Several grading systems have been developed in the bone marrow transplantation setting in attempts to predict survival in patients with chronic graft-versus-host disease (cGVHD). In this study, we evaluated the prognostic value of the National Institutes of Health (NIH) scoring system and investigated for any additional prognostic factors in a series of 171 patients undergoing peripheral blood stem cell transplantation (PBSCT) from matched related donors. The cumulative incidence of cGVHD was 70%; cumulative incidences of mild, moderate, and severe cGVHD were 29%, 42% and 28%, respectively. Overall, 68% of patients were free from immunosuppression 5 years after transplantation. Absence of previous acute GVHD (aGVHD; hazard ratio [HR] = 2; P = .004) and mild cGVHD (HR = 4.2; P = .007) increased the probability of being off immunosuppressive treatment by the last follow-up. Overall survival (OS) at 5 years was 52%. Severe cGVHD, according to the NIH scoring system (HR = 13.27; P = .001) adversely influenced outcome, whereas de novo onset (HR = 0.094; P = .003) had a more favorable impact on survival. The combination of both variables allowed us to identify 4 different subgroups of patients with OS of 82%, 70%, 50%, and 25%. Our findings indicate that the NIH scoring system has some prognostic value in patients undergoing PBSCT and, together with the type of onset, must be considered to predict the possible outcome of patients who develop cGVHD.

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The most common approach for the treatment of chronic graft-versus-host disease (cGVHD) has been the long-term use of systemic steroids. Beclomethasone dipropionate (BDP) is a topically active corticosteroid with relatively low absorption from the gastrointestinal mucosa. It has been successfully used to treat acute GVHD (aGVHD), but its use in the cGVHD setting is far more limited. In the current study, BDP was administered to 33 patients who underwent allogeneic transplantation and had biopsy-proven gastrointestinal cGVHD (GI cGVHD). Twenty-six patients with GI cGVHD received BDP as first-line and 7 as either second- or third-line treatment. All patients received BDP together with a calcineurin inhibitor, except for 1 patient who was also receiving mycophenolate mofetil (MMF). BDP was administered for a minimum of 16 weeks and was tapered during 4 additional weeks. Of those patients receiving BDP as the first line of treatment, 22 (84.6%) achieved complete remission (CR) of GI cGVHD, 2 (7.7%) achieved a partial response (PR) and 2 (7.7%) did not respond or progressed. Median time to response was 28 days. Nevertheless, only 7 (27%) patients had maintained the response at last follow-up, whereas 19 (73%) finally relapsed or progressed. Median time to relapse was 147 days after the end of BDP. In the case of the patients who received BDP as a second- or third-line treatment, 3 (42.9%) achieved CR and 2 (28.6%) PR. For the whole series of patients, 13 patients (39.4%) were not receiving immunosuppressive treatment at final follow-up. Only 4 patients developed cytomegalovirus (CMV) reactivation, which was successfully treated with antiviral drugs. No fungal infection was observed during the treatment period. In conclusion, the current study shows that BDP, in the absence of systemic steroids, is a highly effective initial therapeutic approach for GI cGVHD, which helps to avoid complications related to systemic steroids.

Pleural involvement in Non-Hodgkin Lymphoma (NHL) is well documented, but primary pleural lymphomas are extremely rare, occurring mostly in immunosuppressed patients or associated with chronic pleural inflammation. Nevertheless, the pathogenesis and therapeutic approaches to counteract primary pleural lymphomas are still matter of debate. The authors present the clinical case of an 81-year-old female with respiratory and constitutional symptoms. A valvular heart disease and bilateral pleural effusion were known. The study carried out showed a large right pleural effusion; the fluid analysis was compatible with Diffuse Large B-cell Lymphoma (DLBCL), and two lymphomatous masses with pleural origin were found at the ipsilateral hemithorax. Primary pleural lymphoma was considered and chemotherapy was initiated with a good response and evolution. The authors report this remarkable clinical case because of its rarity, its excellent clinical evolution and the absence of an immunodeficiency context.

Natural gas exploitation has been increasing progressively and the pipeline community are facing more challenging demands to ensure safe and reliable operations. In that direction, gas fields in very harsh environments are demanding material and welding procedure selections to comply with a combination of important requirements such as toughness at low temperature, sour environment, very low hardness, manual ultrasonic inspection (for UOE longitudinal weld soundness assurance) and others. Looking forwarding big challenges, Tenaris Confab has been successfully working to continue improving the know how regarding plate to pipe mechanical properties behavior, through steel selection using TMCP plates, welding consumables definition and process control to assure material performance. Considering this scenario, the main challenge is to comply with a combination of toughness and hardness requirements, assuring the material soundness through manual ultrasonic testing after 48h. These combination lead to a careful selection of welding consumable to add the right content of alloy element at the welding pool aiming a specific weld metal chemical composition after dilution. The alloy element selection has to be considered due to the aimed final microstructure at the weld metal, i.e. increases acicular ferrite, in order to achieve the toughness, hardness and manual ultrasonic performance for delayed hydrogen cracking (DHC); it is important to avoid grain boundary ferrite (GBF) nucleation. High wall thickness and high heat input increases residual stress after pipe welding, high residual stress combined to poor microstructure and hydrogen, is a perfect scenario for DHC. To avoid hydrogen cracks, a robust pipe forming process and welding concept is needed to give enough energy to diffuse hydrogen out from weld metal. Quality controls were applied to strict hydrogen content such as welding consumable specifications, evaluating the correlation curve between flux moisture and diffusible hydrogen, flux temperature control and others. As a result of those actions, good mechanical properties were achieved and overcoming the hydrogen cracking performance during automatic and manual ultrasonic testing confirm a robust pipe forming and welding procedure for demanding projects.