Intrahepatic cholestasis (SCIC) is an uncommon but potentially fatal complication of sickle cell disease (SCD), with a high death rate, observed mainly in patients with homozygous sickle cell anemia. Herein, we describe a case of severe SCIC treated successfully with aggressive manual exchange transfusion (ET). The patient was admitted with enlarged liver and signs of hepatic failure, such as hyperbilirubinemia and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. We performed several sessions of ET in order to reduce the percentage of HbS to levels inferior to 30%, which was successfully accomplished. The patient had a complete recovery of hepatic function. This case has shown that ET is an effective treatment of SCIC and should be introduced early on the onset of this severe complication.

The development of the Brazilian Registry of Hematopoietic Cell Transplantation (HCT) in collaboration with the Center for International Blood and Marrow Transplant Research (CIBMTR) continues to provide a comprehensive assessment of the activity and general outcomes of HCT in Brazil. In this paper, we report an update of such activity. Brazilian transplant centers report their data to the CIBMTR, using the FormsNet3 platform. The data then return to the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) through the Data Back to Centers (DBtC) tool. Data from patients who received an HCT from 2012 to 2024 from Brazilian centers were extracted from the CIBMTR. A descriptive analysis was carried out using patient, disease and transplant-specific variables and overall survival analysis using the Kaplan Meier method. A total of 14,331 patients were eligible for this study (6,583 autologous and 7,748 allogeneic HCTs). The number of reporting centers increased from 40 to 45 during the period. The most common HCT indication in Brazil for allogeneic HCT was AML, with 171 HCTs per year and, for autologous HCT, multiple myeloma, with 273 HCTs per year. Among allogeneic HCT, in the last 4 years, mismatched related donor was the main source of donors. Regarding the graft source for allogeneic HCTs, bone marrow (BM) was the most frequent among pediatric HCTs, while peripheral blood (PB) was the most used in adults. Infections were the leading cause of death in the first 100 days after all types of HCTs. Patients with acute leukemia who underwent HCT at an advanced disease stage had lower survival rates compared to those at earlier stages. Despite the differences in the number of cases and follow-up time, the results in this study were similar to those presented in the United States (USA) Summary Slides.

The development of the Brazilian Registry of Hematopoietic Cell Transplantation in collaboration with the Center for International Blood and Marrow Transplant Research (CIBMTR) allowed for an assessment of the activity and general outcomes of transplants in Brazil. Here, we report an updated activity. Brazilian transplant centers report their data to the CIBMTR, using the FormsNet3 platform. Information returns to Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) through the Data Back to Centers (DBtC) tool. Data from patients who received an HCT from 2012 to 2023 from Brazilian centers were extracted from CIBMTR. Descriptive analysis was carried out by patient-, disease- and transplant-specific variables and overall survival analysis using Kaplan Meyer. A total of 12,230 patients were eligible for this study (5,573 autologous and 6,657 allogeneic transplants). The number of reporting centers increased from 40 to 44 during the period. The most common HCT indication in Brazil is AML for allogeneic HCT with 152 transplants year and multiple myeloma for autologous HCT with 245 transplants per year. Among allogeneic HCT, in the last 4 years, mismatched related donor was the main source of donors. Regarding the graft source for allogeneic transplants, BM was the most frequent among pediatric transplants, while PBSC was the most used in adults. Infections were the leading cause of death in the first 100 days after all types of transplants. Patients with acute leukemia who underwent HCT with advanced stage disease had lower survival rates compared to those at other stages. Despite the differences in the number of cases and follow-up time, the results in this study were similar to those presented in the United States (US) Summary Slides.

The first hematopoietic stem cell transplantation (HSCT) program in Latin America started in 1979 at the federal university hospital in Curitiba, Paraná, Brazil. Over the years, the number of centers performing transplants in our country has increased tremendously, generating the need to know the results of this treatment modality. Understanding the HSCT scenario in Brazil is still challenging, since not all Brazilian centers report data to the Center for International Blood and Marrow Research (CIBMTR). Despite the improvement in the number of reporting centers over the past few years, infrastructure and trained data managers are still lacking. The partnership between the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) and the CIBMTR enabled the establishment of the Hematopoietic Stem Cell Transplantation Brazilian Registry (HSCTBR), using the CIBMTR Data Back to Center (DBtC) tool to retrieve Brazilian HSCT data in a standardized and organized way. Since then, it has been possible to gather country-level data on HSCT demographics and transplant outcomes. Between 2012 and 2022, complete information on 9,868 transplants were reported to the CIBMTR from 40 Brazilian transplant centers. The consolidation of the HSCTBR using CIBMTR infrastructure allowed the development and regular update of the Brazilian Summary Slides. Despite the differences in the number of cases and follow-up time, the results in this study were similar to those presented in the United States (US) Summary Slides. In this paper we present the 2023 SBTMO-CIBMTR Summary Slides prepared by the SBTMO data managers (GD-SBTMO).

Chimeric antigen receptor T-cells (CAR-T cells) are a new modality of oncological treatment which has demonstrated impressive response in refractory or relapsed diseases, such as acute lymphoblastic leukemia (ALL), lymphomas, and myeloma but is also associated with unique and potentially life-threatening toxicities. The most common adverse events (AEs) include cytokine release syndrome (CRS), neurological toxicities, such as the immune effector cell-associated neurotoxicity syndrome (ICANS), cytopenias, infections, and hypogammaglobulinemia. These may be severe and require admission of the patient to an intensive care unit. However, these AEs are manageable when recognized early and treated by a duly trained team. The objective of this article is to report a consensus compiled by specialists in the fields of oncohematology, bone marrow transplantation, and cellular therapy describing recommendations on the Clinical Centers preparation, training of teams that will use CAR-T cells, and leading clinical questions as to their use and the management of potential complications.

Intestinal dysbiosis represents a critical determinant of clinical outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Distinct microbiota patterns represent potential prognostic biomarkers and therapeutic targets. However, the exponential growth in microbiota research and analytical complexity has created significant interpretive challenges for clinicians. This review provides a synthesis of current literature examining microbiota fingerprints and their clinical implications. We analyzed key studies evaluating the clinical implications of intestinal microbiota fingerprints in allo-HSCT. Additionally, we examined current therapeutic strategies for microbiota modulation and approaches for translating research findings into clinical practice. We identified three major microbiota fingerprints: (1) decreased intestinal microbiota diversity, (2) reduced abundance of short-chain fatty acid-producing bacteria, and (3) Enterococcus domination. These fingerprints are associated with critical clinical outcomes including overall survival, Graft-versus-host disease, transplant-related mortality, and infection-related complications. While fecal microbiota transplantation and dietary interventions appear promising, current studies suffer from limited sample sizes and lack standardized protocols. Despite significant advances in microbiota research, biological, methodological, and logistical challenges continue to hinder its clinical translation. Understanding microbiota fingerprints represents a promising avenue for improving allo-HSCT outcomes. However, successful clinical implementation requires standardized methodologies, mechanistic studies, and multi-center collaborations to translate research into actionable clinical tools.