Key Points
Practices in early-stage FL are variable and include radiation alone, systemic therapy, CMT, or observation. Each practice resulted in similar excellent outcomes; randomized trials are required to determine the optimal treatment.
This case illustrates a 36-year-old man who presented with a factor VIII (FVIII) inhibitor (acquired haemophilia A) with cutaneous bleeding and a significant thigh haematoma. No traditional risk factors for the development of a FVIII inhibitor were identified. However, previous treatment with alemtuzumab for multiple sclerosis was noted in the patient’s history. Alemtuzumab is an anti-CD52 monoclonal antibody and is known to be associated with the development of a number of autoimmune conditions, with a delay in onset of these conditions as long as 5 years after the cessation of treatment. To our knowledge, there have only been three previously documented cases of a FVIII inhibitor in the setting of alemtuzumab therapy. This case adds further evidence to the current body of literature suggesting alemtuzumab as a causative agent for the development of an FVIII inhibitor.
Background
The Townsville Hospital is a tertiary hospital in North Queensland with one of the largest regional transplant centres in Australia, performing primarily autologous haemopoietic stem cell transplants (HSCT) for various haematological malignancies.
Aims
This single‐centre, retrospective, observational study aims to describe the activity and outcomes of autologous HSCT at The Townsville Hospital between 2003 and 2017 to verify safety standards.
Methods
Patient‐level data were collected, including demographics, frequency and indication for transplant, conditioning, current clinical status and cause of death. Key outcomes included overall survival, non‐relapse mortality, incidence of therapy‐related neoplasm and causes of death. Progression‐free survival in the multiple myeloma (MM) subgroup was also assessed.
Results
There were 319 autologous HSCT in 286 patients, with a median age of 58 years (range 14–71 years); 62% of patients were male. Indications for transplantation were: MM 53.7%, non‐Hodgkin lymphoma 29.4%, Hodgkin lymphoma 5.0% and other 11.9%. Causes of death were: disease progression/relapse (65.2%), second malignancy (17.0%), infection (9.8%) and other (8.0%). Non‐relapse mortality was 1.2% (95% confidence interval 0.4–3.0) and 3.2% (1.7–5.7) at 100 days and 1 year, respectively, post‐HSCT. Overall survival at 2 years was 81.0% (73.8–86.4) for MM and 69.6% (58.8–78.1) for non‐Hodgkin lymphoma. The median progression‐free survival in the MM cohort was 3.3 years.
Conclusion
The Townsville Hospital transplant centre provides an important transplant service in regional Queensland, with outcomes comparable to national data. We reported a relatively high rate of second malignancy as a cause of death.
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