Issue Archive

Edited by Associate Editor Robert Zeiser, this How I Treat series focuses on post–allogeneic transplant management of high-risk patients. These patients are at risk for relapse of malignancy and severe graft-versus-host disease (GVHD). Two articles in the series discuss adoptive cellular immunotherapy and maintenance therapy to preempt relapse of acute myeloid leukemia. The third article addresses the state of the art for preventing GVHD in this subset of stem cell transplant recipients.

There have been no prospective studies to establish the risk of pregnancy for patients with immune thrombocytopenia (ITP). In this Plenary Paper, Guillet and colleagues report on a prospective, multicenter observational cohort study comparing ITP outcomes in 131 pregnant vs 131 nonpregnant women with a history of ITP. Neonatal thrombocytopenia occurred in 14%, similar to previous reports. However, pregnancy did not increase bleeding or the degree of thrombocytopenia over nonpregnant patients, providing some reassurance to patients with ITP contemplating pregnancy.

Edited by Associate Editor Robert Zeiser, this How I Treat series focuses on post–allogeneic transplant management of high-risk patients. These patients are at risk for relapse of malignancy and severe graft-versus-host disease (GVHD). Two articles in the series discuss adoptive cellular immunotherapy and maintenance therapy to preempt relapse of acute myeloid leukemia. The third article addresses the state of the art for preventing GVHD in this subset of stem cell transplant recipients.

Edited by Associate Editor Robert Zeiser, this How I Treat series focuses on post–allogeneic transplant management of high-risk patients. These patients are at risk for relapse of malignancy and severe graft-versus-host disease (GVHD). Two articles in the series discuss adoptive cellular immunotherapy and maintenance therapy to preempt relapse of acute myeloid leukemia. The third article addresses the state of the art for preventing GVHD in this subset of stem cell transplant recipients.

Edited by Associate Editor Robert Zeiser, this How I Treat series focuses on post–allogeneic transplant management of high-risk patients. These patients are at risk for relapse of malignancy and severe graft-versus-host disease (GVHD). Two articles in the series discuss adoptive cellular immunotherapy and maintenance therapy to preempt relapse of acute myeloid leukemia. The third article addresses the state of the art for preventing GVHD in this subset of stem cell transplant recipients.

The indications for, and optimal timing of, allogeneic stem cell transplantation (alloSCT) for patients with inborn errors of immunity (IEI) are not established. Cheminant et al report on a retrospective study from a French national registry examining the outcomes of transplanted and nontransplanted adults with severe IEI. Despite a 13% rate of transplant-related mortality (TRM), disease-free survival for patients who received alloSCT is 58% compared to 33% for those not transplanted, suggesting alloSCT prevents progressive IEI morbidity sufficiently to justify the risk of TRM.

Aplastic anemia (AA) is characterized by T-lymphocyte–mediated stem cell destruction. Groarke and colleagues report on preclinical studies of ruxolitinib (RUX), a Janus kinase (JAK) 1/2 inhibitor that suppresses cytotoxic T-cell activation and inhibits the production of a range of cytokines. Using a murine model of AA, the authors show that RUX decreases bone marrow hypoplasia and improves survival. While the mouse models do not perfectly reflect human AA, these studies provide support for a trial of JAK/STAT inhibitors for the treatment of human bone marrow failure syndromes.

Turcotte and colleagues evaluate the impact of improved treatment and supportive care in childhood acute myeloid leukemia (AML) on chronic complications, late mortality, and health status in 886 survivors of AML in the Childhood Cancer Survivor Study. Mortality was high in patients undergoing hematopoietic cell transplantation (HCT) in the 1970s but is lower in survivors of HCT in the 1990s. Long-term morbidity and mortality remain greater in patients undergoing HCT, partially reflecting that high-risk patients preferentially undergo HCT, but the gap has narrowed.

Acquired von Willebrand syndrome (AVWS) occurs in patients with congenital heart disease, related to shear stress from disordered blood flow. To enable both a preoperative and intraoperative assessment, Icheva et al used a rapid turnaround test for AVWS measuring the Gp1bM/VWF:Ag ratio rather than the time-consuming standard multimer analysis. Patients identified with AVWS have increased blood loss and require more transfusions of plasma and fibrinogen concentrates. This rapid turnaround test allows for patient-tailored treatment to reduce surgical bleeding complications.