Allogeneic hematopoietic stem cell transplantation represents a curative modality for patients with myelodysplastic syndrome (MDS), yet relapse risk persists. The prognostic performances of the Revised International Prognostic Scoring System (IPSS-R) and the Molecular International Prognostic Scoring System (IPSS-M) for 129 MDS patients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) were evaluated. Using IPSS-M, 29.5% of patients were reclassified to a higher risk and 14.0% to a lower risk compared to IPSS-R. The two-year recurrence-free survival (RFS) and overall survival (OS) post-transplant were similar across IPSS-R groups, but significantly lower in the very-high risk category with IPSS-M (P = 0.005 for RFS; P = 0.014 for OS). Multivariate analysis revealed that patient age (P = 0.009, P = 0.017), very-high risk category in IPSS-M (P = 0.003, P = 0.001), and KPS score (P = 0.034, P = 0.055) were independent factors for OS and RFS. Only very-high risk category in IPSS-M was the independent factor affecting cumulative incidence of relapse (P = 0.003). Prophylactic interventions for relapse significantly decreased the risk of relapse (P = 0.003) and increased the survival of patients in the very-high risk category (P = 0.002 for OS, P = 0.006 for RFS). The study suggested that the IPSS-M system could identify the high relapse risk patients post-transplant who may benefit from early prophylactic interventions.

Abstract Allogeneic hematopoietic stem cell transplantation represents a curative modality for patients with myelodysplastic syndrome (MDS), yet relapse risk persists. The prognostic performances of the Revised International Prognostic Scoring System (IPSS-R) and the Molecular International Prognostic Scoring System (IPSS-M) for 129 MDS patients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) were evaluated. Using IPSS-M, 29.5% of patients were reclassified to a higher risk and 14.0% to a lower risk compared to IPSS-R. The two-year recurrence-free survival (RFS) and overall survival (OS) post-transplant were similar across IPSS-R groups, but significantly lower in the very-high risk category with IPSS-M (P=0.005 for RFS; P=0.014 for OS). Multivariate analysis revealed that patient age (P=0.008), very-high risk in IPSS-M (P=0.002), Karnofsky Performance Status score (P=0.003), and Grade 3-4 acute graft-versus-host disease (P=0.014) were independent factors for OS and RFS. Only very-high risk category in IPSS-M was the independent factor affecting cumulative incidence of relapse (P=0.003). Prophylactic interventions for relapse significantly decreased the risk of relapse (P=0.003) and increased the survival of patients in the very-high risk category (P=0.002 for OS, P=0.006 for RFS). The study suggested that the IPSS-M system could identify the high relapse risk patients post-transplant who may benefit from early prophylactic interventions.

The low-dose anti-thymocyte globulin (ATG) plus low-dose post transplantation cyclophosphamide (PTCy) -based (low-dose ATG/PTCy-based) regimen had a promising activity in preventing of graft-versus-host disease (GVHD) in adult patients. However, its efficacy in pediatric patients remain to be defined. Here, we presented the findings from 35 pediatric patients undergoing haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with the new regimen for GVHD prophylaxis. The cumulative incidences (CIs) of grades II-III and III-IV acute GVHD (aGVHD) were 34% (95% CI, 17-48%) and 11% (95% CI, 0-21%) within 180 days post-transplantation, respectively. The CIs of chronic GVHD (cGVHD) and moderate-to-severe cGVHD within 2 years were 26% (95% CI, 7-41%) and 12% (95% CI, 0-25%), respectively. The 2-year probabilities of overall survival, relapse-free survival, and graft-versus-host disease and relapse-free survival were 89% (95% CI, 78-100%), 82% (95% CI, 68-98%) and 59% (95% CI, 43-80%), respectively. The CIs of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation by day 180 were 37% (95% CI, 19-51%) and 20% (95% CI, 6-32%) respectively. These results strongly advocate for the efficacy of the low-dose ATG/PTCy-based regimen as a robust strategy for GVHD prevention in haplo-PBSCT for pediatric patients.

BACKGROUND:Mechanical ventilation plays an important role in perioperative management and patient outcomes. Although mechanical ventilation with high tidal volume (HTV) is injurious in patients in the intensive care unit, the effects of HTV ventilation in patients undergoing liver transplant (LT) has not been reported. The aim of this study was to determine if intraoperative HTV ventilation was associated with the development of acute respiratory distress syndrome (ARDS).METHODS:Patients undergoing LT between 2013 and 2018 at a tertiary medical center were reviewed. The tidal volume was recorded at 3 time points: after anesthesia induction, before liver reperfusion, and at the end of surgery. Patients were divided into 2 groups: HTV (>10 mL/kg predicted body weight [pBW]) and non-HTV (≤10 mL/kg pBW). The 2 groups were compared. Independent risk factors were identified by multivariable logistic models.RESULTS:Of 780 LT patients, 85 (10.9%) received HTV ventilation. Female sex and greater difference between actual body weight and pBW were independent risk factors for HTV ventilation. Patients who received HTV ventilation had a significantly higher incidence of ARDS (10.3% vs 3.9%; P = .01) than those who received non-HTV ventilation.CONCLUSIONS:In this retrospective study, we showed that HTV ventilation during LT was common and was associated with a higher incidence of ARDS. Therefore, tidal volume should be carefully selected during LT surgery. More studies using a prospective randomized controlled design are needed.

Takotsubo syndrome (TTS) can develop after liver transplant (LT), but its predisposing factors are poorly understood. In this study, we aimed to determine if perioperative factors were associated with posttransplant TTS. Adult patients who underwent primary LT between 2006 and 2018 were included. Patients with and without TTS were identified and matched by propensity scores. Of 2181 LT patients, 38 developed postoperative TTS with a mean left ventricular ejection fraction of 25.5% (±7.8%). Multivariable logistic regression revealed two preoperative risk factors (alcoholic cirrhosis and model for end‐stage liver disease‐sodium scores) for TTS. Post‐propensity match analyses showed that TTS patients had significantly higher doses of epinephrine and lower doses of fentanyl during LT compared with non‐TTS patients. A higher dose of epinephrine and a lower dose of fentanyl was associated with a higher predicted probability of TTS. All TTS patients had full recovery of cardiac function and had comparable 1‐year survival. In conclusion, TTS occurred at a rate of 1.7% after LT and was associated with two pretransplant risk factors. The higher doses of epinephrine and lower doses of fentanyl administered during LT were associated with posttransplant TTS. More studies on the relationship between intraoperative medications and TTS are warranted.

Objective: Acute Myeloid Leukemia (AML) with translocation of chromosome 8 and 21 [t(8;21) (q22;q22)] is known to have a favorable prognosis. Once relapse occurred, allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is recommended for Complete Remission (CR) patients after salvage chemotherapies. Allo-HSCT might be as a salvage strategy for patients without achieving morphological CR. Methods: We performed a retrospective study on 21 relapsed AML patient (13 with molecular relapse and 8 with morphological relapse) with t(8;21) treated with allo-HSCT at our center from August 2016 to January 2021. Results: The median time of follow-up was 15 (5 to 47) months. Nineteen from twentyone patients achieved full donor chimerism at 30 days after transplantation. All eight patient with morphological relapse got molecular CR, while eleven from thirteen patients with molecular relapse achieved molecular CR. The 2-year Cumulative Incidences of Relapse (CIR) and Non-Relapse Mortality (NRM) for all patients were 19.0% and 20.4%, respectively. The 2-year CIRs were 7.7% and 37.5% in molecular and morphological relapse groups (p=0.1001), respectively. The 2-year NRM were 11.1% vs. 40.0% (p=0.1585) without statistical significance. The 2-year probability of Overall Survival (OS) were similar between the molecular and the morphological relapse group (74.1% vs. 60.0%, p=0.3789), while the 2-year probability of Relapse-Free Survival (RFS) was 80.8% and 37.5% (p=0.04), respectively. Conclusion: Allo-HSCT has yielded encouraging results in this study focusing on relapsed AML with t (8;21) translocation and could be as an effective salvage modality for morphological relapsed patients.