Background:Daratumumab is a human anti‐CD38 monoclonal antibody approved for the treatment of relapsed or refractory multiple myeloma (MM). Due to the physiological presence of the antigen CD38 on the red blood cell (RBC) membrane, Daratumumab (DARA) inteferes with the classical pre‐transfusion tests, impairing the identification of potential auto‐ or alloantibodies whenever present. The duration of this interference has been reported to be of 2‐6 months after the last DARA administration [Oostendorp M, Transfusion 2015].Aims:The present analysis aims at evaluating the duration of DARA‐related pre‐transfusion testing interference after the end of treatment at our Center, in order to better define an optimal strategy to assign compatible packed RBCs for transfusion therapy.Methods:According to our policy, all patients were typed for AB0, full Rh phenotype, K/k, direct/indirect antiglobulin tests and extended sierological RBCs typing before starting with DARA [2016 SIMTI recommendations]; the identification of compatible packed RBCs was obtained after crossmatching using dithiothreitol‐treated patient's blood sample.Results:From October 2017, a total of n = 7 MM patients received DARA at a median age of 68y (range: 50‐79); median number of previous therapeutic lines was 3 (range: 1‐7) and the median number of weekly administrations was 7 per patient (range: 1‐12). Two patients are still receiving DARA (1 and 12 administrations respectively). As expected, both direct and indirect antiglobulin tests were positive for all patients; moreover, one patient had also a well‐identified allo anti‐D antibody. Among the n = 5 ongoing patients, n = 4 are evaluable because they underwent the subsequent pre‐transfusion tests after the end of DARA treatment: n = 1 still presents interference 50 days after the end of DARA whereas interference disappeared in n = 3 patients at 48, 65 and 111 days after the last treatment.Summary/Conclusion:Our preliminary data confirm the persistence of DARA‐related pre‐transfusion testing interference after the end of treatment for a median period of 2 months in this cohort of MM patients treated at our Institution. Futher follow‐up and the analysis of additional patients in the next future will allow to better determine the duration of interference; we believe these data are worthy of note due to increasing use of DARA, even for other clinical situations [Chapuy CI, NEJM 2018; Kwun JEB, Am J Transplant 2017]

Background:The World Health Organization (WHO) determines as post‐partum anemia values of harmoglobin (Hb) less than 10 g/dl. In most cases, it's an iron deficiency anemia and affects about the 27% of new mothers and has as a consequence a strong socio‐economic impact. One of the most important causes is the post partum haemorrhage (PPH), that's to say 500 ml of blood loss in the first 24 hours after a vaginal delivery or more than 1000 ml after a caesarean section. Nowadays PPH is one of the most common causes of mortality and morbidity rate among obstetric population and its frequency is between the 5% and the 22 % of the total deliveries.Aims:The objective of the present study is to determine the efficacy of an iron supplementation protocol for post‐èartum anemia.Methods:Our protocol provides a valuation of Hb in the post partum period. When Hb is greater than 8..5 g/dl, the new mother can be discharged from hospital and is treated by oral iron supplementaion with ferrous sulfate but it will be necessary to control the Hb value after 30 days. In case of HB belove 8..5 g/dl, parenteral iron is used (iron carbossymaltose) in the Obstretician Unit, then there will be a new assessment after 10/15 days at Service of Immunohaematology and Trasfusional Medicine to decide if to go on supplementation.Results:From 01/06/2017 to 31/12/2018 36 new mothers, average age 34 years (range 23 ‐ 43) have been enrolled. During the recovery, 34 new mothers have been treated with ferric carboxymaltose: 26 with a dosage of 500 mg and 8 with 1 g. Among these 34 women, 4 have been trasfused after a severe PPH and concomitant thalassaemic trait. Only 2 of the new mothers have been discharged with ferrous sulfate. At discharge, average Hb was 7.3 g/dl. At first access in Transfusional Center, the average Hb value was 10.8 g/dl with a medium delta of 3.5 g/dl. According to the hemoglobin values, 18 new mothers have continued oral iron therapy, 14 have been treated with ferric carboxymaltose and only 2 didn’t need therapy.Summary/Conclusion:Our protocol has been implemented thanks to the indications of National Blood Center about the PMB to ensure, through the multidisciplinarity, the transfusion appropriatness, the resource optimization and the improvement of the patient's outcome. The intravenous iron therapy with ferric carboxymaltose in new mothers suffering a severe iron deficiency anemia allows a fast rise of hemoglobin values and an improvment of psychophysical wellbeing of the new mother and a lowering of the number of blood transfusions.

Background:The hemoglobin (Hb) value adopted in the real life setting for the clinical decision of packed red blood cell (RBC) transfusion (transfusion trigger) is sometimes difficult to accurately retrieve and could be different to what is indicated in the blood request. The identification of the transfusion trigger is critical for the analysis of the distinct physicians’ attitudes across the different units within the same hospital and for the dissection of transfusion appropriateness.Aims:The aims of the present analysis is to compare the transfusion trigger across the multiple medical and surgical units at our Center and to describe the Hb values before and after the transfusion events. Further, considerations about the feasibility and the potential applications of this analytical approach are discussed.Methods:Data extraction procedure focused on the first semester 2018, dealing with transfusion episodes of 1–2 packed RBCs administered to patients hospitalised at ASST GOM Niguarda, Milan, Italy. Each single episode was registered, regardless of the number of the total packed RBCs transfused, as well as the Unit where the patient was admitted and the Hb values at admission, before and after the transfusion, together with the respective date and time. Comparisons analyses were made using the classical statistical tests. The Hb value before the transfusion is considered as the trigger for transfusion decision by the physician(s) in charge of the patients.Results:On a total of n = 501 episodes, n = 497 were evaluable for completeness of data. The corresponding number of packed RBCs represents the 2% of all the packed RBCs transfused at our Hospital in one year (n = 22170 in 2018). Median Hb was 10.70 (range: 6.30–16.70), 8.60 (range:3.00–15.10) and 10.30 (range: 5.00–16.30) at admission, before and after transfusion, respectively. Analyzing separately by unit, we observed that the transfusion trigger was higher in Cardiac Surgery, Vascular Surgery and Intensive Care Units, with median values of 9.50, 8.75 and 8.70 respectively. Conversely, transfusion trigger was comparable among the other surgical units (including Orthopedics) and the medical ones: Hb median values were 8.20, 8.20 and 8.30 respectively. Cardiology showed a slightly higher trigger: 8.65 when compared with the other non‐surgical units.Summary/Conclusion:The present analysis, accounting for « only » the 2% of the total transfusion burden at our Hospital in 2018, allows for a satisfactory definition of the transfusion trigger across the multiple medical and surgical units as well as the confirmation of the expected post‐transfusion Hb values. Our analysis model supports the feasibility of such an approach as a potential audit instrument and intervention policies in the area.

Correction to: Bone Marrow Transplantation (2017) 52, 683–688; doi:10.1038/bmt.2016.348; published online 16 January 2017 Since the online publication of this article, it has been noted that the author name JE Cheikh was incorrect and should be replaced with J El-Cheikh. The authors would like to apologise for this error.

Renal cell carcinoma (RCC) is particularly sensitive to immune intervention. HLA-G, a non-classical HLA class I molecule with immunomodulatory properties, has been studied with regard to outcome after hematopoietic stem cell transplantation (HSCT), in particular the 14 bp insertion/deletion polymorphism in the 3′ untranslated region. Here we analyzed n=56 patients affected by metastatic RCC who received an allogeneic HSCT between 1998 and 2006 in Milano, Marseille, Clermont-Ferrand and Stockholm. The 14 bp polymorphism was analyzed in correlation with overall survival (OS), PFS, acute and chronic GvHD. With a median follow-up of 13 years, a trend towards better outcome was observed when homozygosity for the 14bp-del allele was present: multivariate hazard ratio was 0.50 (95% confidence interval (CI): 0.23–1.13; P=0.10) and 0.57 (95% CI: 0.26–1.26; P=0.17) for OS and PFS, respectively, when 14bp-del/del was compared with 14bp-ins/X. Further exploratory analysis revealed a significant association between T/C at p3003 and improved OS (P=0.05) and PFS (P=0.006) compared with T/T. To our knowledge this is the first study on HLA-G and outcome after HSCT for a solid malignancy. After a coordinated multicenter study, we found that the more tolerogenic polymorphisms (14bp-del/del) is associated with better PFS and OS. The finding on p3003 deserves further investigation.

The calcineurin inhibitor and the intensity of the conditioning regimen may affect the occurrence of polyomavirus-associated hemorrhagic cystitis after haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide

The patient’s CMV serological status affects clinical outcome after T-cell replete haplo-HSCT and post-transplant cyclophosphamide

Correction to: Bone Marrow Transplantation (2016) 51, 462-465; doi:10.1038/bmt.2015.289; published online 23 November 2015 Since the publication of this article, it has been noted that the name of J El-Cheikh was incorrect. This has now been rectified and the corrected article together with this erratum appears in this issue.

Background and objectives Several transplantation outcomes have been shown to be associated with the infused bone marrow cell dose/kg of the recipient's body weight. The donor bone marrow density is directly related to the infused cell dose. The aim of the present study was to identify donor-related variables that are associated with high donor bone marrow density.Materials and methods We retrospectively analysed the predictive factors of high marrow density in 65 consecutive HLA-haploidentical bone marrow donors harvested at our centre between 2009 and 2013.Results Body mass index (BMI) and peripheral white blood cell (WBC) count were directly associated with bone marrow density (regression coefficient beta = 5.33 and beta = 2.93, respectively; P < 0.01). The likelihood of obtaining a collection with a high density was first predicted using BMI (BMI >= 30, mean density = 25.8 TNC/ml x 10(6)). Second, donors with a BMI <30 were split into two groups according to peripheral WBC count (WBC <8 x 10(3)/mm(3) : mean density = 18.4 TNC/ml x 10(6); WBC >= 8 x 10(3)/mm 3 : mean density = 23.1 TNC/ml x 10(6)). We also observed that the density of the first collected bag directly correlated with the overall density (R-2 = 0.69, P < 0.01).Conclusion The donor-related features BMI and WBC count affect the cell quantity obtainable with the harvest and should be taken into account when choosing the donor.

Unmanipulated haploidentical transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy) represents an alternative for patients with high-risk diseases lacking HLA-identical donor. Although it provides low incidences of GVHD, the efficacy of Haplo-SCT is still questioned, especially for patients with myeloid malignancies. Thus, we analyzed 60 consecutive patients with refractory ( n =30) or high-risk CR ( n =30) AML or myelodysplastic syndromes (MDSs) who underwent PT-Cy Haplo-SCT. The median age was 57 years (22–73 years), hematopoietic cell transplantation comorbidity index was ⩾3 in 38 patients (63%) and Haplo-SCT was the second allogeneic transplantation for 10 patients (17%). Although most of patients received PBSC as graft source ( n =48, 80%), we found low incidences of grade 3–4 acute (2%) and severe chronic GVHD (4%). Among patients with high-risk CR diseases, 1-year non-relapse mortality, cumulative incidence of relapse, progression-free and overall survivals were 20%, 32%, 47% and 62%, respectively. In patients with refractory disease, corresponding results were 34%, 35%, 32% and 37%, respectively. We conclude that PT-Cy Haplo-SCT could provide promising anti-leukemic effect even in the setting of very advanced diseases. Thus, it represents a viable alternative for high-risk AML/MDS patients without HLA-identical donor.

Correction to: Bone Marrow Transplantation (2015) 50, 865–867; doi:10.1038/bmt.2015.22; published online 2 March 2015 Since the publication of this article, it has been noted that the name of J El-Cheikh was incorrect. This has now been rectified and the corrected article together with this erratum appears in this issue.

Early recovery of CMV immunity after HLA-haploidentical hematopoietic stem cell transplantation as a surrogate biomarker for a reduced risk of severe infections overall