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Treatment of autoimmune cytopenias remains unsatisfactory for patients refractory to first-line management. We evaluated the safety and efficacy of low-dose rituximab plus alemtuzumab in patients with steroidrefractory autoimmune hemolytic anemia and immune thrombocytopenic purpura. Nineteen of 21 included patients were assessable for response (11 with immune thrombocytopenic purpura, 8 with autoimmune hemolytic anemia). Treatment with 10 mg of alemtuzumab subcutaneously on days 1 to 3, plus 100 mg of rituximab intravenously weekly in 4 doses, was administered. The overall response rate was 100%, with complete response in 58%. IntroductionAutoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP) are characterized by antibody-mediated destruction of red blood cells and platelets; as in other autoimmune disorders, B and T lymphocytes have important roles in their pathogenesis. 1 Corticosteroids are the standard initial treatment, with a 60% response rate. Patients unresponsive to corticosteroids usually experience a complicated course and show increased morbidity and mortality rates. Splenectomy and a large number of drugs have been used as second-line therapies with variable success, without evidence that any single agent is more effective than another. 2 Rituximab effectively depletes B cells involved in the production of antibodies and has been studied as a second-line treatment for ITP at full 3-10 and low doses 11,12 ; its use in ITP has led to a median overall response rate of approximately 60%. 7,9 Alemtuzumab, a humanized IgG monoclonal antibody specific for the CD52 antigen, expressed on lymphocytes, has been used in the treatment of lymphoproliferative disorders and recently for autoimmune diseases. 13,14 Preliminary results indicate that alemtuzumab may induce responses in patients with autoimmune cytopenias. [15][16][17][18] We evaluated the safety and efficacy of low-dose rituximab plus alemtuzumab in combination therapy in patients with steroidrefractory AIHA and ITP. The rationale for combining the 2 monoclonal antibodies was their reported single-agent activity, and the possibility of a synergistic effect, based on the fact that T lymphocytes are involved in the control of expansion of immunoglobulinproducing, autoreactive B-lymphocyte clones. MethodsApproval for the study was obtained from the Ethics Committee of the School of Medicine and University Hospital of the Universidad Autónoma de Nuevo León. Eligible patients were adults with active symptomatic ITP or AIHA, who had previously received treatment with at least one line of therapy, or followed a chronic relapsing course, and who provided written informed consent. Patients were excluded if they had active bacterial or viral infection, HIV, hepatitis C virus, cytomegalovirus immunoglobulin M (CMV-IgM)-positive serology, hepatitis B surface antigen positivity, pregnancy, or concomitant malignant disease. Pretreatment assessment included complete blood, reticulocyte, lymphocyte subset counts, serum immunoglobulins, direct an...

The objective of the study was to evaluate the current standard practice of using volume and total nucleated cell (TNC) count for the selection of cord blood (CB) units for cryopreservation and further transplantation. Data on 794 CB units whose CD34+ cell content was determined by flow cytometry were analyzed by using a receiver operating characteristic (ROC) curve model to validate the performance of volume and TNC count for the selection of CB units with grafting purposes. The TNC count was the best parameter to identify CB units having 2 × 10(6) or more CD34+ cells, with an area under the ROC curve of 0.828 (95% confidence interval, 0.800-0.856; P < .01) and an efficiency of 75.4%. Combination of parameters (TNC/mononuclear cells [MNCs], efficiency 74.7%; TNC/volume, efficiency 68.9%; and volume/MNCs, efficiency 68.3%) did not lead to improvement in CB selection. All CB units having a TNC count of 8 × 10(8) or more had the required CD34+ cell dose for patients weighing 10 kg or less.

Background and Objective. Hematopoietic stem cell transplantation (HSCT) in developing countries is cost-limited. Our primary goal was to determine the cost structure for the HSCT program model developed over the last decade at our public university hospital and to assess its clinical outcomes. Materials and Methods. Adults and children receiving an allogeneic hematopoietic stem cell transplant from January 2010 to February 2011 at our hematology regional reference center were included. Laboratory tests, medical procedures, chemotherapy drugs, other drugs, and hospitalization costs were scrutinized to calculate the total cost for each patient and the median cost for the procedure. Data regarding clinical evolution were incorporated into the analysis. Physician fees are not charged at the institution and therefore were not included.

BackgroundHeterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia.MethodsThe patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented.ResultsThe records of 203 children aged 0–15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450–600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4–15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000–544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%.ConclusionData differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.