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Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLA-haploidentical HSCT. The use of PTCY in the unrelated donor HSCT setting is less explored. We conducted a retrospective study of 132 consecutive patients undergoing a matched or 9/10 mismatched unrelated donor HSCT in 4 centers in Spain, 60 with anti-thymocyte globulin (ATG)-based prophylaxis combined with MTX-CsA, and 72 using a PTCY-based regimen. Peripheral blood stem cells were used as graft in most patients (111 patients, 84%); mMUD donors were balanced between groups. Cumulative incidences of grades II-IV and III-IV acute GVHD at 100 days were lower in the PTCy group (46% vs. 67%, p = 0.008; 3% vs. 34%, p = 0.003), without statistically significant differences in the 2-year cumulative incidence of chronic moderate-severe GVHD. At 2 years, no significant differences were observed in overall survival, event-free survival, cumulative incidence of relapse, and non-relapse mortality. GVHD was the most frequent cause of NRM in the ATG group. No differences were observed between groups in the composite endpoint of GVHD-free and relapse-free survival. In this study, PTCy combined with additional immunosuppression after MUD/mMUD HSCT showed a reduction of aGVHD rate with safety results comparable to those obtained with the ATG-based prophylaxis.

Background: In community-acquired pneumonia host inflammatory response against the causative microorganism is necessary for infection resolution. However an excessive response can have deleterious effects. In addition to antimicrobial effects, macrolide antibiotics are known to possess immunomodulatory properties. We aimed to evaluate inflammatory cytokine profiles - both locally (bronchoalveolar lavage) and systemically (blood) - in community-acquired pneumonia admitted patients after at least 72 hours of antibiotic treatment (with and without macrolide containing regimens) and requiring bronchoscopic examination for inadequate response due to infection progression and/or lack of clinical stability. Methods: A prospective study was performed on 52 admitted patients who developed an inadequate response after 72 hours of antibiotic treatment -non-responders community-acquired pneumonia - (blood and bronchoalveolar lavage), and two control groups: 1) community-acquired pneumonia control (blood) and 2) non-infection control (blood and bronchoalveolar lavage). Cytokine profiles (interleukin (IL)-6, IL-8, IL-10), tumour necrosis factor a and clinical outcomes were assessed. Results: Non-responders patients treated with macrolide containing regimens showed significantly lower levels of IL-6 and TNF-alpha in bronchoalveolar lavage fluid and lower IL-8 and IL-10 in blood than those patients treated with non-macrolide regimens. Clinical outcomes showed that patients treated with macrolide regimens required fewer days to reach clinical stability (p < 0.01) and shorter hospitalization periods (p < 0.01). Conclusions: After 72 hours of antibiotic effect, patients who received macrolide containing regimens exhibited lower inflammatory cytokine levels in pulmonary and systemic compartments along with faster stabilization of infectious parameters.

Background: Malignant pleural effusion is a clinical problem that impairs Quality of Life in patients with advanced malignancies. An indwelling pleural catheter is an alternative treatment to palliate some of the symptoms. Aim: To evaluate the Quality of Life of outpatients with malignant pleural effusion who were treated with an indwelling pleural catheter. Questionnaire compliance, catheter patency time, and survival were analyzed. Design: A multicenter observational study was conducted across five hospitals in Spain. Quality of Life was assessed at three different time points (before catheter placement and at 30 and 60 days post-placement) using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire QLQ-C30. For lung cancer patients, the QLQ-LC13 was also used. Participants: Patients with recurrent malignant pleural effusion treated with an indwelling pleural catheter. Results: A total of 51 outpatients completed the baseline QLQ-C30 questionnaire. Of these, 28 completed the questionnaire at 30 days. Of these 28 patients, 13 completed the questionnaire at 60 days. Scores showed a significant improvement in symptoms scales at 30 days (p = 0.03). Global health status and functional scales showed a non-significant trend to improvement at 30 and 60 days. A total of 27 lung cancer patients completed the QLQ-LC13 questionnaire. Items assessing dyspnea showed a significant improvement following catheter placement (p = 0.002). Conclusion: Indwelling pleural catheter is useful for palliative management of recurrent malignant pleural effusion in that it benefits Quality of Life in outpatients with advanced malignancies. In lung cancer patients, scores indicated that indwelling pleural catheter also provides significant relief of dyspnea.

Pneumonia continues to be the main cause of death due to infection in the world, and it produces a high consumption of healthcare resources. The guidelines established by the scientific societies improve the care of patients with pneumonia. One way of evaluating the effect of the guidelines is to analyze their impact on the prognosis of the infection. To evaluate this effect, cohort studies have been performed using before-after, observational, cost-effectiveness, and, to a lesser degree, randomized designs. The most recent studies show that the implementation of the guidelines is accompanied by an increase in the process of care percentage and a lower inpatient hospital mortality rate- including the first 48 hours and after 30 days. These findings are consistent across various studies, and they have been confirmed in patients admitted to the intensive care unit. Clinical stability is also reached earlier in patients hospitalized for community-acquired pneumonia (CAP) when the antibiotic treatment is begun early and complies with the recommendations. Finally, the choice of antibiotics that adhere to the guidelines is cost-effective in CAP requiring hospitalization, which is responsible for 80% of the total cost of this disease.

The authors declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: T.B. has received support for attending meetings and/or travel from Jazz Pharmaceutical, honoraria from Jazz Pharmaceutical, BMS, and Pfizer. D.V. has received honoraria from Celgene/BMS, Amgen, Novartis, Jazz Pharmaceuticals, and Pfizer and support for attending meetings and/or travel from Amgen, BMS/Celgene, and Jazz. M.D.-C. reports honoraria and membership on entity's Board of directors or advisory committees from Novartis, BMS, and Takeda. Dr G.S. has received personal fees from AbbVie, Amgen, and Astellas and has received research funding from Celgene/BMS Janssen-Cilag, Novartis, Roche, and Takeda. Background: The consequences of infectious toxicity of hypomethylating agents (HMAs) on overall survival (OS) of patients diagnosed with high-risk myeloid neoplasms have not been thoroughly investigated. Objectives: We aimed to evaluate whether infectious events (IEs) negatively influenced the results of HMA treatment in a real-world setting. Design: Observational study. Methods: We obtained data from 412 non-selected consecutive patients from 23 Spanish hospitals who were diagnosed with high-risk myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia and were treated with HMA. HMAs received after chemotherapy or stem cell transplant were excluded. All IEs were recorded. Outcomes included OS, modifications to the pre-planned treatment, incidence and characteristics of IEs, hospitalization, red blood cell transfusions, and factors associated with infection. Results: The rate of infection was 1.2 per patient/year. Next-cycle delay (p = 0.001) and hospitalizations (p = 0.001) were significantly influenced by IEs. Transfusion requirements during each cycle were significantly higher after infection compared with cycles without infection (coefficient = 1.55 [95% confidence interval (CI) = 1.26-1.84], p < 0.001). The median number of cycles was lower in patients experiencing any infection during the first four cycles (5 [3-8] versu 8 [5-16], p < 0.001). In the multivariable analysis, factors associated with lower OS were having any infection during the first four cycles (hazard ratio (HR) = 1.43 [95% CI = 1.09-1.88], p = 0.01), bone marrow blasts ⩾30% (HR = 2.13 [95% CI = 1.14-3.96], p = 0.01), adverse cytogenetics (HR = 1.70 [95% CI = 1.30-2.24], p < 0.001), and platelet count 20% (HR = 1.57 [95% CI = 1.19-2.01], p < 0.001) and adverse cytogenetics (HR = 1.7 [95% CI = 1.35-2.14], p < 0.001) were associated with infection, whereas hemoglobin >9 g/dl (HR = 0.65 [95% CI = 0.51-0.82], p < 0.001) and higher platelet count (HR = 0.997 [95% CI = 0.996-0.998], p = 0.016) protected from it. Conclusion: HMA infectious toxicity worsens OS, hinders the adherence to antineoplastic treatment and results in significant morbidity. Preventive strategies are fundamental in vulnerable patients.