Agnieszka Tomaszewska

Allogeneic hematopoietic cell transplantations (allo-HCT) is a procedure with long history and well-documented efficacy in treating various malignant and non-malignant diseases of the hematopoietic system. While there is a potential for late complications even over 10 years following allo-HCT, the data on longer observations are limited due to loss in follow-up, personnel and organizational changes in transplant centers, and focusing on new promising therapies instead of HCT. The study aimed to evaluate 15- and 20-year overall and progression-free survival of allo-HCT recipients in our center. During the inclusion period from 1999 to 2014, we identified 269 allo-HCT recipients. Survival analyses were performed using Kaplan–Meier curves, the Cox proportional hazards model, and the log-rank test. First, we evaluated 15- and 20-year survival rates for the entire cohort of allo-HCT recipients from matched related donor (MRD) and matched unrelated donor (MUD). Then we performed similar analyses for allo-HCT recipients due to acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), myelodysplastic neoplasms (MDS), non-Hodgkin lymphomas (NHL), and severe aplastic anemia (SAA). It was confirmed that survival benefit continues also during long-term observation. Notably, the plateau effect of PFS was often observed over 20 years following allo-HCT, implying the ability to cure in a relatively large group of patients with otherwise incurable diseases.

Over the years, autologous hematopoietic cell transplantation (auto‐HCT) has become one of the most important therapeutic methods of contemporary hematology. However, analyses of survival after treatment are usually limited to 5‐10 years. Data on longer survival are limited due to difficulties and loss in follow‐up, as well as organizational and personnel changes in transplant centers. Therefore, our study aimed to evaluate the 15‐ and 20‐year overall and progression‐free survival of the recipients of auto‐HCT in our center without exclusion of salvage indications and patients with comorbidities. During the period ranging from 1999 to 2014, there were 452 recipients of auto‐HCT. Survival analyses were performed using Kaplan–Meier curves, the Cox proportional hazards model, and the log‐rank test. First, the entire cohort was evaluated for 15‐ and 20‐year overall and progression‐free survival. Then, similar analyses were performed for subgroups of patients with more frequent indications, including multiple myeloma, AL amyloidosis, Hodgkin lymphoma (HL), non‐Hodgkin lymphomas (NHLs), and acute myeloid leukemia. It was found that after 10 years, both overall and progression‐free survival slowly but gradually declined. Still, a significant proportion of transplanted patients survived 20 years following auto‐HCT, confirming the ability to cure in at least some cases of these earlier incurable disorders.

Chronic graft-versus-host disease (cGvHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Beyond its classical manifestations, cGvHD may involve additional organs, including the central nervous system (CNS), where involvement remains poorly characterized, and therapeutic options are undefined, particularly in steroid-refractory cases. We report the case of a 50-year-old woman who underwent allo-HSCT for myelodysplastic syndrome and subsequently developed classical acute followed by chronic GvHD-overlap syndrome. At 2 years and 9 months post-transplant, she presented with progressive spastic paraparesis, and brain MRI revealed multifocal hyperintense white-matter lesions. A diagnosis of possible CNS-cGvHD was established. Due to poor response and intolerance to prolonged corticosteroid therapy, ruxolitinib was initiated at 10 mg/day and subsequently increased to 20 mg/day, with concomitant tapering of prednisone and immunoglobulin supplementation. Over 12 months, the patient demonstrated both clinical and radiological improvement, including significant functional recovery and marked regression of CNS lesions. This case suggests that ruxolitinib may represent a potential therapeutic option for atypical CNS involvement in cGvHD. Although clinical improvement likely reflected combined treatments, the neurological and radiological response suggests meaningful contribution from JAK inhibition. Further studies are needed to better define the role of ruxolitinib in this rare manifestation of cGvHD.

Background: Haploidentical hematopoietic cell transplantations (haplo-HCTs) with post-transplant cyclophosphamide (PT-Cy) are standard practice, but complications causing morbidity and mortality are not well described. Methods: The aim of this prospective non-interventional multicenter study was to document frequency of potential non-infectious and infection-related complications and main transplant outcomes after the first unmanipulated haplo-HCT with PT-Cy between 2017 and 2019 in 129 adult patients with hematological malignancies. The median follow-up was 37.3 months [95% CI: 34.3–39.7]. Results: The cumulative incidence (CI) of acute graft versus host disease (aGvHD) at day +100 was 22.4% grade II-IV [95% CI: 15.5–30.1] and 8.8% grade III-IV [95% CI: 4.6–14.6], respectively. The cumulative incidence of chronic GvHD (cGvHD) at 24 months was 25.8% [95% CI: 18.5–33.6]; extensive cGvHD was 10.9% [95% CI: 6.3–17.1], respectively. The most frequent non-infectious complications for the whole study population were mucositis—37.5% (n = 48); renal insufficiency—18% (n = 23); and cardiovascular complications—10.9% (n = 14). The following infection-related complications were diagnosed: bacterial in 84 (65.1%), viral in 66 (51.6%), and fungal in 24 (18.6%) recipients. Two-year OS was 58.1% [95% CI: 50.2–67.3]; NRM—27.1% [95% CI: 19.7–35]; PFS—50.4% [95% CI: 42.5–59.8]; and GRFS—38.8% [95% CI: 31.2–48.1]. About 50% of all deaths were directly caused by infection or infection-related conditions. Conclusions: Disease remission status at transplant significantly affected PFS, chronic GvHD, and GRFS. Although clinical applications of haplo-HCT with PTCy are widespread, the study confirms the need to reduce infection-related mortality after this type of GvHD prophylaxis.

Kidney injury encompasses a broad spectrum of structural and functional abnormalities, directly associated with stem cell transplantation. Acute kidney injury and chronic kidney disease represent perilous complications of hematopoietic stem cell transplantation (HSCT), with an elevated risk of mortality and progression to end-stage renal disease. The early detection of these complications is, therefore, paramount, and research is increasingly focused on the identification of novel biomarkers of kidney damage. Recently, proenkephalin (PENK), a monomeric peptide that is freely filtered by the glomerulus and thus reflects glomerular filtration very well, has been shown to be an additional useful predictor of the occurrence of acute kidney injury and heart failure. Dickkopf-3 (DKK3) is a glycoprotein secreted by the renal tubular epithelium in response to stress and has been implicated in the development of interstitial fibrosis. It has therefore been evaluated primarily as a marker of fibrosis in chronic kidney disease (CKD), but may also help predict the development of acute kiney injury. Uromodulin is regarded as a renal marker. Previous studies have examined the potential of PENK, DKK-3 and uromodulin as a biomarker in individuals with preserved renal function. However, the urinary levels of PENK, DKK-3 and uromodulin in patients following HSCT have not yet been established. The objective of the present study was to assess urinary PENK, DKK-3, and uromodulin concentrations in patients who had been under ambulatory care of the Hematology, Transplantation and Internal Medicine Department for a minimum of three months following HSCT, and to investigate their correlations with kidney function, as reflected by serum creatinine and eGFR. The study population comprised 80 patients who had undergone allogeneic HSCT for various reasons, primarily hematological malignancies such as acute leukemias and lymphomas. In addition, 32 healthy volunteers were included in order to establish normal ranges for the biomarkers of interest. Urine concentrations of proenkephalin, DKK-3, and uromodulin were evaluated using a commercially available sandwich ELISA immunoassay. Demographic and clinical data were retrieved from the patients’ records. Statistical analyses were conducted using XLSLAT 2022 (Lumivero, Denver, CO, USA) and STATISTICAv13.0 (StatSoft, Tulsa, OH, USA). The results showed that PENK and DKK-3 levels were significantly higher in patients after HSCT compared to healthy volunteers. Furthermore, when patients were divided according to kidney function (below and over 60 mL/min/1.72 m²), it was found that the concentration of PENK and DKK-3 were significantly higher in 23 patients with CKD stage 3 relative to patients with eGFR over 60 mL min 1.72 m². In univariate correlations, PENK demonstrated an inverse relationship with eGFR (r: −0.21, p < 0.05), while DKK-3 exhibited no significant correlation with creatinine or eGFR.Patients following allogeneic HSCT, despite having normal or near-normal kidney function, exhibited evidence of kidney injury. However, further research is necessary to ascertain the clinical utility of the novel biomarker.

Adult acute lymphoblastic leukemia (ALL) is associated with poor outcomes. ALL is initiated by primary aberrations, but secondary genetic lesions are necessary for overt ALL. In this study, we reassessed the value of primary and secondary aberrations in intensively treated ALL patients in relation to mutator enzyme expression. RT-PCR, genomic PCR, and sequencing were applied to evaluate primary aberrations, while qPCR was used to measure the expression of RAG and AID mutator enzymes in 166 adult ALL patients. Secondary copy number alterations (CNA) were studied in 94 cases by MLPA assay. Primary aberrations alone stratified 30% of the patients (27% high-risk, 3% low-risk cases). The remaining 70% intermediate-risk patients included BCR::ABL1^pos subgroup and ALL lacking identified genetic markers (NEG ALL). We identified three CNA profiles: high-risk bad-CNA (CNA^high/IKZF1^pos), low-risk good-CNA (all other CNAs), and intermediate-risk CNA^neg. Furthermore, based on RAG/AID expression, we report possible mechanisms underlying the CNA profiles associated with poor outcome: AID stratified outcome in CNA^neg, which accompanied most likely a particular profile of single nucleotide variations, while RAG in CNA^pos increased the odds for CNA^high/IKZF1^pos development. Finally, we integrated primary genetic aberrations with CNA to propose a revised risk stratification code, which allowed us to stratify 75% of BCR::ABL1^pos and NEG patients.

Purpose:Nijmegen breakage syndrome (NBS) is a DNA repair disorder with a high predisposition to hematologic malignancies.Experimental Design:We describe the natural history of NBS, including cancer incidence, risk of death, and the potential effectiveness of hematopoietic stem cell transplantation (HSCT) in preventing both pathologies: malignancy and immunodeficiency.Results:Among 241 patients with NBS enrolled in the study from 11 countries, 151 (63.0%) patients were diagnosed with cancer. Incidence rates for primary and secondary cancer, tumor characteristics, and risk factors affecting overall survival (OS) were estimated. The cumulative cancer incidence was 40.21% ± 3.5% and 77.78% ± 3.4% at 10 years and 20 years of follow-up, respectively. Most of the tumors n = 95 (62.9%) were non-Hodgkin lymphomas. Overall, 20 (13.2%) secondary malignancies occurred at a median age of 18 (interquartile range, 13.7–21.5) years. The probability of 20-year overall survival (OS) for the whole cohort was 44.6% ± 4.5%. Patients who developed cancer had a shorter 20-year OS than those without malignancy (29.6% vs. 86.2%; P < 10−5). A total of 49 patients with NBS underwent HSCT, including 14 patients transplanted before malignancy. Patients with NBS with diagnosed cancer who received HSCT had higher 20-year OS than those who did not (42.7% vs. 30.3%; P = 0.038, respectively). In the group of patients who underwent preemptive transplantation, only 1 patient developed cancer, which is 6.7 times lower as compared with nontransplanted patients [incidence rate ratio 0.149 (95% confidence interval, 0.138–0.162); P < 0.0001].Conclusions:There is a beneficial effect of HSCT on the long-term survival of patients with NBS transplanted in their first complete remission of cancer.