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Background Thrombotic thrombocytopenic purpura (TTP) is a hematologic disease that can be fatal if not treated early. We aimed to describe the clinical characteristics of Mexican patients with idiopathic TTP. Study design and methods We conducted a retrospective study, including all adult patients diagnosed with idiopathic TTP from 2011 to 2017 in two Mexican centers. We further compared our results with the published literature. Results Twenty patients were included; 70% were female, with a median age of 38.5 years at diagnosis (range 16‐63). The median time from onset of symptoms to hospital admission was 1.5 days (range 0‐16). Most patients (85%) presented with at least one systemic manifestation at admission (including fever) and 90% had neurological symptoms, most of them major (70%) including loss of consciousness, transient focal abnormalities, headache, and confusion. Only one patient (5%) had the classical pentad at the time of admission. Kidney failure was present in 25% of patients and hemorrhagic symptoms in 60%. Digestive and cardiorespiratory symptoms were less common (45% and 15%, respectively). Median platelet count and lactate dehydrogenase were 10 500/μL and 1319 IU/L, respectively. Eighty percent of patients achieved remission following treatment. Patients admitted within the first 48 hours (after the onset of symptoms) tended to have better overall survival. Conclusion Clinical presentation in Mexican TTP patients is similar to that in other countries. Early admission and a high suspicion for the disease will avoid delays in the initial work‐up and initiation of therapy, further improving prognosis.

Angiosarcomas are neoplasms of blood or lymphatic vessels with aggressive behavior. We report the coexistence of this malignancy within soft tissue of the breast in a 49-year-old woman who was diagnosed with Klippel-Trenaunay-Weber syndrome (KTW-S) during childhood. The patient has no previous history of radiation therapy on the chest and does not have any known risk factor for developing angiosarcoma, except for her congenital disease. To the best of our knowledge, the association between soft tissue angiosarcoma of the breast and KTW-S has never been previously reported.

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Introduction: The use of filgrastim biosimilars for healthy adult and pediatric donor mobilization in hematopoietic stem cell transplantation has been met with increased safety and efficacy concerns in contrast to generic small molecule drugs. In Mexico, several filgrastim-intended copies (FIC) have been available and marketed since 2001, while no clinical comparability studies to evaluate their use in this setting have been published and thus are not considered to be true biosimilars. In this study, we report our experience using three different FIC products currently available (Filatil, Dextrifyl, and Biofilgran). Methods: We retrospectively evaluated 118 related donors of all ages who received any brand 5 μg/kg subcutaneously twice daily for 4 days and were harvested in a single apheresis system on day 5. Results: Donors had a median age of 38 years (range, 1-69). A successful harvest defined as ≥2 × 10 6 CD34+ cells/kg of recipient weight was achieved in 95.8% of cases, with a median CD34+ cell dose of 9.4 × 10 6 /kg (range 1-42.8). A single apheresis session was performed in 89.8% of cases. No significant difference in cell yield between each brand was observed. All pediatric donors had a successful harvest with similar results to adult donors. No immediate severe adverse effects were documented in any case. Conclusions: In conclusion, three FICs available in Mexico were efficacious and without immediate severe adverse effects, resulting in significant cost savings.Evaluation of immunogenicity and establishment of a pharmacovigilance program with the use of FICs is warranted. K E Y W O R D S apheresis, biosimilar, filgrastim, g-CSF, healthy donor, hematopoietic stem cell transplantation, peripheral blood Presented in an abstract form in ASBMT/CIBMTR Tandem meetings, Orlando FL 2017.

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Highlights d Doublets and multiplets in single-cell RNA-seq confound biological results d Single-cell VDJ-seq and CITE-seq can aid the identification of doublets/multiplets d Machine learning can identify further heterotypic and homotypic doublets/multiplets

Despite the anti-tumor effects of CD8+ T-cells, chronic exposure to tumor antigens causes T-cell exhaustion, dampening tumor growth control. A subset of exhausted T-cells with stem-like properties ( SL T-cells) has been identified in tumor samples, characterized by the expression of inhibitory molecules (PD-1, CTLA-4), the transcription factor TCF1, and reduced cytotoxic effects. After immune checkpoint inhibition (ICI), SL T-cells rapidly proliferate and differentiate into terminally differentiated/exhausted T-cells ( TD T-cells) with increased effector mechanisms, associating with favorable cancer outcomes patients. Moreover, various epigenetic mechanisms have been implicated in the development of exhausted T-cells, in which the transcription factor TOX has a crucial role. Getting a better understanding of T-cell exhaustion is essential to develop novel prognostic and therapeutic strategies that improve clinical responses to cancer immunotherapies. This review focuses on T-cell exhaustion: features, development, and therapeutic strategies to overcome this dysfunctional T-cell condition in cancer.