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Abstract Background Parenteral nutrition is a critical therapeutic approach for patients undergoing hematopoietic stem cell transplantation. However, parenteral nutrition is associated with complications such as mineral disorders. This study evaluated the prevalence of hypophosphatemia, hypokalemia, and hypomagnesemia in adult transplant patients before and within the first 24 days of parenteral nutrition infusion. Patients and Methods This retrospective cohort study included patients who underwent hematopoietic stem cell transplantation and required parenteral nutrition at a public quaternary hospital in Brazil between January 2012 and January 2022. Patients were categorized based on indications for parenteral nutrition and specific diagnoses. Laboratory monitoring of phosphorus, potassium, and magnesium levels was performed at predefined intervals during parenteral nutrition infusion, starting at 72 h and during subsequent 4-day intervals until engraftment. Hypophosphatemia, hypokalemia, and hypomagnesemia were defined as levels below established reference values. Descriptive analyses were applied, and the chi-square test, crude odds ratios, and Fisher's exact test were used to compare categorical variables between the periods. Results The study revealed varying prevalences of hypophosphatemia (21.1–40.3 %), hypokalemia (10.5–31.2 %), and hypomagnesemia (50.0–62.3 %) among the 77 patients included in the study. Severe mineral disorders were observed in only a small proportion of patients. Conclusion Patients undergoing hematopoietic stem cell transplantation had a high prevalence of mineral depletion throughout the engraftment period.

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Abstract Introduction Philadelphia-negative myeloproliferative neoplasms are clonal blood disorders characterized by abnormal blood cell production. This study explores the clinical and epidemiological profiles of 111 Ecuadorian patients diagnosed with Philadelphia-negative myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia, and primary myelofibrosis, between 2014 and 2023. Methods Patients were treated in different institutions, with clinical data collected on disease progression, complications, and survival. Results Polycythemia vera was the most common subtype (45.9%), followed by essential thrombocythemia (42.3%) and primary myelofibrosis (9%). The JAK2 V617F mutation was most prevalent in essential thrombocythemia (53.2%) and polycythemia vera (41.2%). Hydroxyurea, the most widely used treatment, was prescribed to 77% of the patients. Disease progression to myelofibrosis occurred in three polycythemia vera and two essential thrombocythemia cases, meanwhile One case of primary myelofibrosis and one case of myeloproliferative neoplasm, unclassified, progressed to acute myeloid leukemia. Survival rates varied across the cohort; notably, certain patients with polycythemia vera and essential thrombocythemia achieved survival durations of up to 19 years. Conclusion These results reveal a relatively homogeneous epidemiological profile across the Latin American region and underscore the need for more multicenter studies to better characterize pH– MPNs in Ecuador and the region, to optimize diagnostic and treatment strategies.

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Abstract Background For eligible patients with mantle cell lymphoma who respond to induction therapy, first-line consolidation with autologous hematopoietic progenitor cell transplantation remains a standard treatment. However, outcomes for these patients in Argentina have not been fully characterized. This paper aims to describe the factors linked to improved survival of patients with mantle cell lymphoma after transplantation in Argentina. In addition, the association between relapse within the first 24 months after transplant and overall survival was evaluated. Methods A retrospective, multicenter study was carried out. Patients over 18 years of age with a diagnosis of mantle cell lymphoma who received autologous hematopoietic progenitor cell transplantation from 2007–2023 at centers affiliated with the Argentine Group for Bone Marrow Transplantation and Cellular Therapy (GATMO-TC) were included. For the survival analysis, a landmark approach was utilized: overall survival was calculated from the date of progression for the group that relapsed within 24 months, and from the 24-month post-transplantation landmark for those who did not. Results One hundred and sixty-six patients from nine Argentine centers were included, 128 of whom were men (77%). The median age at transplantation was 58 years. Eighteen (11%) had blastoid morphology. The pretransplant status was complete response in 145 (87%) patients. With a median follow-up of 38.4 months, the median overall survival and progression-free survival were 102 and 48.8 months, respectively. In the multivariate analysis, the blastoid variant, an age ≥55 years, and a transplant comorbidity index ≥2 were independent predictors of survival. Conclusions >70% achieved prolonged survival. Blastoid morphology, age older than 55 years, and comorbidities diminished outcomes after transplantation.

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Abstract Objective To evaluate immunoglobulin G antibody responses against Severe Acute Respiratory Syndrome Coronavirus 2 in multiple myeloma patients in the northeastern region of Mexico following different COVID-19 vaccination regimens. Methods This retrospective study included 33 multiple myeloma patients, and 28 healthy controls vaccinated with mRNA (BNT162b2, mRNA-1273) or adenovector (AZD1222) vaccines. Anti-spike receptor-binding domain (RBD) and anti-nucleocapsid immunoglobulin G levels were measured. Laboratory parameters, including monocyte and lymphocyte counts and serum-free light chains, were analyzed. Statistical comparisons used ANOVA, Kruskal-Wallis, and logistic regression. Results No significant differences in anti-spike receptor-binding domain immunoglobulin G levels were observed between multiple myeloma patients and healthy controls after one vaccine dose. Multiple myeloma patients who received ≥3 doses showed higher anti-spike receptor-binding domain immunoglobulin G levels compared to single-dose recipients. Anti-nucleocapsid antibodies (indicative of prior subclinical infection) were detected in 51.5% of multiple myeloma patients and correlated with elevated anti-spike receptor-binding domain levels. Patients in the third anti-spike immunoglobulin G quartile (10,427.9–23,954.0 AU/mL) had higher monocyte counts compared with patients in the lower quartiles. No correlations were found between anti-spike immunoglobulin G and lymphocyte counts, serum proteins, or gamma globulins. Abnormal kappa/lambda light chain ratios did not impair antibody responses in nucleocapsid-positive patients. Conclusion Multiple myeloma patients achieved comparable immunoglobulin G responses to healthy controls after one vaccine dose, with enhanced responses following ≥3 doses. Subclinical infections may augment humoral immunity. Elevated monocyte counts are indicative of innate immune activation following the administration of the vaccine. These findings support prioritizing booster doses for multiple myeloma patients despite immunosuppressive therapies.

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Abstract Asciminib represents a significant advancement in the treatment of chronic myeloid leukemia, establishing a novel therapeutic paradigm by specifically targeting the ABL1 myristoyl pocket, a mechanism distinct from that of conventional adenosine triphosphate-competitive inhibitors. Such a selective inhibitor offers an alternative treatment strategy for patients with chronic myeloid leukemia who have developed resistance to previous tyrosine kinase inhibitor therapies. Although asciminib demonstrates a superior safety profile, primarily characterized by a reduction in cardiovascular adverse events associated with prior tyrosine kinase inhibitors, its clinical significance extends further. The effectiveness of asciminib, combined with its capacity to overcome resistance through combination strategies with adenosine triphosphate-binding site tyrosine kinase inhibitors, establishes it as a focal point in emerging chronic myeloid leukemia treatment approaches. It remains essential to continue research and clinical trials to enhance the therapeutic efficacy of asciminib and manage its associated side effects.

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Abstract Anti-Kpa is an irregular antibody of clinical significance directed against the red blood cell antigen Kpa of the Kell system. It is rare in the general population and, therefore, uncommon as a cause of transfusion or hemolytic complications. It has been documented in isolated cases, mainly in the context of alloimmunization after transfusion exposure or during pregnancy; its incidence in clinical practice is limited and can be difficult to detect in routine pre-transfusion testing, which could lead to failure to identify the antibody prior to transfusion. The production of Anti-Kpa antibodies is less common than antibodies against other Kell system antigens, such as anti-K. However, when generated, these antibodies can mediate hemolytic reactions in patients receiving incompatible blood and can cause hemolytic disease in the fetus since in addition to immune destruction of red blood cells, Kell system antibodies such as Anti-Kpa can cause suppression of fetal erythropoiesis, resulting in severe anemia.

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Abstract Background Autoimmune hemolytic anemia is a rare disorder characterized by the autoimmune-mediated destruction of red blood cells. The condition is classified into subtypes based on the thermal reactivity of the autoantibodies, with warm autoimmune hemolytic anemia representing the most common form in adults. This review aimed to summarize the clinical evidence regarding warm autoimmune hemolytic anemia generated in adult patients within the Latin American region. Methods A literature search was conducted in Embase, Medline, Lilacs, Cochrane Library, Epistemonikos, and Value in Health in April 2023. Gray literature was also consulted. Records were eligible for inclusion if they presented data on the epidemiology, diagnosis, treatment, or healthcare resource utilization among adult warm autoimmune hemolytic anemia patients in Latin American countries. Clinical practice guidelines on the condition issued in Latin American were also eligible. Results Nine records were included: seven retrospective studies (six single-center), one national clinical guidelines (Mexico), and one therapeutic protocol (Brazil). Corticosteroids are the cornerstone of first-line treatment, reported in 97.7 % of 354 patients enrolled in the studies, primarily as monotherapy (91 %). While response rates were high (69–84 %), a considerable proportion of patients (15–40 %) required second-line therapies. The use of splenectomy varied widely between studies, from being the preferred second-line option to not being performed in any patient. Access barriers contribute to a limited use of rituximab. Conclusion Compared to other hemolytic disorders, warm autoimmune hemolytic anemia studies are lacking in Latin American and consist primarily of single-center, retrospective case series. Further research is warranted to understand management strategies in refractory disease.

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Abstract Intravenous iron formulations differ in benefits and risks that evolve across clinically relevant timepoints. A comprehensive network meta-analysis of randomized trials compared different intravenous iron formulations with oral iron and with each other. In addition to overall estimates, results are presented by predefined timepoints (4, 8, 12 and 24 weeks) for hemoglobin, ferritin, transferrin saturation, serious adverse events, and hypophosphatemia. Over 4-8 weeks, ferric carboxymaltose more consistently increased iron stores (ferritin/transferrin saturation) compared with the alternatives at the cost of a higher risk of hypophosphatemia. In 12-24 weeks, differences in iron stores attenuated and safety considerations became the main driver of choice, with ferric derisomaltose and iron sucrose generally favored when mineral safety is prioritized (e.g., for chronic kidney disease and inflammatory bowel disease). Effects on hemoglobin were broadly comparable between ferric carboxymaltose and ferric derisomaltose across most timepoints. These findings support conditional, scenario-specific decisions rather than a single ‘best’ formulation: ferric carboxymaltose when rapid repletion is critical and monitoring for hypophosphatemia is feasible; ferric derisomaltose and iron sucrose when safety predominates, or longer-term maintenance is planned. This windowed presentation facilitates pragmatic evidence translation for clinical decision-making while maintaining transparency through standard network meta-analysis diagnostics and certainty assessments.

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Abstract Palliative care is, according to the World Health Organization (WHO), “a global ethical responsibility” and crucial to person-centered healthcare, for the relief of physical and psychological symptoms and social and spiritual suffering, impacting the improvement of the quality of life not only of pediatric and adult patients dealing with life-threatening illnesses, but also of their families. Despite the growing recognition of palliative care in the hematological setting and the increase in the number of publications on the subject, the available data are still scarce and limited. The objective of this consensus is to establish recommendations for the referral of pediatric and adult hematological patients to specialized palliative care teams and the possible integration of these two specialties.