Beitnerienė, Martyna

Background: Toxic epidermal necrolysis (TEN) is a rare but life-threatening complication that may occur in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly in the context of extensive drug exposure. In this population, TEN can closely resemble severe acute graft-versus-host disease (GVHD), making diagnosis and management challenging. Case presentation: We report the clinical course of an allo-HSCT recipient who developed a rapidly progressive skin rash early after transplantation, and we analyzed the clinical features, histopathology, treatment and outcome. Results: The patient developed rapidly progressive epidermal detachment with severe oral, ocular, and genital mucosal involvement shortly after exposure to trimethoprim/sulfamethoxazole (TMP-SMX). Disease severity was reflected by a SCORTEN score of 5, corresponding to a very high predicted mortality risk. The clinical picture raised concern for both TEN and severe acute GVHD, while histopathological findings favored TEN but were not definitive. Management included systemic corticosteroids, intravenous immunoglobulin, ruxolitinib, and intensive supportive care. The patient gradually re-epithelialized and recovered without long-term sequelae. Conclusions: This case underscores the diagnostic difficulty of distinguishing TEN from severe acute GVHD in the early post-transplant period. Careful assessment of drug exposure, clinical evolution, and multidisciplinary evaluation are essential to guide timely and appropriate management.

Background and Objectives CMV infection remains a common and clinically significant complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly in the setting of profound post-transplant immunosuppression. CMV reactivation occurs frequently in the early post-transplant period and represents a major challenge in clinical management, especially among seropositive recipients. It may contribute not only to direct organ involvement but also to indirect effects, including increased susceptibility to secondary infections and impaired immune reconstitution. The clinical impact of CMV reactivation may vary depending on patient-related and transplantrelated factors, reflecting the heterogeneity of the transplanted population. Despite advances in viral monitoring and preemptive therapy, CMV reactivation continues to be associated with an increased risk of post-transplant complications and higher mortality rates. This study aimed to assess the frequency of CMV reactivation and evaluate its impact on complications and early post-transplant mortality in a retrospective single-center cohort. Material and Method A retrospective single-center study was conducted including 77 patients who underwent allogeneic hematopoietic stem cell transplantation at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2020 and 2025. The study population consisted of adult patients with a median age of 56 years, with a balanced sex distribution, and predominantly myeloid underlying diseases. CMV reactivation was monitored using quantitative polymerase chain reaction. Associations between CMV reactivation and post-transplant complications as well as early posttransplant mortality were analyzed using appropriate statistical methods, including chisquare or Fisher’s exact test for categorical variables and non-parametric tests for continuous variables. Early mortality was defined as death during the initial posttransplant hospitalization or within 100 days after transplantation, whichever occurred later. Multivariate logistic regression analysis was performed to identify independent risk factors. IBM SPSS Statistics (version 30.0.0) was used for statistical analysis. A p-value < 0.05 was considered statistically significant. Results CMV reactivation was observed in 53.2% of patients and occurred in 58.0% of seropositive recipients with available serostatus data. The median time to CMV reactivation was 14 days after transplantation (IQR 7.5–27.5), with a mean of 17.8 ± 12.0 days. Antiviral treatment for CMV infection was required in 43.9% of patients with reactivation, reflecting a substantial clinical burden of CMV management after transplantation. CMV reactivation was more frequently observed in patients who developed graft-versus-host disease (65.0% vs. 49.1%), although this difference did not reach statistical significance. Patients with CMV reactivation had a higher frequency of infectious complications (70.7% vs. 55.6%) and overall complications (85.4% vs. 72.2%) compared to those without reactivation; however, these associations did not reach statistical significance. A similar trend was observed across different complication types, suggesting a consistent pattern despite the lack of statistical significance. No significant association was found between CMV DNA load and the number of complications; however, this finding should be interpreted with caution given the limited sample size. CMV reactivation was associated with significantly increased early post-transplant mortality (36.6% vs. 11.1%; p = 0.010), indicating a clinically meaningful impact on early outcomes. In multivariate analysis adjusted for age and graft-versus-host disease, CMV reactivation remained an independent predictor of early mortality (OR = 5.00; 95% CI: 1.44–17.39; p = 0.011). These findings highlight the clinical relevance of CMV reactivation in the early post-transplant period. Conclusions and Recommendations CMV reactivation is a frequent complication after allo-HSCT and was associated with significantly increased early post-transplant mortality, remaining an independent predictor after adjustment for relevant clinical factors. A consistent trend towards higher rates of infectious and overall complications was observed in patients with CMV reactivation, although statistical significance was not reached. In contrast to findings reported in the literature, no association was identified between CMV DNA load and complication burden, which is likely related to the limited sample size of this study. The relatively small cohort (n = 77) may have reduced the statistical power to detect significant associations. These findings highlight the importance of careful CMV monitoring and timely antiviral intervention in the early post-transplant period. Further studies with larger cohorts are needed to better define the clinical impact of CMV reactivation and to validate these findings.

Background: Cytomegalovirus (CMV) infection/reactivation continues to represent one of the most opportunistic infections after haematopoietic stem cell transplantation (HSCT). CMV infection can escalate to CMV disease with complex outcomes that may be challenging to manage. CMV can indirectly contribute to reduced overall survival (OS) and increase non–relapse mortality (NRM) in HSCT patients. Prevention of CMV and early pre–emptive strategies are fundamental to reduce the risk of end–organ disease. Risk factors for CMV infection or disease include CMV seropositive recipients, mismatched and unrelated transplants, the use of T cell depletion agents, steroid therapy, graft–versus–host disease (GvHD), administration of CMV–positive blood products in seronegative recipients, among other factors. Ganciclovir or valganciclovir remain the mainstream of CMV management in HSCT. Due to adverse effects such as leukopenia and nephrotoxicity, some patients may exhibit intolerance or necessitate early discontinuation of such drugs. A recent review indicated that the pre–emptive use of CMVIG resulted in an overall response in 65%–100% of patients with a clearance time of 14 to 21 days (Whittaker et al 2023). Methods: Objectives: To assess the efficacy of CMVIG in the early pre–emptive management of CMV in high–risk HSCT recipients. Methods: Between December 2022 and October 2024, 13 high–risk patients’ post–prophylaxis with early detection of CMV reactivation were treated with CMVIG. All patients were managed with CMVIG as monotherapy. Clinical parameters such as viral load (IU/ml), medication side effects, and patient tolerance were systemically evaluated. Results: All patients experiencing CMV reactivation exhibited at least one–risk factor predisposing them to CMV reactivation, including D + /R+ serostatus, exposure to anti–thymocyte globulin (ATG), or received a matched unrelated donor (MUD) or haploidentical donor. All patients were receiving Valacyclovir 500 mg b.i.d. for prophylaxis. The median age at transplantation was 53.8 years (range: 24–69). The median viremia level detected during treatment was 3175 IU/ml. (1300 IU/ml. min; 7000 IU/ml. max) with no clinical symptoms. A favourable response defined as achieving undetectable CMV viral load was achieved in all patients. None of the patients required additional antiviral therapy following early initiation of CMVIG. The median duration to achieve viral response was 20 days with CMV load monitoring 2 times per week. CMVIG was well tolerated among all patients, with no reported adverse reactions recorded. Conclusions: This single–centre experience demonstrates the clinical efficacy of CMVIG as monotherapy in the early pre–emptive management of CMV infection, achieving complete remission of in all patients with no product related side effects recorded. CMVIG may be considered as a suitable option in the pre–emptive management to enhance virus clearance, and to avoid or shorten the need for antiviral therapy in high–risk patients or in patients presenting with intolerance to antiviral drugs

Background and Objectives Cytomegalovirus (CMV) infection remains a prevalent and an important challenge encountered post haematopoietic stem cell transplantation (HSCT) (1). If left unaddressed, CMV infection can escalate to CMV disease with adverse outcomes. Additionally, CMV infection alone can indirectly contribute to reduced overall survival (OS) and increased non-relapse mortality (NRM) (2). Prevention serves as the cornerstone for managing CMV infection, while early pre-emptive strategies are employed to mitigate the risk of end-organ disease. Risk factors for CMV infection or disease include CMV seropositive recipients, mismatched and unrelated transplants, the use of T cell depletion agents, steroid therapy, graft-versus-host disease (GvHD), administration of CMV-positive blood products in seronegative recipients, among the other factors. Valganciclovir or ganciclovir remain the mainstream of CMV management in HSCT; however, due to adverse effects such as leukopenia and nephrotoxicity, some patients may exhibit intolerance to these medications or necessitate early discontinuation. Recent survey from the European Society for Blood and Marrow Transplantation (EBMT) highlight the inclusion of CMV immunoglobulin (CMVIG) as a therapeutic option for prophylaxis or pre-emptive interventions (3). The objective was to assess the efficacy of CMVIG in managing early CMV reactivation among high-risk HSCT recipients. [...].

Background Cytomegalovirus (CMV) infection remains a prevalent and an important challenge encountered post haematopoietic stem cell transplantation (HSCT). If left unaddressed, CMV infection can escalate to CMV disease with adverse outcomes. Additionally, CMV infection alone can indirectly contribute to reduced overall survival (OS) and increased non-relapse mortality (NRM). Prevention serves as the cornerstone for managing CMV infection, while early pre-emptive strategies are employed to mitigate the risk of end-organ disease. Risk factors for CMV infection or disease include CMV seropositive recipients, mismatched and unrelated transplants, the use of T cell depletion agents, steroid therapy, graft-versus-host disease (GvHD), administration of CMV-positive blood products in seronegative recipients, among the other factors. Valganciclovir or ganciclovir remain the mainstream of CMV management in HSCT; however, due to adverse effects such as leukopenia and nephrotoxicity, some patients may exhibit intolerance to these medications or necessitate early discontinuation. Recent survey from the European Society for Blood and Marrow Transplantation (EBMT) highlight the inclusion of CMV immunoglobulin (CMVIG) as a therapeutic option for prophylaxis or pre-emptive interventions. Objectives To assess the efficacy of CMVIG in managing early CMV reactivation among high-risk HSCT recipients. Methods Between December 2022 and February 2024, 13 high-risk patients’ post-prophylaxis with early detection of CMV reactivation were treated with CMVIG. All patients were managed with CMVIG as monotherapy. Clinical parameters such as viral load (IU/ml), medication side effects, and patient tolerance were systemically evaluated. Results All patients experiencing CMV reactivation exhibited at least one-risk factor predisposing them to CMV reactivation, including D+/R+ serostatus, exposure to anti-thymocyte globulin (ATG), or received a matched unrelated donor (MUD) or haploidentical donor. All the patients were receiving Valacyclovir 500 mg b.i.d. for prophylaxis. The median age at transplantation was 53.8 years (range: 24-69). The median viremia level detected during treatment was 3175 IU/ml (n=6). A favourable response defined as achieving undetectable CMV viral load was achieved in all patients. None of the patients required additional antiviral therapy following early detection of CMV viral load. The median duration to achieve viral response was 20 days. CMVIG was well tolerated among all patients, with no reported adverse reactions recorded. Conclusion This single-center analysis demonstrates the clinical efficacy of CMVIG in the pre-emptive management of CMV reactivation, achieving complete remission in all patients without necessitating additional antiviral therapy. Given the inherent neutropenic status of such patients, the use of CMVIG represents a critical strategy to mitigate additional sources of myelotoxicity. Accordingly, CMVIG should be regarded as a valuable therapeutic tool for achieving early control of viral load and preventing further escalation of viremia and CMV-associated disease.

Background: Peripheral blood stem cells (PBSCs) are widely used for autologous blood stem cell transplantation (auto-SCT) around the world. Post-thaw viable CD34+ cell count is the important parameter for quality assurance of the cryopreserved cells. The CD34+ cell post-thaw viability was analysed and its relationship with clinical parameters was evaluated in this study. Methods: The study included 236 apheresis, 329 products and 106 hematopoietic SCT on 100 patients undergoing auto-SCT in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from 2015 to 2019 August. Patient’s plasma and DMSO (final concentration of 10%) was used for PBSC cryopreservation. All PBSC products were initially cryopreserved in a controlled freezer, then stored in vapor phase nitrogen. PBSC were thawed before use in water bath at 37°C. Viability was assessed immediately after thawing using BD FACS Canto flow cytometer and BD Stem Cell Enumeration Kit. A multivariate regression model and Pearson correlation were applied for statistical analysis. Results: In total 100 patients (51 females, 49 males) with a median age of 59 (range 18-73) years were harvested after G-CSF (10 g/kg) or Cyclo+G-CSF or additional mobilizing agents such as plerixafor (0,24mg/kg, n=4) for auto-SCT. Indications were multiple myeloma (n=82), non-Hodgkin lymphoma (n=15), germ-cell testicular tumor (n=1), sarcoma (n=1) and autoimmune encephalitis (n=1). Most patients received one auto-SCT. 24 patients received double SCT and 1 patient triple SCT. PBSC transplantations were performed for patients with the following diagnosis: 94 myeloma, 7 lymphoma, 3 germ-cell testicular tumors, 1 CNS lymphoma and 1 autoimmune encephalitis. The median post-thaw CD34+ viability was 79% (range 42-96). Median leukocytes (>1.0 x 109/l) engraftment on two consecutive days was 11 (range 8-13) days, and 15 days for platelets (>50 x 109/l), ranging 9-23 days after [...].

Background and Objectives Peripheral blood stem cells (PBSCs) are widely used for blood stem cell transplantation around the world. Viable post thaw CD34+ cell count is the important parameter for quality assurance of the cryopreserved cells. The cell processing results from the Hospital of Lithuanian University of Health Sciences Kauno Klinikos are presented in this study. Material and Method The study included 128 patients undergoing blood stem cell transplantation from the Hospital of Lithuanian University of Health Sciences Kauno Klinikos from 2015 to 2020 June. It included 288 apheresis, 405 cryopreserved PBSC products and 141 autologous and 1 allogeneic hematopoietic stem cell transplantation. Before autologous transplantation cells were cryopreserved using patient's plasma and DMSO (final concentration of 10%). All PBSC products were initially cryopreserved in a controlled freezer, stored in vapor phase nitrogen. Viability was assessed from a vial no less than 24 hours after cryopreservation, thawed immediately before testing with BD FACS Canto flow cytometer and BD Stem Cell Enumeration Kit. PBSC for transplantation were thawed before use in a water bath at 37°C. Allogeneic cells had a minor incompatibility and were processed by removing donor's plasma. Cells were kept at +2 - +8°C and transplanted in less than 24 hours. Results In total 128 patients (69 females, 59 males) with a median age of 59 (range 18-73) years were harvested after G-CSF (10μg/kg) or Cyclo+G-CSF or additional mobilizing agents such as plerixafor (0.24mg/kg, n=4) for auto-SCT. Most patients received one auto-SCT. The first allogeneic stem cell transplantation was performed for a Hodgkin lymphoma patient. Indications for autologous transplantations were multiple myeloma (n=120), non-Hodgkin lymphoma (n=14), germ-cell testicular tumor (n=3), CNS lymphoma (n=1), Ewing's sarcoma (n=1), multiple sclerosis (n=1) and autoim...[...].

Background and Objectives Autologous peripheral blood stem cell (PBSC) transplantation has been associated with improved response and progression-free survival rates. The high-dose therapy followed by PBSC transplantation is the standard treatment for multiple myeloma patients. Tandem or double autologous PBSC transplantation is usually performed for myeloma patients within a time period of no more than six months. It is associated with better outcomes compared to a single transplant. Therefore, it is important to collect enough PBSC to ensure availability to perform tandem transplantation and save some PBSCs in case of relapse. Material and Method In this study, we present the results of 110 patients with multiple myeloma treated by autologous blood stem cell transplantation in the Hospital of Lithuanian University of Health Sciences (HLUHS) Kauno Klinikos from 2015 to 2020 June. Patients underwent apheresis, collected PBSCs were cryopreserved using controlled rate freezing and stored in vapor phase nitrogen tanks until transplantation. Results The median of 2 aphereses were done for one patient (range from 1 to 4). Only one apheresis was done for 8 patients (7.3%), 2 aphereses for 63 patients (57.3%), 3 aphereses for 34 patients (30.9%), 4 aphereses for 5 patients (4.5%). After one cycle of stimulation the median of 3 bags of cryopreserved cells were prepared per patient, ranging from 1 to 5. Only 1 bag was prepared for 2 patients (1.8%), 2 bags were prepared for 18 patients (16.4%), 3 bags were prepared for 43 patients (39.1%), 4 bags were prepared for 35 patients (31.8%), 5 bags were prepared for 12 patients (10.9%). After one apheresis, the median of 1 bag of cryopreserved PBSC product was prepared per patient (range from 1 to 3) with the median of 3.3 CD34+ cells harvested per kilogram of body weight (range from 0.6 to 38.0). In Kauno Klinikos 70 (63.6%) patients were supplied for both tandem transplant...[...].

Objectives To present The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Oncology and hematology department results of HSCT programs incorporating telemedicine project. Methods Retrospective analysis of 86 autologous HSCT performed for the period of 2015.07–2019.01. Patient’s characteristics, transplantation period data and survival data analyzed. Results Telemedicine project was started under supervision of experienced director with protocols in place 2015 August. During project flow key elements for successful telemedicine project were identified: 1. Personnel Training in a JACIE accreditated HSCT center and selection of local experienced hematologists staff. 2. Establishment of core facilities. 3. Site visit to the facilities. HSCT results: Total number of transplants 86. Sex distribution: Male 48% Female 52%. Number of HSCT distribution according diseases: multiple myeloma 78, lymphoma 5, testicular cancer 3. Treatment related mortality (TRM) in one hundred days (100d) – 1.16%. Multiple myeloma OS 3.5y – 90.7%. Conclusions This innovative model of spreading of knowledge (know-how) and experience in the field of HSCT can serve as excellent example of future cellular therapies cooperation projects. Telemedicine project help to improve learning curve and avoid failures with many years experience and result are comparable with centers that are working for many decades.

Ne Hodžkino limfoma (NHL) – tai piktybinė liga, kuri prasideda limfinėje sistemoje. Be limfmazgių, NHL gali pasireikšti, išplisti ir į kitus organus: blužnį, kaulų čiulpus, kepenis ir kt. Limfoma gali būti kilusi iš B limfocitų (85 proc.), T limfocitų ir NK ląstelių (15 proc.). NHL yra labiausiai paplitęs kraujodaros navikas, sudarantis 4-5 proc. visų piktybinių onkologinių ligų. Vyrai serga dažniau nei moterys [1, 4:1], tačiau dažnis priklauso ir nuo limfomos potipio, pavyzdžiui, tarpuplaučio difuzine didelių B ląstelių limfoma dažniau serga moterys nei vyrai. Serga įvairaus amžiaus žmonės, vidutinis amžius diagnozės metu yra apie 50 metų. Didelio piktybiškumo limfomos dažniau pasitaiko tarp jaunesnio amžiaus ligonių, o mažo piktybiškumo lėtesnės eigos limfoma serga vyresni asmenys.