Transplantation-associated thrombotic microangiopathy (TA-TMA) is a feared complication of allogeneic hematopoietic SCT (HSCT) owing to its high mortality rate. The use of calcineurin inhibitors or sirolimus (SIR) for GVHD prophylaxis has been suggested as a potential risk factor. However, the impact of tacrolimus (TAC) and SIR combinations on the increased risk of TA-TMA is currently not well defined. We retrospectively analyzed the incidence of TA-TMA in 102 allogeneic HSCT recipients who consecutively received TAC plus SIR (TAC/SIR) (n ¼ 68) or plus MTX (TAC/MTX) ± ATG (n ¼ 34) for GVHD prophylaxis. No significant differences were observed in the incidence of TA-TMA between patients receiving TAC/SIR vs TAC/MTX ± ATG (7.4% vs 8.8%, P ¼ 0.8). Only grade III-IV acute GVHD, previous HSCT and serum levels of TAC 425 ng/mL were associated with a greater risk of TA-TMA. Patients developing TA-TMA have significantly poorer survival (Po0.001); however, TA-TMA ceased to be an independent prognostic factor when it was included in a multivariate model. In conclusion, the combination of TAC/SIR does not appear to pose a higher risk of TA-TMA. By contrast, we identified three different risk groups for developing TA-TMA.

No abstract

The management of relapsed or refractory Hodgkin's lymphoma (RR-HL) remains a challenge for hematologists and oncologists. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for RR-HL. However, one of the most controversial aspects is which the best salvage protocol could be. We retrospectively analyzed 82 consecutive RR-HL who received etoposide, steroids, ara-C, and cisplatin (ESHAP) as salvage therapy followed by ASCT. Fifty percent of patients were refractory and 23 % early relapses. Overall response rate (ORR) was 67 % (50 % complete remission (CR)). Ninety one percent of patients (75/82) were transplanted. With a mean follow-up of 87 ± 53 months, the median progression-free survival (PFS) and time to tumor progression (TTP) for the whole population were 52 and 56 months, respectively, and the 5-year overall survival was 72.6 %. Achieving CR after ESHAP was associated with a longer PFS (78 vs 16 % 5-year PFS, respectively, P < 0.01) and TTP (80 vs 19 % 5-year TTP, respectively, P < 0.01). However, there were no differences for overall survival (OS) when comparing CR and partial response (PR) after ESHAP. Toxicity was low and <10 % of patients developed neutropenic fever, with no toxic deaths. Mobilization was possible in 94 % of patients. ESHAP is a safe and efficient therapeutic option for patients with RR-HL who are candidates for ASCT, since it combines a high response rate and mobilizing potential with a low toxicity profile.

No abstract

Keywordsbone marrow, fever of unknown origin, diagnostic. Correspondence AbstractBone marrow (BM) examination is included in the diagnostic algorithm of fever of unknown origin (FUO), although its role is not clearly determined. The purpose of this study was to assess the role of BM studies in patients with FUO. We retrospectively reviewed 45 consecutive patients (25% human immunodeficiency virus-positive) with FUO who underwent a BM study in the University Hospital of Salamanca from 2000 to 2010. We analysed the diagnostic role of BM smears, multiparameter flow cytometry analysis, histology and microbiological cultures. Five patients (11%) were finally diagnosed by BM study (three had an infectious disease and two were found to have haematological malignancies), all of whom were immunocompetent patients. Histology was the most useful study (diagnosis was obtained in 4/5 patients), while BM cultures did not establish the final diagnosis in any patient. Flow cytometry established the diagnosis in one patient, although this patient was also diagnosed by histology.In conclusion, BM study is useful for establishing the aetiology of FUO. BM biopsy for histological examination should be always mandatory if a BM examination is performed.Fever of unknown origin (FUO) is defined as a temperature higher than 38.3°C determined on several occasions over 3 weeks duration, without an established diagnosis after at least 1 week of investigations in the hospital. 1 In addition to this definition, three new categories have been proposed: human immunodeficiency virus (HIV)-associated FUO, neutropenic FUO (neutrophils <500/ mm 3 ) and nosocomial FUO (3 days of fever without a diagnosis after 3 days of investigations). 2 In patients with prolonged fever, initial studies should be performed and have proved unrevealing prior to concluding that a patient has an FUO. Subsequently, specific studies should then be performed. Among these studies, bone marrow (BM) aspirate biopsy is one of the most frequently requested tests. Results of the very few studies published in this regard have shown a very low diagnostic yield for BM cultures and BM smear, and higher for BM biopsy. 3-5 However, the role of BM study is not clearly defined. Moreover, analysis of the BM studies associated with the highest diagnostic efficiency has not been well analysed.To shed further light on this matter, we performed a retrospective analysis to determine the role of different BM studies in patients with FUO. In addition, we aimed to identify clinical features predictive of a higher diagnostic yield.We retrospectively analysed 45 consecutive patients with FUO who underwent a BM study between January 2000 and December 2010 in the University Hospital of Salamanca. All patients fulfilling the diagnostic criteria of FUO, HIV-associated FUO, neutropenic FUO or nosocomial FUO as previously described were included. 1,2 Patients underwent the following tests prior to being considered eligible for the study: past medical history and physical examination, complete blood coun...