International Journal of Hematology-Oncology and Stem Cell Research

Evans Syndrome: Analysis of 1255 Adult Cases in US Hospitals, Revealing Demographics, Associations, and Outcomes

2025-05-05T14:53:11+0430

Background: Evans syndrome (ES) is a rare immune disorder characterized by immune thrombocytopenia and warm autoimmune hemolytic anemia (wAIHA), with the possibility of autoimmune neutropenia (AIN). Limited data due to its rarity led us to perform a descriptive analysis of demographics, outcomes, and comorbidities.

Materials and Methods: This study used the National Inpatient Sample database to identify Evans syndrome hospitalizations (ICD-10 code D69.41) from 2016 to 2019, with national estimates. We collected demographic data, examined outcomes, and assessed patient comorbidity. STATA Version 17 was used for data analysis.

Results: In our study of 1,255 ES hospitalizations, the mean age was 50.13 years, with a relatively even gender distribution. The racial breakdown included White (59.6%), Black (17.1%), and Hispanic (14.6%). Most had Medicare (41.8%), Medicaid (20.4%), or private insurance (33.5%). Charlson Comorbidity Index scores varied, with 36.6% scoring 3 or more. Non-elective admissions accounted for 90.2% of cases, coming from various U.S. Census Divisions, with East North Central (16.2%) and Pacific (16.1%) leading. Large urban teaching hospitals handled 84.1% of cases. Mortality was 5.5%, the mean stay was 7.8 days, with total charges averaging $114,696. Notable associations included SLE (15.63%), ITP (37%), and anemia (53.5%). Inpatient risks included AKI (22.47%) and sepsis (15.33%). Interventions included red blood cell transfusion (18.65%) and platelet transfusion (10.44%).

Conclusion: This study offers key insights into ES in hospitalized adults, emphasizing demographic trends and important associations with other conditions. More research is required to enhance our understanding of ES and enhance outcomes for those affected.

The Prognostic Value of C-Reactive Protein and Albumin in Newly Diagnosed Patients with AML

2025-05-05T14:53:14+0430

Background: Acute-phase reactant proteins, particularly C-reactive protein (CRP), play a critical role in the initiation, progression, and recurrence of cancers such as acute myeloid leukemia.

Materials and Methods: We retrospectively analyzed 127 newly diagnosed non-M3 acute myeloblastic leukemia (non-M3 AML) patients. We investigated pre-treatment levels of C-reactive protein (CRP), Albumin, and C-reactive protein to albumin ratio (CAR) with cytogenetics, response to induction therapy, recurrence, and overall survival.

Results: We did not find any relationship between levels of CRP, Albumin, and C-reactive protein to albumin ratio (CAR) with complete remission rate, recurrence, and risk categorization of patients (P > 0.05).

3-and 5- year overall survival was 40.8% (with a standard error of 4.7%) and 30.1% (standard error: 5.3%), respectively. In addition, 3-year and 5-year event-free survival was 31.3% (standard error = 4.4%) and 25.8% (standard error = 4.8%), respectively. The only prognostic factor was allogenic stem cell transplantation (SCT).

Conclusion: Although CRP, Albumin, and CAR serve as convenient prognostic markers, they were not predictive of overall survival (OS) and event-free survival (EFS) in AML patients. Further studies are needed in the future to confirm or refute our results.

Magnitude of Beta-Hemoglobinopathies through Biomarkers among the Selected Tribes of Dharmapuri, Tamil Nadu: A Community-Based Cross-Sectional Study

2025-05-05T14:53:17+0430

Background: Hemoglobinopathies present a growing challenge to global healthcare resources. These disorders are monogenic: caused by a single gene, and they are inherited in an autosomal recessive manner from parents to offspring. Thalassemia and Sickle Cell Disease are the primary forms of Hemoglobinopathies. India has the highest prevalence of children affected by Thalassemia globally, with a population of 1-1.5 lakh children with Thalassemia, and every year, around 10,000-15,000 babies are born with this condition. This study attempted to estimate the disease burden of Beta-Hemoglobinopathies among the selected tribes residing in Dharmapuri, Tamil Nadu, India.

Materials and Methods: This cross-sectional study includes the data from 62 study participants belonging to the tribes residing in Sitteri hills and Balajangamanahalli – a village in the plains of Nallampalli, Dharmapuri. A semi–structured questionnaire was administered to collect socio–demographic details, and 5 ml of blood was collected for hematological tests: Complete Blood Count (CBC), Peripheral Smear, and High-Performance Liquid Chromatography (HPLC).

Results: Out of the 62 study participants, 43% (n=27) were anemic. Chi-square test of association revealed significant associations between Gender and Anemia, Mentzer’s Index and Anemia, and Mentzer’s Index and HbA2. The present study has reported the disease burden of Beta-Hemoglobinopathies to be 37.1%, in which beta-thalassemia trait/minor was 24.19%, sickle cell beta-thalassemia, beta-thalassemia intermedia, beta-thalassemia major/intermedia, and sickle cell disease were 3.23% each.

Conclusion: Family screening may be conducted to clarify the inheritance patterns of the disease, and genetic counseling should be offered to at-risk couples. To confirm the prevalence of hemoglobinopathies, genetic studies are required to confirm the type of mutations that cause Hemoglobinopathies.

Return to Work in Colorectal Cancer Patients

2025-05-05T14:53:20+0430

Background: Return to work (RTW) significantly impacts the quality of life of cancer survivors and carries substantial economic and social implications. This study investigates the RTW rate among colorectal cancer patients post-surgery.
Materials and Methods: Colorectal cancer patients referred to the Mashhad University of Medical Sciences oncology clinics were enrolled based on inclusion criteria and after obtaining oral consent. Each participant completed a checklist and a questionnaire on the quality of working life for colorectal cancer patients. The checklist included age, gender, insurance type, annual income, marital status, occupation, hospitalization duration, medical history, occupational profile, health status, and disease stage. Data analysis was performed using SPSS software.
Results: A total of 57 patients were included, with 54 (94.7%) males. Forty-four patients (77.2%) returned to work in their previous or new roles. Among these, 27 (47.4%) worked full-time, 17 (29.8%) part-time, and 13 (22.8%) did not RTW. No significant relationship was found between RTW and factors such as age (p=0.116), gender (p=0.547), residence (p=0.333), insurance type (p=0.083), job type (p=0.526), history of chronic diseases (p=0.432), or cancer treatment method (p>0.999). However, significant correlations were observed between RTW and the quality of life questionnaire score (p=0.001), length of hospitalization (p=0.041), and annual income (p<0.001).
Conclusion: Approximately 77% of colorectal cancer patients returned to work following treatment. Shorter hospital stays and higher income were associated with greater RTW rates. Additionally, the quality of working life questionnaire score was strongly correlated with RTW (p=0.001).

The Effects of Released Exosomes from NK-92 Cells with IL15 on the Apoptosis of HL-60 Cell Line

2025-05-05T14:53:23+0430

Background: Most cancers are treated through chemotherapy and radiotherapy. However, these methods have limitations due to cancer cells evading immune detection, prompting researchers to explore alternatives such as immunotherapy. Nonetheless, cancer cells can weaken the immune response, necessitating improvements in immunotherapy methods. Exosomes, tiny cell-derived nanoparticles, reflect the traits of their originating cells. Natural Killer NK cells produce exosomes comprising perforin, granzyme, Fas-L, etc. The small size, proximity to tumors, and stability of these exosomes enable easy absorption by cancer cells. This study demonstrates that IL-15 impacts NK-derived exosomes, enhancing their ability to kill cancer cells.

Materials and Methods: With the addition of 100 nanograms per milliliter of IL-15 to NK-92 cell culture, the cells are incubated for 48 hours. Exosomes are then isolated from treated and non-treated NK-92 cell lines through the ultracentrifuge method. After isolation, different concentrations of exosomes from both groups are added to HL-60 cells for treatment. After 24 hours, the apoptosis rate is assessed through the Annexin-V method.

Results: Increased light absorption in the BCA test, along with thicker bands of CD63 and CD81 in the Western blotting test, indicate a higher yield of exosomes after adding IL-15 to the source cells. The low p-value from the t-test demonstrates that exosomes derived from stimulated NK cells are more cytotoxic than those from the control group. Further, two-way ANOVA confirms differences between the control and treatment groups at each concentration, and Welch’s t-test proves that all differences in the ANOVA test are significant.

Conclusion: This article presents evidence that exosomes obtained from IL-15-induced NK cells not only increase in quantity but also demonstrate significant cytotoxicity against leukemic cells compared to exosomes obtained from non-stimulated NK cells.

High GVHD Prevalence in Travel-Based SCT despite Young Patients and HLA Matching

2025-05-05T14:53:25+0430

Background: Patients from regions without stem cell transplantation (SCT) facilities often seek treatment abroad and return home for post-transplant care. Although extensive data exist on graft-versus-host disease (GVHD) and its risk factors, information on international SCT patients returning to countries that lack transplant facilities and expertise is scarce and not well documented.

Materials and Methods: We screened 149 transplant recipients and analyzed the data of 91 patients who received transplants abroad and were followed up at our center from January 2019 to December 2022. This observational study used data from electronic medical records and employed descriptive statistics, inferential tests, and relative risk calculations with forest plots to analyze the prevalence of GVDH and its key risk factors.

Results: Of the recipients, 31.8% were residents of nine countries residing in the UAE, and 67.2% were UAE citizens. Adults comprised 48.3% of the recipients, whereas 51.7% were pediatric patients. Hematological malignancy was the most common indication (49%), primarily in adults. Siblings comprised the majority of donors (52.6%), followed by related (23.09%) and unrelated donors (8.9%). Most patients (69.2%) received HLA-identical transplants, followed by 21.9% who received haplo-identical transplants. Among adults, 62.2% developed GVHD compared to 26% of pediatric patients. Recipients from related HLA-identical donors had a 50% prevalence of GVDH, whereas those from unrelated identical donors had a 71% prevalence. The overall prevalence of GVDH was 50% in 87.9% of patients who received allogeneic SCTs.

Conclusion: Despite favorable factors, such as young age and matched related donors, we found a high prevalence of GVDH. Ocular GVHD was less prevalent than expected, and lung GVHD was weakly correlated with established risk factors. Larger multicenter studies are needed to assess and confirm the effect of contributing factors.

ESHAP versus IEV Chemotherapy for Relapsed or Refractory Hodgkin's and Non- Hodgkin's Lymphoma

2025-05-05T14:53:28+0430

Background: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard treatment for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) in cases of relapsed or refractory disease. Various salvage chemotherapy regimens have been introduced with specific response rates, toxicity profiles, costs, and stem cell damage before stem cell harvest. The optimal salvage regimen for these patients is unclear.

Materials and Methods: In this retrospective analysis, 276 patients with HL and NHL with relapsed or refractory disease after initial treatment that received ESHAP (etoposide, methylprednisolone, cytosine arabinoside, and platinum) or IEV (ifosfamide, epirubicin, etoposide) as salvage regimen were included. We aimed to compare the efficacy of these two chemotherapy regimens as a life-saving treatment in recurrent or refractory disease.

Results: The mean age of patients was 33.96 ± 12.39 years. Hodgkin's lymphoma accounted for 60.1% and non-Hodgkin lymphoma (DLBCL) accounted for 39.9% of patients. The overall response rate (ORR) was 79.8% (50% complete response (CR)) for patients with Hodgkin lymphoma who received the ESHAP and 85.6% (55.1% CR) for the IEV regimen. Patients with non-Hodgkin's lymphoma who received the ESHAP plus rituximab regimen had an ORR of 60.9% (CR 40.3%), and patients who received the IEV + Rituximab chemotherapy regimen had an ORR of 72.4% (CR 42.4%) (P = 0.03). However, the mortality rate was lower in patients who received the IEV chemotherapy regimen.

Conclusion: IEV treatment is superior to ESHAP in patients with recurrent or refractory Hodgkin's and non-Hodgkin's lymphoma.

The Relationship between the Number of Stem Cells and the Concentration of Stromal Cell-Derived Factor-1 with Disease Severity in Patients with Liver Cirrhosis

2025-05-05T14:53:32+0430

Background: The chemokine stromal cell-derived factor 1 (SDF-1) is important in tissue repair. In this study, we aimed to investigate the relationship between the number of stem cells in the blood and the blood concentration of stromal cell-derived factor 1 with disease severity in cirrhotic patients.

Materials and Methods: In this study, 15 patients with cirrhosis and 15 healthy individuals aged 18 to 65 were randomly selected between January 2016 and July 2017. The number of circulating stem cells and SDF-1 levels were compared in the patient and healthy control groups. The correlation between circulating stem cells (CSC) and SDF-1 concentration with disease severity was evaluated.

Results: 33% of cirrhotic patients were classified as severity B and 67% as severity C by the Child-Pugh method. The percentage of stem cells and mean SDF-1 concentration in patients with cirrhosis was approximately 2.8 (p < 0.01) and 1.81 (P < 0.01) times higher than healthy individuals, respectively. Patients with a more severe form of the disease had significantly higher concentrations of SDF-1 in peripheral blood than patients with a milder form (p=0.04).

Conclusion: The percentage of stem cells and the concentration of SDF-1 in the serum of cirrhotic patients were significantly higher compared with the control group. In addition, there was no significant relationship between the percentage of circulating stem cells and the severity of the disease, whereas a direct relationship between the severity of the disease and the concentration of SDF-1 was observed.

Ex-vivo Expansion of Cord Blood Hematopoietic Stem Cells in Serum-Free Medium with Feeder Layer - A New Hope for Successful Cord Blood Transplantation in Adults

2025-05-05T14:53:35+0430

Background: Umbilical cord blood is widely regarded as a viable option for allogeneic hematopoietic stem cell transplantation (HSCT) and serves as a potential alternative to bone marrow due to its numerous advantages. These include a non-invasive collection process, a high concentration of hematopoietic stem and progenitor cells, and a lower risk of graft rejection. However, its application in adult patients is limited by the suboptimal dose of stem cells available in a single umbilical cord blood unit. This insufficient cell dose increases the risk of engraftment failure and post-transplant mortality, posing a significant challenge for its use in adult populations.

Materials and Methods: This study aims to develop a protocol for expanding umbilical cord blood mononuclear cells (UCB-MNCs) using a serum-free culture medium called StemSpan, supplemented with a mesenchymal stem cell (MSC) feeder layer and a combination of growth factors. The growth factors used include stem cell factor (SCF), thrombopoietin (TPO), fibroblast growth factor-1 (FGF-1), and heparin. The expansion culture was applied to 20 UCB samples and maintained over a period of 13 days. Data collected from the experiments were analyzed using the SPSS program (Statistical Package for the Social Sciences) for Windows, version 21.

Results: The protocol led to a notable increase in the viable mononuclear cell counts, the absolute hematopoietic stem and progenitor cell counts, and the clonogenic progenitors.

Conclusion: This designed protocol could support the expansion of the umbilical cord blood mononuclear cells, including hematopoietic stem and progenitor cells, which could provide hope for better engraftment in adult patient transplantations. The designed protocol could effectively promote the expansion of umbilical cord blood mononuclear cells, particularly hematopoietic stem and progenitor cells. This advancement offers promising potential for improving engraftment outcomes in adult patient transplantations.

Living Medicines Engineered to Fight: A Comprehensive Review on CAR T-Cell Therapy

2025-05-05T14:53:39+0430

The plethora of advancements in cancer treatment has resulted in designing unique signatures and personalized therapies, tailored to patient-specific needs, using medications that target specific markers on cancer cells or even retrain the body's immune system. Chimeric Antigen Receptor T-cell, also called as CAR T-cell, is one such approach wherein a patient's cells are modulated to kill the cancer cells. Conventional cancer treatments invite issues like low specificity, increased chances of relapse, or issues with radiotoxicity and tolerance in the case of chemotherapy. Currently, CAR T-cell therapy is under clinical investigation, and different countries are still coming up with their guidelines for the pragmatic application of CAR T. In this review, we present all one needs to know about CAR T-cell therapy, its types, components, side effects, current authorization status in different countries, along with the technology being used in the therapy. We also briefly upon the recent regulations or guidelines released by Europe and the USA, the countries that have actively initiated the CAR T idea. This review aims to provide insight into this targeted therapy, which has the potential to boost cancer research and to help researchers develop more such patient-specific treatments to improve clinical outcomes in cancer.

Oral Hairy Leukoplakia: A Rare Involvement in a Patient with Polycythemia Vera

2025-05-05T14:53:42+0430

Although there have been some reports of oral hairy leukoplakia (OHL) in patients with hematologic neoplasms, to the best of our knowledge, this study is the first to report this lesion affecting a patient with polycythemia vera. A 54-year-old male patient diagnosed with polycythemia vera presented with non-removable white patches with a rough surface on the bilateral border of the tongue. According to clinical, histopathological, and in situ hybridization features, OHL was established. Two months after diagnosis, the patient developed splenomegaly and initiated ruxolitinib. Bone marrow biopsy showed post-polycythemia vera myelofibrosis. The patient underwent allogeneic haploidentical hematopoietic stem-cell transplant, achieving complete remission of the oral lesion. OHL is an important marker of immunosuppression. In the present case, OHL was diagnosed during the progression of polycythemia vera to myelofibrosis, and its early diagnosis may have contributed to a better clinical outcome.

Durable Remission after Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) for Refractory Mycosis Fungoides: A Case Report

2025-05-05T14:53:45+0430

Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL) and is characterized by a heterogeneous clinical course and variant stage involvement. Indolent disease is usually observed in its early stages. However, the treatment options for patients with advanced MF are limited and have poor outcomes. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential curative treatment for refractory cases. Here, we describe the case of a 34-year-old man who was diagnosed with MF at an advanced stage. Eight months before allo-HSCT, the patient received six courses of polychemotherapy based on cyclophosphamide, doxorubicin, vincristine, and prednisolone, which were administered every three weeks. A partial response was obtained.

He underwent allo-HSCT after a myeloablative conditioning regimen and remained in complete remission (CR) for 26 months posttransplantation. Our findings confirm that allo-HSCT can be a curative option for refractory MF.