This study reports on 382 COVID-19 patients having undergone allogeneic (n = 236) or autologous (n = 146) hematopoietic cell transplantation (HCT) reported to the European Society for Blood and Marrow Transplantation (EBMT) or to the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH). The median age was 54.1 years (1.0–80.3) for allogeneic, and 60.6 years (7.7–81.6) for autologous HCT patients. The median time from HCT to COVID-19 was 15.8 months (0.2–292.7) in allogeneic and 24.6 months (−0.9 to 350.3) in autologous recipients. 83.5% developed lower respiratory tract disease and 22.5% were admitted to an ICU. Overall survival at 6 weeks from diagnosis was 77.9% and 72.1% in allogeneic and autologous recipients, respectively. Children had a survival of 93.4%. In multivariate analysis, older age (p = 0.02), need for ICU (p < 0.0001) and moderate/high immunodeficiency index (p = 0.04) increased the risk while better performance status (p = 0.001) decreased the risk for mortality. Other factors such as underlying diagnosis, time from HCT, GVHD, or ongoing immunosuppression did not significantly impact overall survival. We conclude that HCT patients are at high risk of developing LRTD, require admission to ICU, and have increased mortality in COVID-19.

Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome. Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed. Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01). Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy. Cite this article as: Akleylek C, Gür SG, Sever İH, et al. What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome? Eur J Rheumatol. 2022;9(3):126-131.

Neutropenic enterocolitis or typhlitis is one of the rare but high mortality acute complications of neutropenia that develops in immunosuppressed patients due to chemotherapy. It is a segmental cecal and ascending colon inflammation that can progress to necrosis and perforation. Although it is mostly observed in myelosupressed and immunosuppressed patients, like those who have leukemia and lymphoma, it can also be observed in malignancies treated with myelosupressive chemotherapy. It has been reported particularly in patients with solid tumors treated with taxane-based chemotherapy. In this article, a 40-year-old patient with invasive ductal breast carcinoma is presented, who was diagnosed with neutropenic enterocolitis and colonic perforation that developed 6 days after chemotherapy (Docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2). If neutropenic fever, abdominal pain, abdominal distension, and tenderness develops in a patient under taxane-based chemotherapy, neutropenic enterocolitis is a condition that must definitely be considered. It should be noted that it is possible to reduce mortality and morbidity by means of appropriate antibiotics and a timely surgical intervention.

Aim:Screening for latent tuberculosis infection (LTBI) prior to biological therapy are recommended. Although our country is in the moderate risk category for tuberculosis infection, our national data regarding the seroconversion rate of the tuberculosis test during the use of these drugs remains unclear. The aim of this study was to evaluate the risk of emerging LTBI in our patients during treatment with tumor necrosis factor-alpha inhibitors. Material and Methods:This study included 81 patients with rheumatic diseases who had negative baseline QuantiFERON-TB test. All patients were evaluated by a serial QuantiFERON-TB test during their treatments. The primary endpoint was to reveal the LTBI risk by serial testing, while secondary endpoints were to determine the factors associated with seroconversion. Results:A total of 81 patients were evaluated with serial QuantiFERON-TB testing for an average of 28.3 months. During the follow-up, positive conversion of QuantiFERON-TB was detected in 6 (7.4%) of 81 patients. In multivariate analysis, aging was found to be the only independent risk factor for positive seroconversion rate (p=0.01). Conclusion:In this study, which we conducted in a population where tuberculosis infection is relatively common, QuantiFERON-TB test seroconversion rate was found to be 7.4% during treatment with inhibitors. Five out of six patients who developed seroconversion were in the ankylosing spondylitis group. These results emphasize the importance of annual LTBI screening in both rheumatoid arthritis and spondyloarthritis patients receiving biological therapy.

Objective: In this study, it was aimed to evaluate HBV, HCV, and HIV seroprevalence and their 9-year changes in patients receiving hemodialysis (HD) treatment in the Giresun province in Turkey. Material-Methods: A total of 607 patients over the age of 18 who received hemodialysis treatment in Giresun – Turkey, provincial and district hospitals in 2013 and 2022 were included in our study. The files of the patients were reviewed retrospectively. Demographic characteristics of the patients and serology results of HBV, HCV, HDV, and HIV were recorded. The data was evaluated using the IBM SPSS Statistics 25.0 program. Results: A total of 607 patients, 385 of whom received HD treatment in 2013 and 222 who received HD treatment in 2022, were included in the study. 230 (59.7%) in 2013 and 135 (60.8%) in 2022 of male patients. While the mean age of the patients was 60.26±14 years in 2013, it was 63.08±13.18 years in 2022. In 2013, HBsAg positivity was detected in 9 (2.3%), HBV-DNA positivity in 4 (44.4%), anti-HCV positivity in 31 (8.1%), and HCV-RNA positivity in 8 (25.8%) patients. In 2022, HBsAg positivity was detected in 4 (1.8%), HBV DNA positivity in 2 (50%), and anti-HCV positivity in 31 (8.1%) patients. Compared with dialysis duration, the anti-HCV positivity rate was significantly increased in patients with long dialysis duration (p<0.001). Conclusion: In line with the health policies, the epidemiological data obtained support a decrease in the population’s seroprevalence of HBV and HCV. However, according to the results of our study, it was determined that there was no significant decrease in HBsAg seroprevalence in patients who received HD treatment over nine years. As a result, it was concluded that it would be beneficial to closely monitor the seroprevalence of viral hepatitis in patients receiving HD treatment.