
PB2365 CELL DOSE AND HEMATOLOGIC RECOVERY AFTER AUTOLOGOUS STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA
Authors: Tonev I. , Simeonov S. , Mitkov I. , Ilieva M. , Petrov Y. , Ganeva P. , Arnaudov G. , Spassov B. , Mincheff M. 
Published: June 2019

Background:The relation between the dose of the infused hematopoietic stem cells and the time of hematologic recovery after autologous transplantation has been investigated in different types of patients.Aims:We assessed the strength of this relation in patients with multiple myeloma, transplanted in our center.Methods:We analyzed the relation between different factors and the hematologic recovery in 277 transplantations performed on 249 patients (138 male and 111 female) with multiple myeloma, who underwent autologous transplants between 2005 and 2018. Twenty eight of them had second (tandem or not tandem) transplantation.The conditioning regimen consisted of Melphalan for most of the patients. The average age at the time of transplantation was 55 years (35 ‐ 71). Patients were transplanted with an average cell dose of 2,95 × 106/kg (1,30 – 9,20 × 106/kg) for the first transplantation and 2,36 × 106/kg (1,64 – 3,19 × 106/kg) for the second one (every patient received the same cell dose as for the first) with average cell viability 95,34 % (70 – 99%), with little difference between first and second transplantation.Results:The average time for hematological recovery was 11,60 (between 9 and 19) days for the neutrophils, and 12.11 (between 9 and 20) days for the platelets.We found no correlation between the cell dose and the hematological recovery. There was no difference in the hematopoietic recovery between the first and the second transplantation in the patients, who underwent tandem or two transplantations.Summary/Conclusion:Recovery time is considered by some to be a function of the effective stem cell number. We did not find such correlation, probably because in the analyzed group all the patients, except four of them, received a dose greater than 2 × 106/kg cell, which is accepted as a safe dose for autologous stem cell transplantation.