Héctor Alejandro Vaquera Alfaro

Purpose: The integration of diagnostic tools, immunochemotherapy, targeted agents, and cellular therapies such as chimeric antigen receptor T-cell therapy (CAR-T) cells has transformed lymphoma outcomes in high-income countries. However, in Latin America (LATAM), access to these advances remains limited. This study aimed to assess lymphoma care access and institutional capacity in LATAM. Methods: We conducted a cross-sectional digital survey from July 2025 to August 2025, coordinated by the Grupo de Estudio Latinoamericano de Linfoproliferativos network. The survey captured center-level data covering infrastructure, human resources, diagnostic and therapeutic availability, and clinical research activity. Data were analyzed using descriptive methods. Results: A total of 73 hematology centers from 16 Latin American countries completed the survey. Most centers were public institutions (53%), with a median number of four hematologists per center (range, 2-10). While basic pathology and flow cytometry were widely available, access to advanced diagnostics was limited. Fifteen centers (21%) lacked immunohistochemistry, and pathology turnaround times exceeded 3 weeks in 56%. Positron emission tomography-computed tomography was available in 41% of centers. Novel therapies such as antibody-drug conjugates, bispecific antibodies, and checkpoint inhibitors were not available or restricted in most centers. Hematopoietic stem-cell transplantation was performed in 41% of centers, whereas commercial CAR-T was available in 5%. Clinical trials were conducted in 34% of centers. Conclusion: Our findings highlight striking disparities between guideline-recommended lymphoma care and real-world institutional capacity across LATAM, underscoring the importance of collaborative efforts in building capacity and advocating for equitable access.

PURPOSE: Blockage of PD-1 with drugs such as nivolumab (Nivo) and pembrolizumab (Pembro) has been successfully implemented in the treatment of Hodgkin lymphoma among other types of tumors. Exorbitant costs hinder access for many patients living in low- and middle-income countries (LMICs). Dose reductions on the basis of pharmacodynamic studies have been used to allow access to these drugs to patients with no further options because of economic constraints. In this study, we aimed to systematically review and assess evidence regarding the efficacy and safety of this adapted intervention. METHODS: An expert librarian designed and conducted a literature search in MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Central, and clinicaltrials.gov. Screening was conducted in a title/abstract and full-text phase independently and in duplicate. Primary outcomes were overall survival, overall response rates (ORRs), and incidence of adverse events (AEs). Data extraction was performed independently and in duplicate as well. A qualitative synthesis was performed and reported in the results. RESULTS: Six studies investigated Nivo as an intervention, two Pembro, and 1 both therapies, with a total of 161 patients overall. One study had a single-arm prospective trial design and the rest a retrospective cohort design. ORR ranged from 66% to 100%, with complete response rates between 38% and 75%. The incidence of AEs was mostly high across all studies ranging from 27% to 93%, most of it composed of grade 1-2 AEs (27%-80%). No study reported health-related quality-of-life outcomes. CONCLUSION: Low-dose anti-PD1 immune checkpoint inhibitors have shown to be adequate candidates for testing of their efficacy in randomized trials and could improve access to these high-cost medications for patients with Hodgkin lymphoma both in LMICs and high-income countries.

Fluid overload in patients with end-stage kidney disease (ESKD) usually results in pleural effusions (PEs). While volume overload remains the primary etiology of PE, other possible causes must be ruled out. Thoracic ultrasonography (TUS) is a practical and efficient method for evaluating volume in patients undergoing hemodialysis (HD), although evidence regarding its usefulness in this context is limited. We aimed to investigate the relationship between pleuropulmonary TUS patterns and overload symptoms and their correlation with optimal HD, as measured by total urea clearance (Kt/V) and the urea reduction rate (URR). This prospective longitudinal observational study included patients with ESKD who underwent renal replacement therapy with HD. Point-of-care TUS was performed before and after HD sessions. The ultrasound parameters recorded included the presence, location, sonographic patterns and volume of PE. A total of 136 patients were included in the study. TUS abnormalities compatible with interstitial syndrome (B-lines) were identified in 56 (41%) patients. Forty-four patients (32%) had PE. The PE volume showed a statistically significant decrease after HD and normalized in 12% of the patients. No significant difference in the proportion of patients who achieved a URR > 65 or optimal Kt/V was observed between patients with abnormal (B-lines) and normal TUS results (P = .39). The presence of PE and B-lines was significantly associated with overload symptoms; however, these overload symptoms were not related to optimal HD, as measured by the Kt/V or URR. PE and B-lines demonstrated a stronger association with overload symptoms than Kt/V or URR in HD patients. No relationship was found between the TUS pleuropulmonary changes and HD efficacy.