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A letter to the editor is presented in response to the article related to prognosis of acute myeloid leukemia (AML) patients and allogeneic hematopoietic stem cell transplantation (HSCT) in the July 30, 2013 issue.

Summary:Antithymocyte globulin (ATG) treatment prevents graft failure and results in a low incidence of GVHD, but an increased risk of relapse could be expected as a consequence of reduced GVHD. From September 1995 to June 2001, 28 consecutive chronic myeloid leukemia (CML) patients underwent unrelated bone marrow transplants: 21 were in chronic phase (CP) and seven in advanced phase (AP). Median age was 35.5 years (range 20-50). HLA typing was based on high-resolution molecular techniques; in eight cases there were one or more allele mismatches. The preparative regimen consisted of TBI, EDX 120?mg/kg and rabbit ATG 15?mg/kg. All patients engrafted and no rejection occurred. Acute GVHD grade III-IV occurred in six patients (21%). Chronic GVHD occurred in 10 (40%) and it was extensive in one. Four out of seven patients transplanted in AP had a hematological relapse. Of 21 in CP, there was one cytogenetic and one molecular relapse: these two patients are now in complete remission with imatinib mesylate. With a median follow-up of 45.7 months, the 5-year survival is 76.2% for those transplanted in CP. These data demonstrate that transplants performed in CP, with low-dose ATG, are associated with a good outcome, low incidence of GVHD and no increase of relapse.Bone Marrow Transplantation (2003) 32, 237-242. doi:10.1038/sj.bmt.1704138 [ABSTRACT FROM AUTHOR]

Presents information on a study which evaluated whether BDCA-2 expression on TH2-inducing dendritic cells (DC2) is impaired in patients undergoing an allogeneic hematopoietic stem cell transplantation and in healthy donors treated with G-CSF for HSC mobilization. Insight on dendritic cell blood precursors; Materials and methodology of the study; Results and discussion.

In this study we compared the lymphocyte reconstitution in 13 multiple myeloma (MM), nine acute myeloid leukemia (AML) and 10 chronic myeloid leukemia (CML) patients after allogeneic G-CSF-mobilized PBSC transplantation from HLA-identical siblings. Conditioning regimens included standard total body irradiation + cyclophosphamide (CY), or busulphan + CY, whereas VP-16 was added in patients with advanced disease. Overall comparable numbers of mononuclear cells, CD34+ cells and CD3+ T cells were infused in each group. A significantly higher CD3+ T cell number was observed in MM and AML than in CML patients 1 month after transplant. However, MM patients showed a faster and better recovery of CD4+ T cells than both AML and CML patients at 3 months (P = 0.01 and P = 0.01, respectively) and 12 months (P = 0.01 vs AML, while P = NS vs cml) after transplant, and had a cd4:cd8 ratio >1 with a median CD4+ t cell value >400/μl 1 year after transplant. development of acute graft-versus-host disease (gvhd) did not affect cd4:cd8 ratios but patients who experienced acute gvhd >grade I had lower CD4+ and CD8+ t cell numbers at all time points. however, after excluding patients with gvhd >grade I, MM patients still showed a significantly higher CD4+ T cell value than patients with myeloproliferative diseases 1 year after transplant. These findings suggest that although allogeneic PBSC transplantation induces rapid immune reconstitution, different kinetics may occur among patients with hematological malignancies. In particular, the rapid reconstitution of CD4+ T cells in MM patients may contribute to the low transplant-related mortality achieved in this disease. Bone Marrow Transplantation (2000) 26, 1325–1331. [ABSTRACT FROM AUTHOR]

The article focuses on a study concerning successful treatment of severe hemorrhagic cystitis (HC) with selective vesical artery embolization. Severe HC can sometimes be life-threatening after stem cell transplantation. Late-onset HC persists as a severe complication. Possible risk factors include grade II-IV acute graft-versus-host disease, use of busulfan and/or total-body irradiation in the conditioning regimen, older age at transplant and certain viruses which can reactivate in immune deficiency conditions. Medical management of severe HC is based on hyperhydration, bladder irrigation and transfusional support, and is frequently ineffective.