ABSTRACT Introduction: Granulocyte colony-stimulating factor (G-CSF) is the most prevalently used growth factor for peripheral blood hematopoietic stem cell (HSC) mobilization. Most centers split the granulocyte colony-stimulating factor in two daily doses, whereas some centers administer one dose per day. This study aims to investigate the effect of the filgrastim dosing schedule on the quantity of hematopoietic stem cells collected after mobilization in healthy donors. Methods: A total of 251 healthy donors mobilized in our center were included in the study. Mobilization was either once a day (filgrastim 1 x 10 mg/kg/day) or twice a day (filgrastim 2 × 5 mg/kg/day). Results: White blood cell and peripheral CD34+ cell numbers were significantly higher in the Twice-a-day Group on the fifth day compared to the Once-a-day Group. No statistically significant difference was shown between the two groups regarding the number of CD34+ cells collected on the first apheresis day or the number of apheresis procedures needed to achieve the targeted number ofCD34+ cells. Conclusion: This study revealed that one daily dose of 10 mg/kg filgrastim is as effective as administering the same dose split on two days for an adequate amount of CD34+ cells in healthy donors.

ABSTRACT Objective: To elucidate the molecular basis, hematological features, and electrophoretic and chromatographic mobility behavior of an unstable α2-globin chain variant, and to describe the diagnostic approach. Methods: A Thai patient with unexplained chronic anemia and her daughter were investigated. Hematological data were analyzed using a standard automated cell counter. Hemoglobin was analyzed using high-performance liquid chromatography (HPLC) and capillary electrophoresis (CE). Mutational analysis was performed using appropriate polymerase chain reaction (PCR) techniques and direct sequencing. Additionally, α-globin haplotype analysis was conducted. Simple and rapid diagnostic methods were developed. Results: Hemoglobin analysis in the patient revealed anomalous peaks separated from normal hemoglobin visible using the HPLC technique. These peaks were virtually absent in the daughter. DNA analysis identified a G to C mutation at codon 14 of the α2-globin gene responsible for hemoglobin Jax in trans to the α0-thalassemia gene in the patient. Heterozygosity of this mutation was identified in her daughter. Hematological analysis showed mild thalassemia-like changes in simple heterozygotes and exhibited a hemoglobin H-like phenotype when combined with (α0-thalassemia. Isopropanol stability testing and bioinformatic software indicated that the variant was unstable and potentially damaging. This mutation was confirmed using allele-specific PCR. Hemoglobin Jax was strongly associated with the haplotype [+ - S + - + -]. Conclusions: Hemoglobin Jax, a pathological α-globin variant, is asymptomatic in simple heterozygotes and demonstrates more pronounced clinical effects when associated with deletional ( -thalassemia. This knowledge can help develop strategies to prevent hemoglobinopathies in regions of high prevalence. Accurate identification requires DNA level analysis.

ABSTRACT Background: Screening of transfusion-transmissible infectious agents of blood components is carried out in order to guarantee the safety of the transfusion process. The objective of this investigation was to characterize cases positive for transfusion-transmissible infectious agents in blood donations in the North ofPortugal. Method: Data from 2010 to 2022 of the Local Health Unit-Santo Antonio were used for this study. In specific epidemiological situations, malaria, Chagas disease and West Nile virus were screened. Main results: Over 12 years, the health unit, received 137,751 donations with 108 positive tests. The proportions of human immunodeficiency viruses, syphilis, human hepatitis viruses type B and C varied between 0 and 44/100,000 donations. In this period, two cases of malaria were detected in 2020-2021, and 21 were detected in 2022 corresponding to 52.1/1000 donations screened. In 2022, two cases of Chagas disease and no cases of West Nile virus were detected. Conclusion: These results highlight the importance of a rigorous investigation at the time of donation in which the donor’s history, including origin and movement in areas of greater geographic risk, are assessed. The recent and increasing detection of cases of malaria and Chagas disease confirms the presence of emerging infectious diseases transmitted by vectors, including mosquitoes, in blood donors. The increased risk of vector-borne diseases in Europe is a public health problem and represents a new challenge in screening donations.

Abstract Objective To evaluate the accuracy of the galactomannan serum test in diagnosing oral invasive aspergillosis. Methods This prospective observational study included oncohematological neutropenic patients with suspected invasive aspergillosis, but without signs of pulmonary involvement. These patients underwent nasofibroscopy, biopsy, galactomannan serum testing, and maxillofacial high-resolution computed tomography to diagnose invasive aspergillosis. Patients were divided into two groups: Group 1 consisted of those with proven invasive aspergillosis, while Group 2 included patients without proven invasive aspergillosis. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results Thirteen patients were included in Group 1 and four in Group 2. The sensitivity, specificity, positive predictive and negative predictive values were 0.69, 1.0, 1.0 and 0.5, respectively. Sensitivity was higher in cases with Aspergillus sinusitis than in cases with exclusive oral lesions (0.77 versus 0.5, respectively). The galactomannan serum test optical density index was higher in Group 1 (2.4; range 0.2-3.5) than in Group 2 (0.2; range: 0.1-0.3; P-value = 0.007. Conclusions The galactomannan serum test is a valuable tool for screening invasive aspergillosis, especially in cases with nasal or sinus involvement, but biopsy is still the gold standard for diagnosis.

Abstract Introduction Venous thromboembolism, a common complication associated with cancer, causes increased morbidity and mortality. D-dimer levels are often increased non-specifically in cancer which limits their use to diagnose venous thromboembolism. The current study aimed to investigate the role of the serum soluble suppression of tumorigenicity 2 (sST2) as a new biomarker to diagnose venous thromboembolism in cancer. Methods Eighty-eight patients with different types of cancer were enrolled and divided into two groups: Group I: 44 cancer patients with confirmed diagnosis of venous thromboembolism and Group II: 44 age- and sex-matched cancer patients without any thrombotic complications. The D-dimer test and sST2 measurement were performed for all study subjects. Results Serum sST2 levels were significantly higher in Group I than in Group II (p-value < 0.001); the median serum sST2 was 13.02 ng/mL (range: 7.65-117.9 ng/mL) in Group I versus 8.56 ng/mL (range: 5.59-10.33 ng/mL) in Group II. There was a significant positive correlation between serum sST2 and the D-dimer level. Using a receiver operating characteristic curve, sST2 had a greater area under the curve than the D-dimer test (0.974 versus 0.869, respectively). Although the D-dimer test was more sensitive, sST2 had a greater specificity than D-dimer (95.45 % versus 27.3 %, respectively) and a higher positive predictive value (95.3 % versus 56.8 %, respectively). Conclusion The results of the current study support a potential role of soluble ST2 to aid in diagnosing venous thromboembolism in cancer patients.

Abstract The introduction of tyrosine kinase inhibitors has revolutionized the treatment of chronic myeloid leukemia vastly improving the prognosis and clinical outcome of most patients. It was estimated that approximately 40-50 % of patients treated with imatinib will require treatment with a second-generation or third-generation tyrosine kinase inhibitor to achieve an optimal response. The treatment duration, increased patient survival, and aging of the population receiving tyrosine kinase inhibitors raise concerns as to long-term toxicities, such as an elevated cardiovascular risk and a higher rate of comorbidities. Ponatinib is a highly potent third-generation tyrosine kinase inhibitor that was shown to be effective in patients with a wide range of ABL mutations, including T315I. The use of ponatinib is associated with significant vascular toxicity, including peripheral arterial occlusive disease, ischemic heart disease, cerebrovascular accidents, and venous thromboembolism. This review discusses the vascular toxicity of ponatinib and presents a comprehensive panel of tests for the evaluation of patients requiring ponatinib therapy. Moreover, the management of patients with cardiovascular risk factors who receive ponatinib is discussed. Finally, the strategy for establishing the optimal dose of ponatinib in patients with chronic myeloid leukemia is described.

Abstract Background and objectives Stem cell mobilization is a well-known procedure to harvest hematopoietic stem cells for autologous stem cell transplantation in certain hematologic diseases. Numerous studies have been conducted to identify risk factors for poor mobilization but there are no studies that identify good mobilizers. In our hospital, we decided to explore good mobilizers, defining them as those with ≥40 CD34+ cells/μL on Day +4 in order to start early apheresis. Material and methods A descriptive retrospective study was performed at Hospital Universitari Son Espases. A total of 198 patients mobilized with doses of around 10 µg/kg of granulocyte colony-stimulating factor (G-CSF) every 12 h were analyzed for autologous collection between January 2015 and September 2022. Fifty patients who had ≥40 CD34+ cells/μL on Day +4 started early apheresis; the rest continued mobilization as planned. Success was defined as obtaining over 2.5 × 106 CD34+ cells/kg in a single apheresis. Results The necessary number of CD34+ cells/kg to perform an autologous stem cell transplantation was reached in a single apheresis session in 62 % of patients with ≥40 CD34+ cells/μL in peripheral blood. A cutoff of 102 CD34+ cells/μL on Day +4 was shown to have the best success rate (94 %). In an analysis of success, age, previously failed mobilization and having one or more adverse factors for bad mobilization were statistically significant. Conclusion Patients considered as good mobilizers were matched with our factors of poor mobilization, revealing that most patients (79 %) had none or only one risk factor for poor mobilization. Apheresis on Day +4 in good mobilizers was shown to be an effective alternative to reduce mobilization duration and decrease the amount of granulocyte-colony stimulating factor administered.