Hematological Malignancies in Sickle Cell Disease Patients: Report of Four Cases in Togo and Literature Review

Background: Hemopathies were rarely observed in major sickle cell disease patients some thirty years ago, probably due to the high mortality rate among the latter as a result of progressive complications. Thanks to advances in the management of sickle cell disease, patients' life expectancy has increased considerably, exposing them more frequently to neoplasia, including hematological malignancies. The increased risk of leukemogenesis is multifactorial and linked to the pathophysiological mechanisms of the clinical manifestations of sickle cell disease. Study Setting: The clinical haematology department of campus teaching hospital and the paediatric onco-haematology unit of Sylvanus Olympio teaching hospital in Lomé were used as study settings. Observations: Four hematologic malignancies were collected in a cohort of 5847 major sickle cell syndromes. The median age of the patients was 31.25 years (extremes: 14 and 58 years) and they were predominantly female (sex ratio M/F = 0.25). Two were on background therapy with hydroxyurea. Among the four patients, there were two cases of acute lymphocytic leukemia, including ALL3 in a 58-year-old SS woman and T-ALL2 in a 12-year-old SC. Then, a case of lymphocytic lymphoma in a 20-year-old SS man was reported and finally a case of chronic myelocytic leukemia in a 33-year-old woman of Sβ+ thalassaemia phenotype. Conclusion: To further report this coexistence, it is therefore essential to systematically consider hematological malignancies during major sickle cell syndromes even if there are similarities in the symptomatology of these two serious pathological situations.

Hematological Alterations in an Eastern Sudanese Chronic Kidney Disease Patient Population

Background: Chronic Kidney Disease (CKD), associated with a slow and progressive loss of kidney function over a period of several years, is an important clinical disaster with an increasing rate of morbidity and mortality especially in the least developed countries. Many hematological parameters are thought to alter dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. Methods: We tried, retrospectively, to evaluate the peripheral blood hematological alterations in a group of patients undergoing hemodialysis in an eastern Sudan dialysis center to add local medical information. Results: Anemia (Low hemoglobin and hematocrit) was detected in 94% of the patients’ group. Mean Erythrocyte count (3.32vs.4.76 (×109/L)), Hemoglobin concentration (9.4vs.13 (g/dl)), Hematocrit (28.7vs.38.7 (L/L)) and platelet count (296 vs. 238 (×109/L)) were significantly lower in the patients’ group than in the control group (P-values Conclusion: Five out of eight studied parameters (Red cell count, hemoglobin, hematocrit, mean cell hemoglobin concentration, and platelets count) have shown a significant alteration in CKD patients. As the complete blood count (CBC) test is the most utilized test in clinical laboratory practice, these alterations may be considered as early indicators for CKD. Furthermore, all patients with CKD must be routinely checked for these alterations.

Comprehensive evaluation of nutritional status before and after hematopoietic stem cell transplantation in 170 patients with hematological diseases

Objective： To investigate the nutritional status of patients before and after hematopoietic stem cell transplantation（HSCT）, and explore optimal methods for assessing nutritional status in patients with hematological diseases.Methods： This cohort study enrolled 170 patients who were diagnosed with hematological diseases and underwent allogeneic HSCT in the Department of Hematology, Peking University People＇s Hospital between May2011 and April 2013. We used fixed-point continuous sampling and four nutritional screening tools, Nutritional Risk Screening 2002（NRS-2002）, Mini Nutritional Assessment（MNA）, Subjective Global Assessment（SGA） and Malnutrition Universal Screening Tools（MUST）, in combination with body measurements, to extensively screen and evaluate nutritional risks and status in patients receiving HSCT before entering and after leaving laminar air flow rooms.Results： After HSCT, patients had significant reduction in weight, hip circumference, waist-hip ratio, calf circumference, mid-upper arm circumference, and suprailiac skinfold thickness compared with pre-HSCT measurements. Before HSCT, NRS-2002 identified that 21.2% of patients were at nutritional risks, compared with100% after HSCT. MUST indicated that before HSCT, 11.77% of patients were at high nutritional risk,compared with 59.63% after HSCT. MNA assessed that 0.06% of patients were malnourished before HSCT,compared with 19.27% after HSCT. SGA identified that before HSCT, 1.76% of patients had mild to severe malnutrition, which increased to 83.3% after HSCT. There is a significant increase in the nutritional risk and malnutrition in patients who received HSCT.Conclusions： Before HSCT, some patients already had nutritional risk or nutritional deficiencies, and prompt and close nutritional screening or assessment should be performed. The nutritional status of patients after HSCT was generally deteriorated compared with that before transplantation. Body measurements should be taken more frequently during the subsequent treatment window in the laminar air flow rooms. After HSCT, it is recommended to combine MNA and SGA to fully evaluate the nutritional status, and thus provide timely and reasonable nutritional support.

Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales

BACKGROUND Seeking potentially novel blood markers of liver fibrosis and steatosis is constantly of crucial importance.Despite a growing number of studies in this field of hepatology,a certain role of hematological indices in the course of liver disorders has not been fully elucidated,yet.AIM To evaluate a diagnostic accuracy of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and mean platelet volume-to-platelet-ratio(MPR)in the course of alcoholic liver cirrhosis(ALC)and nonalcoholic fatty liver disease(NAFLD).METHODS One hundred forty-two patients with ALC,92 with NAFLD and 68 persons in control group were enrolled in the study.Hematological indices(NLR,PLR and MPR),indirect and direct markers of liver fibrosis(aspartate transaminase to alkaline transaminase ratio,aspartate transaminase to platelet ratio index,fibrosis-4,gamma-glutamyl transpeptidase to platelet ratio,procollagen Ⅰ carboxyterminal propeptide,procollagen Ⅲ aminoterminal propeptide,transforming growth factor-α,platelet-derived growth factor AB,laminin)were measured in each person.Model for end-stage liver disease(MELD)score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients.Receiver operating characteristic(ROC)curves and area under the curve(AUC)values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD.RESULTS MPR and NLR values in ALC patients were significantly higher in comparison to control group;PLR level was significantly lower.MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis.MPR,NLR and PLR correlated with MELD score.NLR level in NAFLD patients was significantly higher in comparison to controls.MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score.AUC values and proposed cut-offs for NLR,PLR and MPR in ALC patients were:0.821(>2.227),0.675(<70.445)and 0.929(>0.048),respectively.AUC values and proposed cut-offs for NLR,PLR and MPR in NAFLD group were:0.725(>2.034),0.528(>97.101)and 0.547(>0.038),respectively.CONCLUSION Hematological markers are inseparably connected with serological indices of liver fibrosis in ALC and NAFLD patients.MPR and NLR turned out to be the most powerful parameters in ALC patients.

Sarcopenia and gut microbiota alterations in patients with hematological diseases before and after hematopoietic stem cell transplantation

Objective: The aim of this study was to investigate the prevalence of sarcopenia(SP) and its relationship with gut microbiota alterations in patients with hematological diseases before and after hematopoietic stem cell transplantation(HSCT).Methods: A total of 108 patients with various hematological disorders were selected from Peking University People’s Hospital. SP was screened and diagnosed based on the 2019 Asian Sarcopenia Diagnosis Strategy. Physical measurements and fecal samples were collected, and 16S rRNA gene sequencing was conducted. Alpha and beta diversity analyses were performed to evaluate gut microbiota composition and diversity.Results: After HSCT, significant decreases in calf circumference and body mass index(BMI) were observed,accompanied by a decline in physical function. Gut microbiota analyses revealed significant differences in the relative abundance of Enterococcus, Bacteroides, Blautia and Dorea species before and after HSCT(P<0.05). Before HSCT, sarcopenic patients had lower Dorea levels and higher Phascolarctobacterium levels than non-sarcopenia patients(P<0.01). After HSCT, no significant differences in species abundance were observed. Alpha diversity analysis showed significant differences in species diversity among the groups, with the highest diversity in the postHSCT 90-day group and the lowest in the post-HSCT 30-day group. Beta diversity analysis revealed significant differences in species composition between pre-and post-HSCT time points but not between SP groups. Linear discriminant analysis effect size(LEfSe) identified Alistipes, Rikenellaceae, Alistipes putredinis, Prevotellaceae defectiva and Blautia coccoides as biomarkers for the pre-HSCT sarcopenia group. Functional predictions showed significant differences in anaerobic, biofilm-forming and oxidative stress-tolerant functions among the groups(P<0.05).Conclusions: This study demonstrated a significant decline in physical function after HSCT and identified potential gut microbiota biomarkers and functional alterations associated with SP in patients with hematological disorders. Further research is needed to explore the underlying mechanisms and potential therapeutic targets.

Hematological Disorders during Chronic Kidney Disease Stages 3 to 5 Non-Dialysed in Cameroon

Introduction: Haematological disorders are common complications of chronic kidney disease (CKD) leading by anemia which increase with the severity of the disease. Objective: Assess the haematological profile of CKD patients stages 3 to 5 non-dialysed seen at the first nephrology consultation in Cameroon. Patients and Methods: A hospital-based cross-sectional study was conducted from February to July 2018 at the nephrology unit of the Yaounde University Teaching Hospital and Douala General Hospital. All adults’ (≥18 years old) patients who provided a written informed consent and attended their first nephrology consultation with a nephrologist diagnosis of CKD stages 3 to 5 non-dialysed were included. Clinical and paraclinical data (serum creatinine, full blood count, reticulocytes count, iron status, vitamin B12 and folates count, and bleeding time) were collected. Parametric, non-parametric and correlations tests were used to compare variables. Results: We included 105 (59% males) participants with a mean age of 55.2 ± 13.6 years divided into 20 (19%), 36 (34.3%) and 49 (46.7%) respectively in stage G3, G4 and G5 of CKD. The profile of hematological abnormalities was anemia (86.7%), leucopenia (15.2%), hyperleucocytosis (6.7%), thrombopenia (23.8%), thrombocytosis (3.8%) and prolonged bleeding time (13.3%) without any association with the stage of CKD (p > 0.05). The pattern of anemia was mainly normocytic and normochromic (59.3%) and aregenerative (92.3%) with iron deficiency found in 23 (21.9%) participants. There was no case of vitamin B12 and folates deficiency. Prolonged bleeding time was observed in 14 (13.3%) participants with a weak correlation between platelets count and bleeding time (r = 0.122). Conclusion: We observed that aregenerative normocytic normochromic anemia is the leading haematological abnormality during CKD in this setting. None of the full blood count parameters was associated with CKD stages and there was a week correlation between bleeding time and platelet count.

Application of Quality of Life Scale in Hematological Disease Research

Quality of life research is an emerging and rapidly developing health measurement technology.Quality of life assessment is performed using scales.Accurate quality of life assessment provides comprehensive information of patient which allows clinicians to put emphasis on overall quality of life(Total QOL)of patient.Quality of life scales have been applied for analysis of diseases such as leukemia and immune thrombocytopenia.This article reviews the use of commonly used quality of life scales for hematological diseases.

Methods and New Developments in the Treatment of Hematological Diseases with Integrated Traditional Chinese and Western Medicine

Objective:To understand the methods and progress of integrated Chinese and Western medicine in the treatment of hematological diseases,and to provide ideas for integrated Chinese and Western medicine in the treatment of hematological diseases.Methods:Searching the CNKI,Wanfang and Weipu databases with"integrated traditional Chinese and Western medicine","hematological disease",and"traditional Chinese medicine"as the key words,for related literature of integrated traditional Chinese and Western medicine in the treatment of hematological disease,screening and analyzing the literature.Results:After decades of development,the methods of integrated traditional Chinese and Western medicine in the treatment of hematological diseases have been developed from initial exploration to clinical practice,from wide application to recent progress.The combination methods include the combination of Western medicine and traditional Chinese medicine,as well as the combination of Western medicine and non-medicine of traditional Chinese medicine.The combination of traditional Chinese and Western medicine includes the combination of Chinese and Western medicine,sequential and alternate methods,etc.The combination of traditional Chinese and Western medicine in the treatment of hematological diseases has significant effects in enhancing efficiency and reducing toxicity,improving the quality of life and prolonging the survival period.Conclusion:The combination of traditional Chinese and Western medicine has obvious curative effect,high safety and various methods in treating hematologic diseases.

Ailogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age

Objective To investigate the efficiency and safety of allogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age. Methods From May 2002 to January 2010,35 patients P 】 50 years with malignant hematological diseases received allogeneic hematopoietic

Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load

BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis of VL is currently based on clinical signs,symptoms,and specific in-vitro markers and bone marrow investigations.However,VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.AIM To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.METHODS This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients.The data focused on hematological and bone marrow results.We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum,Sudan from the period of 2016 to 2020.RESULTS The majority of pediatric patients included in this study are below 5-years-old(n=59,55.2%).Moreover,anemia,thrombocytopenia,and leukopenia were among the prevalent characteristics in the population under study.To further analyze the data,we developed a machine learning model using boosted forest algorithms to predict L.donovani parasites load,with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46,0.50,and 0.74 for mild,moderate,and severe L.donovani parasite load in the validation dataset.CONCLUSION This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells(n=88,82.2%)with present macrophage hemophagocytes(n=103,96.3%).While anemia and thrombocytopenia were the most common hematological changes.These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.

Is the traditional Chinese medicine helpful for patients with hematologic malignant diseases? A meta-analysis of randomized controlled trials

AIM:To evaluate the efficacy of traditional Chinese medicine(TCM)for the treatment of hematologic malignant diseases.METHODS:We searched the Cochrane CENTRAL,PubM ed,Embase,Web of Science,AMED,CNKI,Wanfang Platform;China Sinomed and the clinical trial registry web sites and Googlescholar electronically up to June19th,2014 and hand searched related publications.Only randomized controlled trials(RCTs)researching on whether TCM as the adjuvant treatment improved the effect for hematologic malignant diseases were included.Two reviewers extracted data and evaluated the studies independently.Pooled risk ratios(RR)were calculated as outcome measures.Our primary outcomes were the overall response(OR)rate.RESULTS:We retrieved 13143 references and included11 RCTs involved 891 participants after screening.Because the non-significant heterogeneity we used the fixed effect model to combine data and TCM had a significantly higher OR and CR(complete response)rates than the control[RR=1.17,95%CI:(1.10,1.25),P<0.00001;RR=1.24,95%CI:(1.11,1.37),P<0.0001,respectively].Only three studies included in the survival rate analysis.We combined them with random effects model and there was no significant difference between the TCM and control arms.Becauseof the low heterogeneity we used the fixed effect model to combine the non-hematologic adverse effects(AEs)data.Our results showed that TCM significantly decreased non-hematologic AEs rates we researched,the gastrointestinal reaction[RR=0.50,95%CI:(0.37,0.68),P<0.0001],liver and/or kidney injury[RR=0.37,95%CI:(0.26,0.53),P<0.00001]and heart injury[RR=0.24,95%CI:(0.09,0.68),P=0.007].Additionally,TCM had a trend to decrease the infection rate[RR=0.16,(0.02,1.12),P=0.07],but not statistically significantly.CONCLUSION:TCM increases OR and CR rates for hematologic malignances and reduces treatment associated serious non-hematologic AEs.Therefore,TCM should be included in the treatment of hematologic malignances.

On the road: Clinical trials with stem cell extended to non-hematologic disease

Increasing evidence in scientific journals declares that stem cell can be used in human medicine for therapeutic purposes. We reviewed the lated literature on clinical trials conducted with stem cells. The main information was offered by http://www.ClinicalTrials.gov. These clinical trials cover almost all human diseases, from hematologic diseases to non-hematologic diseases including Interventional trials and observational trials. In conclusion, at present, the clinical trials with stem cells have been extending to almost all human diseases. Optimal medicinal effect reported in some non-hematologic diseases is pushing the advance of stem cells

Comparative Evaluation of the Effects of Velogenic Newcastle Disease Virus Infection on the Hematology of Ducks and Chickens

The hematological lesions consequent upon velogenic Newcastle disease virus (NDV) infection were investigated in 6-week-old ducks and chickens. Following intramuscular inoculation, the results indicated significantly lower (p < 0.05) packed cell volume (PCV) in infected chickens (IC) on days 3 - 9 post inoculation (PI) and in infected ducks (ID) on days 3 - 15 PI. The hemoglobin concentrations were significantly lower (p < 0.05) in IC on days 3, 6 and 15 PI while in the ID, they were significantly lower (p < 0.05) on days 3, 9 and 15 PI. The total erythrocyte counts were significantly lower (p < 0.05) in IC on days 3, 9 and 15 PI and in ID, they were significantly lower (p < 0.05) on days 3 and 9 PI. The mean corpuscular values indicated macrocytic hypochromic anemia in IC and macrocytic normochromic anemia in ID. The leucogram showed leucopenia in IC and initial leucopenia followed by leucocytosis in ID. The hematological pictures of the velogenic NDV in this experiment indicate less susceptibility of ducks when compared with the chickens. The severity of this virus infection in chickens and the mild clinical signs and lesions presented by ducks showed that ducks are far less susceptible than chickens.

Hematologic diseases: High risk of Clostridium difficile associated diarrhea

AIM: To investigate the incidence and clinical outcome of Clostridium difficile (C. difficile) associated diarrhea (CDAD) in patients with hematologic disease.

Helicobacter pylori and extragastric diseases: A review

Helicobacter pylori(H. pylori) infection is very common and affects approximately half of the world population. It causes gastric diseases, but some authors have reported an association of H. pylori infection with other systemic manifestations beginning in 1994. The list of potential effects of H. pylori outside the stomach includes a number of extragastric manifestations and we focused on neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases. This review discusses these important reported manifestations that are not related to the gastrointestinal tract.

Diagnostic performance of Neutrophil CD64 index,procalcitonin,and C-reactive protein for early sepsis in hematological patients

BACKGROUND Patients with hematological diseases are immunosuppressed due to various factors,including the disease itself and treatments,such as chemotherapy and immunotherapy,and are susceptible to infection.Infections in these patients often progress rapidly to sepsis,which is life-threatening.AIM To evaluate the diagnostic efficacy of the neutrophil CD64(nCD64)index,compared to procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP),for the identification of early sepsis in patients with hematological diseases.METHODS This was a prospective analysis of patients with hematological diseases treated at the Fuxing Hospital affiliated with Capital Medical University,between March 2014 and December 2018.The nCD64 index was quantified by flow cytometry and the Leuko64 assay software.The factors which may affect the nCD64 index levels were compared between patients with different infection statuses(local infection,sepsis,and no infection),and the control group and the nCD64 index levels were compared among the groups.The diagnostic efficacy of the nCD64 index,PCT,and hs-CRP for early sepsis was evaluated among patients with hematological diseases.RESULTS A total of 207 patients with hematological diseases(non-infected group,n=50;locally infected group,n=67;sepsis group,n=90)and 26 healthy volunteers were analyzed.According to the absolute neutrophil count(ANC),patients with hematological diseases without infection were divided into the normal ANC,ANC reduced,and ANC deficiency groups.There was no statistically significant difference in the nCD64 index between these three groups(P=0.586).However,there was a difference in the nCD64 index among the non-infected(0.74±0.26),locally infected(1.47±1.10),and sepsis(2.62±1.60)groups(P<0.001).The area under the diagnosis curve of the nCD64 index,evaluated as the difference between the sepsis and locally infected group,0.777,which was higher than for PCT(0.735)and hs-CRP(0.670).The positive and negative likelihood ratios were also better for the nCD64 index than either PCT and hs-CRP.CONCLUSION Our results indicate the usefulness of the nCD64 index as an inflammatory marker of early sepsis in hematological patients.

Pleiotropy within gene variants associated with nonalcoholic fatty liver disease and traits of the hematopoietic system

Genome-wide association studies of complex diseases,including nonalcoholic fatty liver disease(NAFLD),have demonstrated that a large number of variants are implicated in the susceptibility of multiple traits—a phenomenon known as pleiotropy that is increasingly being explored through phenome-wide association studies.We focused on the analysis of pleiotropy within variants associated with hematologic traits and NAFLD.We used information retrieved from large public National Health and Nutrition Examination Surveys,Genome-wide association studies,and phenome-wide association studies based on the general population and explored whether variants associated with NAFLD also present associations with blood cell-related traits.Next,we applied systems biology approaches to assess the potential biological connection/s between genes that predispose affected individuals to NAFLD and nonalcoholic steatohepatitis,and genes that modulate hematological-related traits—specifically platelet count.We reasoned that this analysis would allow the identification of potential molecular mediators that link NAFLD with platelets.Genes associated with platelet count are most highly expressed in the liver,followed by the pancreas,heart,and muscle.Conversely,genes associated with NAFLD presented high expression levels in the brain,lung,spleen,and colon.Functional mapping,gene prioritization,and functional analysis of the most significant loci(P<1×10-8)revealed that loci involved in the genetic modulation of platelet count presented significant enrichment in metabolic and energy balance pathways.In conclusion,variants in genes influencing NAFLD exhibit pleiotropic associations with hematologic traits,particularly platelet count.Likewise,significant enrichment of related genes with variants influencing platelet traits was noted in metabolic-related pathways.Hence,this approach yields novel mechanistic insights into NAFLD pathogenesis.

Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

BACKGROUND Looking for undiscovered blood markers of liver fibrosis and steatosis still remains an issue worth exploring.There are still plenty of unresolved issues related to the actual role of hematological indices as potential markers of liver function.AIM To study red blood cell distribution width(RDW),RDW-to-platelet ratio(RPR)and RDW-to-lymphocyte ratio(RLR) in alcohol-related liver cirrhosis(ALC) and metabolic-associated fatty liver disease(MAFLD).METHODS The study group was composed of 302 people:142 patients with ALC and 92 with MAFLD;68 persons were included as controls.RDW,RPR and RLR were measured in each person.Indirect and direct parameters of liver fibrosis were also assessed [aspartate transaminase to alkaline transaminase ratio,aspartate transaminase to platelet ratio index(APRI),fibrosis-4(FIB-4),gamma-glutamyl transpeptidase to platelet ratio(GPR),procollagen I carboxyterminal propeptide,procollagen Ⅲ aminoterminal propeptide,transforming growth factor-α,plateletderived growth factor AB,laminin].MELD score in ALC patients and nonalcoholic fatty liver disease(NAFLD) fibrosis score together with BARD score were obtained in the MAFLD group.The achieved results were compared to controls.Then a correlation between assessed markers was done.Diagnostic value of each investigated parameter and its suggested cut-off in the research group RESULTS RDW,RPR and RLR values turned out to be significantly higher in ALC and MAFLD groups compared to controls(ALC:P<0.0001;NAFLD:P<0.05,P<0.0001 and P<0.0001,respectively).RPR correlated positively with MELD score(P<0.01) and indirect indices of liver fibrosis(FIB-4 and GPR;P<0.0001) in ALC patients;negative correlations were found between PDGF-AB and both:RDW and RPR(P<0.01 and P<0.0001,respectively).RPR correlated positively with NAFLD fibrosis score and APRI(P<0.0001) in the MAFLD group;a positive relationship was observed between RDW and FIB-4,too(P<0.05).AUC values and suggested cut-offs for RDW,RPR and RLR in ALC patients were:0.912(>14.2%),0.965(>0.075) and 0.914(>8.684),respectively.AUC values and suggested cut-offs for RDW,RPR and RLR in MAFLD patients were:0.606(>12.8%),0.724(>0.047) and 0.691(>6.25),respectively.CONCLUSION RDW with its derivatives appear to be valuable diagnostic markers in patients with ALC.They can also be associated with a deterioration of liver function in this group.

Advances in haplo-identical stem cell transplantation in adults with high-risk hematological malignancies

Allogeneic bone marrow transplant is a life-saving procedure for adults and children that have high-risk or relapsed hematological malignancies. Incremental advances in the procedure, as well as expanded sources of donor hematopoietic cell grafts have significantly improved overall rates of success. Yet, the outcomes for patients for whom suitable donors cannot be found remain a significant limitation. These patients may benefit from a hematopoietic cell transplant wherein a relative donor is fully haplotype mismatched. Previously this procedure was limited by graft rejection, lethal graft-versus-host disease, and increased treatmentrelated toxicity. Recent approaches in haplo-identical transplantation have demonstrated significantly improved outcomes. Based on years of incremental preclinical research into this unique form of bone marrow transplant, a range of approaches have now been studied in patients in relatively large phase Ⅱ trials that will be summarized in this review.

Epidemiological and Disease Burden Profiles of Leukemias and Malignant Lymphomas: Overview and Trends in the Republic of Moldova and Worldwide

Introduction: Hematological malignancies (HM) are relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-economic impact in the advanced stages and phases. Objective: The objective of the study was to identify the epidemiological patterns, and to evaluate the epidemiological trends and disease burden issues of HM in the Republic of Moldova and worldwide. Materials and Methods: The following research methods were used: epidemiological, descriptive statistics, clinico-analytic. The diagnosis was proved in all cases by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The qualitative type researches were performed and enriched by the narrative synthesis of the data. From the specialized international bibliographic sources and official statistics concerning HM. The narrative review of the reference sources was fulfilled in the form of a synthesis. Results: The number of newly diagnosed and followed-up patients with HM at the Institute of Oncology in 2016, 2017, 2018, 2019, 2020 and 2021 amounted respectively to 725, 802, 613, 628, 536 and 528, the incidence (new cases per 100,000 population) being 17.6, 19.5, 14.9, 17.7, 15.1 and 20.3. In 2021 HM constituted 6.2% of all newly-diagnosed cases with malignant tumors in the Republic of Moldova. In the same year Hodgkin lymphoma was diagnosed in 10.04% of cases, non-Hodgkin’s lymphomas—in 31.63%, multiple myeloma and plasma cells neoplasms—in 7.77%, lymphoid leukemias—in 17.42%, myeloid leukemias—in 12.31%, monocytic leukemias—in 0.95%, and other leukemias—in 16.29%. In 2019 the male rate was 51.5%, and the female rate—48.5%. Within 2 years males were 266 (50.4%), females—262 (49.6%). The age of 50 - 79 years prevailed in both genders (males—65%, females—72.5%). The children constituted 4.0% of the newly diagnosed cases, 4.8% of those under the follow-up at the end of the year 2019 and 6.4% of the newly diagnosed cases in 2021. The disease span from the onset to diagnosis ranged between 1 - 24 months and constituted on average 5.63 months, without a significant difference as compared to 2019 (5.76 months). The incidence of HM in Western countries is 14 - 19 new cases per 100,000 population (4% of all cases with malignant tumors). The incidence of non-Hodgkin’s lymphomas increased by 45% between 2006 and 2016, from 319,078 to 461,000 cases. Between 2006 and 2016, the incidence of leukemias increased by 26%, from 37,000,000 to 467,000 cases. Conclusions: The epidemiological study revealed slightly lower morbidity by HM in the Republic of Moldova as compared to the West European countries mainly due to the migration of a workable population. The patients with malignant lymphomas, male gender and age categories of 50 - 79 years proved to be commonly registered epidemiological patterns. The narrative analysis of the literature revealed that patients with HM may experience a considerable disease burden with a negative impact on their employment status, working productivity and annual household income.