Allogeneic peripheral blood stem cell transplantation in the treatment of severe aplastic anemia and severe infection

Objective To investigate the efficacy of allogeneic peripheral blood stem cell transplantation (PBSCT) in the treatment of severe aplastic anemia (SAA) and severe infection. Methods A patient with SAA and pseudomonas aeruginosa septicemia was treated with PBSCT from an HLA-identical sibling with cyclophosphamide (CY) and total body irradiation (TBI) for conditioning. The patient was infused with 20.3×108/kg mononuclear cells including 61.0×106/kg CD34+cells following the conditioning regimen. Results Twelve days after PBSCT, the absolute neutrophil count (ANC) of 1.0×109/L was achieved, with platelet count >50×109/L at twenty days. The donor origin of engraftment was confirmed by polymerase chain reaction (PCR) analysis of short tandem repeats at the end of the first, sixth and twelfth month. The patient’s body temperature dropped to normal level when her ANC reached 0.5×109/L on day 10, and the bacterial culture of blood sample became negative subsequently. Symptoms and signs of acute or chronic graft versus host disease (GVHD) were not observed in 30 months after PBSCT. Conclusions Hematopoiesis was reconstituted shortly after PBSCT. The combination of CY and TBI and the infusion of sufficient peripheral blood stem cells may contribute to the successful engraftment. PBSCT may be considered as the first choice when hematopoietic stem cell transplantation is needed for SAA patients complicated with severe infection.

Impact of COVID-19 in patients with lymphoid malignancies

The first cases of coronavirus disease 2019(COVID-19)were detected in Wuhan,China,in December 2019.Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies.Approximately onethird of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection.Major risk factors for a poor outcome are age and co-morbidities,but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population.Notably,despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy,active treatment,including B-cell depleting agents such as rituximab,do not appear to be associated with an increased risk of a poorer outcome.Indeed,some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection.There are risks associated with hemopoietic stem cell transplantation,but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive.Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients.This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.