These data suggest that SIBO occurs more frequently in SSc patients than in controls. Intestinal symptoms in these patients may be related to this syndrome and its eradication seems useful to improve clinical features. OCTT is significantly delayed in SSc patients, suggesting an impairment of intestinal motility, a further risk factor for the development of SIBO.

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Besides its terrible claim in terms of human lives, SARS-CoV-2 pandemic hit hard also on the hospital management with most healthcare facilities being overwhelmed by hundreds of patients with SARS-CoV-2-related symptoms. Therefore, hospitals needed to combine prevention of in-hospital SARS-CoV-2 spread and maintenance of standard of care for non-SARS-CoV-2 patients. Such challenges also affected Italian facilities that were then reorganized with entire buildings dedicated to SARS-CoV-2. 1,2 Similarly, also the IRCCS San Martino Hospital in Genoa (Italy) created separate pathways for SARS-CoV-2-free and SARS-CoV-2-positive patients, both in the emergency department and in the different wards with our Internal Medicine division being designated as SARS-CoV-2-free by the director of the hospital. A major pitfall of such strategy was immediately identified in the rather long time of COVID-19 incubation, which may hamper the allocation of patients to the correct and safe pathways. This issue was previously investigated by our research group in a recently published article in the European Journal of Clinical Investigation (EJCI), reporting clinical and laboratory variables useful to predict late in-hospital SARS-CoV-2 positivity. 3 Such patientsadmitted at the ED as negative at the first test-were then found positive for the virus during short-term follow-up testing, when they already passed the filter 'grey' zones. During the second and third waves of virus spread, the IRCCS San Martino Hospital-the biggest healthcare facility of the Liguria Region-demonstrated great plasticity and adaptation by creating every week new COVIDdedicated units and moving the filter zones within the COVID-free wards. However, the big issue of incubation time remained and, given the high number of multiple occupancy rooms in our hospital, COVID-free units had

Thirty-one patients (median age, 44 years) with advanced hematologic malignancies were given thiotepa 15 mg/kg, and cyclophosphamide 120 (n = 14) or 150 (n = 17) mg/kg followed by unfractionated peripheral blood stem cell transplants (PBSCT) from genotypically identical siblings (n = 28) or one antigen mismatched family donor (n = 3). Donors were mobilized with granulocyte colony-stimulating factor 5 to 10 microgram/kg/d for 6 days and underwent two to three leukapheresis on days +5, +6, +7. The median cell yield per donor expressed/kg of recipients body weight was as follows: nucleated cells 13 x 10(8)/kg; CD34+ cells 6 x 10(6)/kg; colony-forming unit-granulocyte macrophage 38 x 10(4)/kg, and CD3+ cells 449 x 10(6)/kg. The diagnoses were chronic myeloid leukemia (n = 4), acute myeloid (n = 9) or lymphoid leukemia (n = 2), acute myelofibrosis (n = 2), multiple myeloma (n = 1), lymphoma (n = 6), chronic lymphocytic leukemia (n = 1) myelodysplasia (n = 6). Twenty-eight patients had advanced disease, 29 patients were first grafts, and 2 were second transplants 3 and 9 years after the first. Neutrophil counts of 0.5 x 10(9)/L and platelet counts of 30 x 10(9)/L platelets were both achieved on day +14 (median). Engraftment could be proven by sex markers or DNA polymorphism in 29 of 31 patients: one had early leukemia relapse and one patient was unevaluable because of early death. Acute graft-versus-host disease (GVHD) was scored as minimal or absent (grade 0 to 1) in 14 patients, moderate (grade II) in 13, and severe (grade III to IV) in four. Causes of death were leukemia (n = 4), acute GVHD (n = 4, with associated cytomegalovirus infections in three), sepsis (n = 1), liver failure (n = 1), multiorgan failure (n = 1), and hemorrhage (n = 1). The actuarial transplant mortality is 29%, the actuarial relapse rate 22%. Nineteen patients survive with a median follow up of 288 days (100–690). The actuarial 2-year survival is 57%. Three patients received PBSCT from family donors mismatched for one class II antigen: all engrafted, one developed grade I aGVHD; one died of leukemia on day +155; two are alive disease free 267 to 290 days postgraft. This study suggests that thiotepa cyclophosphamide followed by unfractionated PBSC allograft may be an alternative form of transplant for adults with advanced leukemia, also in the setting of one antigen mismatched donor. The engraftment is rapid with acceptable GVHD and relatively low transplant-related mortality.

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