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Atypical Hemolytic Uremic Syndrome in the Setting of Acute Clostridium difficile Colitis.

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS can be secondary to multiple etiologies such as infections, medications, and immune processes. A rare, yet significant, etiology of HUS includes acute Clostridium difficile colitis. Here, we present a case of atypical HUS secondary to acute C. difficile colitis, successfully treated with hemodialysis and systemic corticosteroids. It is imperative that clinicians are cognizant of C. difficile-associated HUS given the overall rising incidence of acute C. difficile

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… The cornerstone management in HUS is supportive therapy, including red blood cell and platelet transfusion when clinically indicated, fluid and electrolyte management to maintain adequate intravascular volume and correct electrolyte abnormalities, and discontinuation of nephrotoxic medications [ 5 ]. …

Outpatient Rescue With Stem Cells Boost for Refractory Hematotoxicity Following anti-BCMA CAR T-Cell Therapy: A Case Report.

Prolonged and refractory hematotoxicity is a severe complication of anti-BCMA CAR-T cell therapy, associated with substantial morbidity. When conventional supportive measures (transfusions and hematopoietic growth factors) fail, alternative strategies are urgently needed. We report the case of a 55-year-old man who developed persistent cytopenias after idecabtagene vicleucel. Reinfusion of cryopreserved autologous stem cells (stem cell boost), administered without conditioning chemotherapy, resulted in rapid and complete hematopoietic recovery after 14 days. This case highlights the potential

Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review.

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Arterial thromboembolism, including myocardial infarction and stroke, is also prevalent. Risk differs in subgroups, with higher rates observed in specific cancers including pancreas, stomach, and multiple myeloma. Thromboprophylaxis is recommended for most patients with active cancer hospitalized for medical illnesses and after major cancer surgery. Outpatient thromboprophylaxis is not routinely recommended, but emerging data suggest

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… For patients with symptomatic SPE or more proximal PE, proximal DVT, or history of recurrence, full anticoagulation associated with platelet transfusion (threshold ≥40 × 10 9 /l) may be indicated. … According to guidelines, patients who experienced VTE and low platelet count (<50 × 10 9 /l) should be treated with full anticoagulation and possibly with platelet transfusion during the first 30 days after diagnosis of VTE. …

Critically ill cancer patient's resuscitation: a Belgian/French societies' consensus conference.

To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts' opinion and a final consensus conference about nine predefined questions1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be

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… Platelet transfusion strategies can be prophylactic or therapeutic (i.e., for proven hemorrhagic complications). … However, a lower threshold is safe and decreases the number of platelet transfusions. Recommendations In the absence of data specific to cancer patients in ICU, it is necessary to follow the recommendations of scientific societies. …

Результаты лечения мелфлюфена у пациентов с повторной/отправленной миеломой.

Объект &lt; &lt; Объект мельфалан флуфенамид &gt; &gt; (мельфлюфен) плюс дексаметазон полностью утвержден в Европе для пациентов с повторной/реферативной множественной миеломой (RRMM) ≥ 3 предыдущие линии терапии. Мы проанализировали эффективность и безопасность мелфлюфена в реальном мире. В этом ретроспективном анализе мы изучили базовые характеристики, эффективность и результаты безопасности с мелфлюфеном плюс дексаметазоном в группе 12 в Институте рака Даны-Фарбера, США. 5.5 предыдущие линии терапии. Three (больные)25%) страдал внематочной болезнью, three (В тыс.25%) цитогенетически высокор

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… In the overall HORIZON population ( N = 157), approximately 65% of patients received concomitant RBC or platelet transfusions, and 68% received concomitant growth factor support [ 20 ]. … Monitoring for cytopenias and providing appropriate management and supportive care, including growth factor support, platelet transfusions, and the use of romiplostim, may mitigate safety concerns with melflufen. …

Emergency Care

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Risk and response adapted therapy following autologous stem cell transplant in patients with newly diagnosed multiple myeloma (RADAR (UK-MRA Myeloma XV Trial): study protocol for a phase II/III randomised controlled trial.

IntroductionMultiple myeloma is a plasma cell malignancy that accounts for 1%-2% of newly diagnosed cancers.At diagnosis, approximately 20% of patients can be identified, using cytogenetics, to have inferior survival (high-risk). Additionally, standard-risk patients, with detectable disease (minimal residual disease (MRD)-positive) postautologus stem cell transplant (ASCT), fare worse compared with those who do not (MRD-negative). Research is required to determine whether a risk-adapted approach post-ASCT could further improve patient outcomes.MethodsRADAR is a UK, multicentre, risk-adapted, r

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… Platelet transfusions within 3 days prior to eligibility assessments are not permitted. Creatinine clearance ≥30 mL/minute, according to the Cockcroft-Gault formula, following correction of reversible causes (eg, dehydration, hypercalcaemia, sepsis). … The allowance of blood support products, blood transfusions and platelet transfusions as per institutional guidelines at eligibility and pretreatment assessments. An update of exclusion criteria to allow for previous plasmacytomas. …

Cytopenia after CAR-T Cell Therapy-A Brief Review of a Complex Problem.

Chimeric Antigen Receptor T-cell (CAR-T) immunotherapy has emerged as an efficacious and life extending treatment modality with high response rates and durable remissions in patients with relapsed and refractory non-Hodgkin lymphoma (NHL), follicular lymphoma, and B-cell acute lymphoblastic leukemia (B-ALL) as well as in other diseases. Prolonged or recurrent cytopenias after CAR-T therapy have increasingly been reported at varying rates, and the pathogenesis of this complication is not yet well-understood but is likely contributed to by multiple factors. Current studies reported are primarily

Cost-Effectiveness of Preemptive Plerixafor Versus Rescue Plerixafor for Mobilization and Collection of Hematopoietic Stem Cells in Patients With Multiple Myeloma and Lymphoma.

BackgroundPlerixafor combined with granulocyte colony-stimulating factor (G-CSF) has shown superior efficacy in mobilizing hematopoietic stem cells (HSCs). However, its widespread use is constrained by high costs, and there is ongoing debate regarding the effectiveness of mobilization strategies. This study evaluated the cost-effectiveness of preemptive versus rescue plerixafor in patients from the Brazilian Public Health Care System with multiple myeloma or lymphoma eligible for autologous stem cell transplantation (ASCT).MethodsThis observational study assessed the costs and clinical outcome

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… Platelet engraftment was defined as the first of three consecutive days with a platelet count of 20 000/μL or higher, without any need for platelet transfusion for at least seven consecutive days. …

Сопоставление мобилизации стволовых клеток с химиотерапией и цитокином (G-CSF) и цитокином в одиночку у пациентов миеломы (MOCCCA): случайная стадия II, открытая маркировка, испытание ненарушения.

В тех случаях, когда пациенты с недавно поставленным диагнозом миэлома, высокая доза химиотерапии (HCT), за которой следует аутологическая трансплантация стволовых клеток (ASCT), считается нормой медицинского обслуживания. Для мобилизации клеток CD34+ для ASCT обычно используются комбинированная цитотоксичная химиотерапия и G-CSF. Однако значение цитостатической химиотерапии для надежной мобилизации остается неясным. Этот потенциальный случайный этап II, не связанный с ферьерством, сравнил только G-GSF (G) с стандартной химиотерапией/G-CSF (CG) для мобилизации CD34+. Основной конечный показате

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… Hematological engraftment was assessed daily and was defined as the first day of neutrophils rising above 0.5 × 10 9 /l and platelets rising above 20.0 × 10 9 /l for three days after HDCT in the absence of platelet transfusion. … transfusion h , n (%) | 105 (77) | 51 (79) | 54 (86) | 0.40 Units of platelets transfused per patient; median (IQR) | 2 (1–3) | 2 (1–3.5) | 2 (1–3) | 0.69 Red blood cell transfusion h , n (%) | 43 (32) | 21 (32) | 22 (35) | 0.90 Units of red blood cell transfused per patient; median (IQR) | 1 (1–2) …

Unresponsive Thrombotic Thrombocytopenic Purpura (TTP): Challenges and Solutions.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy secondary to a severely decreased A Disintegrin And Metalloprotease with ThromboSpondin type 1 repeats 13 (ADAMTS13) activity, resulting in the formation of widespread von Willebrand factor - and platelet-rich microthrombi. ADAMTS13 deficiency is mainly acquired through anti-ADAMTS13 autoantibodies in adults. With modern standards of care, unresponsive TTP has become rarer with a frequency of refractory/relapsing forms dropping from >40% to <10%. As patients with unresponsive TTP are at increased risk of mortality, promp

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… Prophylactic platelet transfusion should be avoided whenever possible in the context of unresponsive TTP. 77 Unresponsive TTP: Management Algorithm Proposal In our institution, first line therapy for suspected TTP includes daily TPE, corticosteroids, caplacizumab (despite doubts about its cost-effectiveness …

Prolonged haematologic toxicity in CAR-T-cell therapy: A review.

Chimeric antigen receptor-T-cell (CAR-T-cell) therapy is a novel immunotherapy with encouraging results for treatment of relapsed/refractory haematologic malignancies. With increasing use, our understanding of immune-mediated side effects such as cytokine release syndrome and neurotoxicity has improved; nevertheless, prolonged haematologic toxicity (PHT), with a high incidence rate, remains underrecognized. Owing to heterogeneity in populations, the CAR-T cells used and diseases treated as well as differences in the definition of PHT, its rate, risk factors and management vary across studies.

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… CONSIDERATION FOR TREATMENT OF PROLONGED HAEMATOLOGIC TOXICITY Granulocyte colony‐stimulating factor In addition to symptomatic supportive treatment, such as red blood cell transfusion and platelet transfusion, granulocyte colony‐stimulating factor (G‐CSF) is the main and common therapeutic method … Eltrombopag treatment promotes platelet recovery and reduces platelet transfusion for patients with post‐transplantation thrombocytopenia. Ann Hematol. 2020;99(11):2679‐2687. 75. Kuhne T, Imbach P. …

Management of refractory autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: current perspectives.

Autoimmune hemolytic anemia (AIHA) is increasingly observed after allogeneic hematopoietic stem cell transplantation (allo-HSCT), with a reported incidence between 4% and 6%. The disease is generally severe and refractory to standard therapy, with high mortality, and there are neither defined therapies, nor prospective clinical trials addressing the best treatment. Most of the knowledge on the therapy of AIHAs derives from primary forms, which are highly heterogeneous as well, further complicating the management of post-allo-HSCT forms. The review addresses the risk factors associated with pos

Autologous hematopoietic stem cell transplant at a tertiary care centre in India: achieving comparable outcomes with adaptations.

Autologous stem cell transplantation (ASCT) is the standard treatment for many high-risk solid tumors. Patients undergoing ASCT should be managed in a dedicated hematopoietic stem cell transplantation (HSCT) unit with isolation rooms, high-efficiency particulate air (HEPA) filters, and positive pressure. We report the outcomes of the first 20 pediatric patients who underwent ASCT in isolation rooms with no HEPA filters or positive pressure. Moreover, the isolation rooms were not part of a dedicated HSCT unit. Data from 20 patients were analyzed. All patients included in the study underwent ASC

Clinical Manifestations, Treatment Characteristics, and Clinical Outcomes in Patients with Immune Thrombotic Thrombocytopenic Purpura (iTTP) in a Real-World Setting: An Interim Analysis of the Turkish iTTP Registry

OBJECTIVE: This study aimed to investigate the clinical manifestations, treatment patterns, and clinical outcomes of patients with immune thrombotic thrombocytopenic purpura (iTTP) across Türkiye via an interim analysis of the Turkish iTTP Registry. MATERIALS AND METHODS: A total of 215 patients with iTTP (median age at diagnosis: 41 years; 58.6% female) diagnosed between 2001 and 2023 were retrospectively analyzed in the interim analysis of a prospective non-interventional observational multicenter iTTP registry study (ClinicalTrials.gov Identifier: NCT05950750) conducted at 19 tertiary hema

Цитоплания и инфекция после цитакабагена автолейкеля в сильно обработанном реанимированном или рефрактном миеломе.

В феврале Управление по контролю за продуктами питания и лекарственными препаратами одобрило автолекцию Ciltaakabtagene (cilta-cel). 2022 для лечения повторной/реактивной множественной миэломы после four циклы терапии. По поводу CARTITUDE-1 в ходе судебного разбирательства, ≥3 Широко распространены цитопентия и инфекции. Здесь мы пытались охарактеризовать цитопению и инфекцию после вливания цита-села в стандартную систему ухода. Это многоцентральное, ретроспективное исследование включало 105 - пациенты, получившие цилта-сел; 91 Днем 90 и 49 Днем 180 о последующей деятельности. Класс должности

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… Transfusions after day 30 were needed in 16 patients (15%) who required packed red blood cells and in 15 (14%) who required platelet transfusions. Eleven patients (10%) received thrombopoietin agonist support, starting at a median of 36 days after infusion and continuing for a median of 29 days. … Notably, ~15% of patients required either packed red blood cells or platelet transfusions after day 30, while 10% required a stem cell boost due to persistent severe cytopenias beyond day 90. …

Guided immunotherapy for residual solid tumor: integrating platelets and CAR T cells to reduce post-surgical recurrence.

Postoperative recurrence remains a major obstacle to durable remission in patients with solid tumors, even after complete macroscopic resection. Growing evidence suggests that surgery creates a transient yet highly permissive biological window characterized by inflammatory signaling, coagulation activation, endothelial disruption, and systemic immune suppression. Together, these processes foster a protective niche that enables microscopic residual disease to evade immune surveillance and initiate metastatic outgrowth. Although modern adjuvant therapies have improved outcomes, their effectivene

Two Случаи протеазонных ингибиторов связаны с тромботическими микроангиопатиями и анализом литературы.

Множественная миелома (ММ) является широко распространенной гематологической халатностью, при этом протеазонные ингибиторы (ИП) играют ключевую роль в ее терапевтическом регулировании. Несмотря на то, что ПИ, как правило, хорошо терпимы и связаны с относительно мягкими побочными эффектами, последние данные все чаще привлекают внимание к протеазной ингибиторной тромботической микроангиопатии (TMA, связанной с ИП). ПРЕДОСТАВЛЕНИЕ СЛЕДУЮЩЕГО ВОПРОСА: two :: случаи с высоким клиническим подозрением в связи с ТМА, связанной с ПИ, с уделением особого внимания диагностическому процессу и последующим

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… transfusion, platelet-raising drugs; & Carfilzomib Table 3 Time of medication and laboratory data in case 2 MBP: maximal blood pressure; Hb: hemoglobin; Plt: platelet; Ret: reticulated corpuscles; LDH: lactate dehydrogenase; Cr: creatinine; eGFR: estimated glomerular filtration rate; TBIL: total bilirubin … ; UCB: unconjugated bilirubin; PT: prothrombin time; APTT: partial prothrombin time; Fg: fibrinogen; D-D: D-dimer; DAT: direct antiglobulin test; NA: not available; *after platelet transfusion, platelet-raising drugs; & Carfilzomib | 3.11 | 3.14& | 3.15 | 3.16 | 3.17 | 3.18 MBP(90–139/60–89) mmHg | …

Current Knowledge of Immune Checkpoint Inhibitor-Induced Thrombocytopenia: Epidemiology, Mechanisms, and Management.

Immune checkpoint inhibitors (ICIs) have been widely adopted in the treatment of malignant tumors, and their durable antitumor effects have revolutionized cancer therapy. Immune checkpoint inhibitor-induced thrombocytopenia (ICIIT) represents a rare but potentially severe or even fatal hematologic toxicity associated with immunotherapy. Therefore, it is imperative for healthcare professionals to recognize this potential adverse event and to understand its identification and management. However, the pathophysiological mechanisms underlying ICIIT remain incompletely understood, and both its diag

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… Platelet transfusions should be reserved for critically low counts (< 10 × 10 9 /L) or active bleeding episodes [ 78 , 79 ]. Management strategies for patients refractory to corticosteroids and/or IVIG vary across guidelines. …

Первая стадия испытания иополосина I 131 и Dexametasone в пациентах с повторной релапсированной/отправленной миеломой.

Справочная информация/цели: Пациенты, страдающие рецидивом/отторжением множественных миелом (RRMM), имеют плохие результаты в плане выживания и ограниченные возможности лечения. Все более широкое использование многоагентной терапии для более ранних направлений лечения и новых классов лекарственных препаратов, включая целевые агенты BCMA в последующих направлениях терапии, обусловило необходимость в новаторских платформах лечения у пациентов, которые вновь вернулись к этим стандартным подходам к уходу или отстали от них. Иопофосин I 131 a 131iodid (131I)-фосфолипидный спаривание, использующее с

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… Nine participants in the single-dose cohorts received a median of five platelet transfusions (range 1–6) while 10 participants in the fractionated-dose cohorts received a median of four platelet transfusions (range 1–16). … All were treated with platelet transfusions. There was one death in cohort B attributed to rapid disease progression. After a single infusion, Grade 3/4 cytopenias developed as early as day 14 and it was determined this was secondary to rapid disease progression. …